Stephanie Gibson

Pain is a common symptom among people living with dementia. Opioid analgesics are often prescribed for pain at hospital discharge. This study aims to investigate opioid prescriptions on hospital discharge and the risk of rehospitalisation and death in people living with dementia. This study used four Victorian datasets to create one comprehensive dataset, which included 14,212 people ≥65 years admitted to hospital between 2015-2018 of which 2,048 have a diagnosis of dementia. Findings relating to people living with dementia who were prescribed an opioid analgesic at hospital discharge were:

• Opioid prescription on hospital discharge, is associated with a higher chance of death or being readmitted to hospital within 28 days (compared to those not prescribed an opioid)
• Most types of opioids may increase the chance of rehospitalisation or death in people with dementia, but some medications may pose a higher risk (for example fentanyl was found to have the highest risk)
• Opioid prescription may be associated with a higher risk of death or rehospitalisation in people with dementia when prescribed on an ad hoc basis (i.e. taken when in pain only), compared to when prescribed on a regular basis. This is in contradiction to current recommendations for opioid prescribing. It is recommended further research is completed to confirm this. 
• Opioid prescription may increase the risk of hospital admission with a possible side effect of the opioid, in particular sedation or drowsiness.

In addition to the above work, a scoping review of the published research studies was undertaken which found that people living with dementia are more prone to developing side effects of opioids, with a likelihood that opioid prescription is associated with falls and fractures and behavioural side effects such as confusion. This indicates that further research is required, to improve guidelines for opioid prescription and thus better health outcomes for people living with dementia.

At the time of award, Ms Gibson was currently the Senior General Medicine Pharmacist at Eastern Health in Victoria, which covers three acute hospital sites.