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Study reveals aged care’s painkiller dependence
Opioid painkiller usage in Australian facilities is 30-fold higher than in other countries, with an expert GP calling on colleagues to ‘think outside the box’.
Around 178,000 Australians aged 65 and older are currently living in permanent residential care.
Almost three in four Australian aged care residents are prescribed a regular painkiller medication, compared to just one in 10 equivalent patients in Japan.
That is according to a new joint study from Monash University and Japan’s Institute for Health Economics and Policy, aimed at better understanding the pharmacological management of pain in residential aged care.
Published in Age and Ageing, researchers also found the use of opioid painkiller medicines in aged care facilities is 30-fold higher in Australia compared to Japan.
The study compared the painkiller usage of 550 residents from 12 residential homes in South Australia to 333 people in four homes in Tokyo.
These residents were all similar in age, sex, and degree of cognitive impairment, as well as being broadly representative of aged care residents in Australia and Tokyo.
It also included the expertise from three focus groups with Australian and Japanese healthcare professionals.
The study’s lead author Laura Dowd said the research highlights the differences in therapeutic goals, painkiller regulations, and treatment durations between the two countries.
‘Australia and Japan both have rapidly ageing populations but appear to have very different patterns of painkiller use,’ she said.
‘Australian participants described their therapeutic goal was to alleviate pain, and reported painkillers were often prescribed on a regular basis.
‘[Meanwhile], Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported opioid painkillers were prescribed for short-term durations, corresponding to episodes of pain.’
The research found oral acetaminophen paracetamol, non-steroidal anti-inflammatory drugs, and opioids were the most popular medications used.
Professor Dimity Pond, a GP with a special interest in aged care, said the research indicates a need for Australia to ‘think outside the box’ when it comes to prescribing painkillers.
‘If the Japanese can manage their older population with fewer medications than we do, then we need to know their secret,’ she told newsGP.
‘We need to unpack why that works for them and if it’s a possible route that we could follow to really improve the quality of life for our older patients.
‘As a society, we tend to say, “I’ve got pain, so I’ve had to take a painkiller”, whereas other societies look at it differently.’
Previous studies have confirmed up to one third of all Australian aged care residents are prescribed opioid painkiller medications.
But while prescriptions are high, Professor Pond said many non-pharmacological management tools can also be used alongside, or instead of, painkillers.
‘It’s actually not rocket science, but it just takes a different approach from what we’re used to,’ she said.
‘In Japan, they’re looking at activities for those older people and I’ve seen some great examples of Japanese facilities where they do a lot of activities, then you’re not concentrating on how awful you feel.
‘For us to implement this, that means more funding, and we could probably do a bit more within current constraints, but the resources, particularly residential aged care but also the community, they need to be pumped up.
‘Being pain free might not be the goal – the goal might be a good quality of life, which would include going for a walk, sitting out in the garden, going for a wander through some bit of a nursing home.’
Currently, around 178,000 Australians aged 65 and older are living in permanent residential care, with the number of women almost double the number of men.
At the same time, 95% of all older people see a GP at least once a year, and the highest rates of Pharmaceutical Benefits Scheme (PBS) prescriptions are dispensed among those aged 85 and over.
Professor Pond said Australia as a culture needs to reframe the way it thinks of ageing and aged care.
‘We think, “you can have fun, but then you get old and decrepit and end up in residential aged care”, which is awful,’ she said.
‘You can have a reasonable quality of life as an older person and even with dementia, you can enjoy life.
‘We need to change our view and whatever it takes to make life better, we need to take steps towards getting there.’
Professor Pond’s advice to her fellow GPs treating patients within residential aged care is to ‘not write them off’.
‘It’s all about function and improving people’s function as they get older,’ she said.
‘We need to look at the outcomes of our painkillers, are they working? Are they overdoing it? Is everyone asleep? So, we need to actually titrate what we give against observable outcomes.
‘Patients may not be able to tell us what they’re feeling if they’ve got cognitive impairment, but we can observe their behaviour and see if they’re over-sedated.’
Researchers said further investigation is now needed to examine the differences in acute and chronic opioid prescribing between the two nations.
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