Objective: To characterize the literature describing the therapeuticuse of opioids in the elderly. Data Sources: Two electronicdatabases, EMBASE and MEDLINE, were searched from years 1990 to September 5,2018. Relevant reference lists were reviewed. Searches were restricted toEnglish language. Study Selection and Data Extraction: Tworeviewers independently screened 827 citations to identify observationalstudies, population-based cohort studies, retrospective analyses, and controltrials looking at the management of persistent pain in patients aged ≥65 yearsand/or frail patients. Data Synthesis: Thirty-nine articles wereincluded in the systematic review. More specifically, 17 observational studies,7 population-based cohort studies, 10 retrospective analyses, and 4 controlledtrials. The most common etiology of persistent pain was musculoskeletal (50%),and the most often adverse effects reported were central nervous system related(41%) and falls/fractures (39%). Relevance to Patient Care and ClinicalPractice: As there is a lack of strong evidence-based recommendationsfor opioid use in the elderly, this review aims to evaluate opioid use in theelderly and compare their efficacy and safety among this population.Conclusions: Overall, central nervous system adverse effectswere most commonly seen in the elderly. However, higher quality evidence isrequired to further appreciate the dose-related effects on efficacy and safetyof opioids in the elderly.
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