Healthcare professionals should be cautious when prescribing and dispensing opioid medications to patients aged 65 years and older. Because of their age, elderly patients may have reduced renal function even in the absence of renal disease, thereby leading to a reduction in medication clearance.
Opioids have risks that may be particularly serious for older people, including: Sedation and mental confusion. Opioids can cause sleepiness or mental clouding, which can dramatically increase the risk of falls and fractures caused by falls.
Box 1 Guidelines for good prescribing in elderly patients
Older adults are often more vulnerable to the adverse effects of opioids and other medications due to alterations in metabolism associated with aging.
However, elderly patients are more likely to have unwanted side effects (eg, constipation, lightheadedness, dizziness, or fainting, stomach upset, weakness) and age-related liver, kidney, heart, or lung problems, which may require caution and an adjustment in the dose for patients receiving tramadol.
The most critical aspect of pain assessment is that it is done on a regular basis (e.g., once a shift, every 2 hours ) using a standard format. The assessment parameters should be explicitly directed by hospital or unit policies and procedures.
Common side effects of medicines in older adults can be dizziness and falls, weight loss or weight gain, and changes in memory or our ability to think and process information. These, in turn, can cause older adults to get hurt and may ultimately lessen their ability to function in day-to-day life.
What Older Adults Can Do to Manage Medications
AVOID Certain Anticholinergic Drugs
Alcohol Use Despite increasing rates of illicit and prescription drug misuse among adults older than 65 years,5,6,10 alcohol remains the most commonly used substance among older adults.
One quarter of the prescription drugs sold in the United States are used by the elderly, often for problems such as chronic pain, insomnia, and anxiety. The prevalence of abuse may be as high as 11 percent with female gender, social isolation, depression, and history of substance abuse increasing risk.
When opioids are used chronically as pain relievers they may cause mild cognitive deficits in attention, complex working memory, and episodic memory [1, 2].
Classified as a Schedule IV drug, tramadol is considered useful as a pain reliever with a low potential for abuse. Despite these concerns, tramadol is one of many common treatments recommended for osteoarthritis and other painful conditions.
Contraindications associated with tramadol listed by the US Food and Drug Administration (FDA) include: prolonged elimination half-life for patients ages >75 years with recommended adjustment in daily dosages; a risk of serotonin syndrome and seizures, especially in combination with antidepressants; respiratory
Long term utilization of tramadol is associated with various neurological disorders like seizures, serotonin syndrome, Alzheimer’s disease and Parkinson’s disease.