Perspectives on paIN managemenT with Opioids for persistent non-palliative pain in the oldest old

Pain is common in people aged 85 or over (called the ‘oldest old’) and can be difficult to manage in this age group. Currently clinical guidelines recommend non-drug options to help manage pain, like exercise, physiotherapy, or psychological therapies. The use of pain-killing medication, particularly strong painkillers like opioid medications (which include medicines that contain codeine, tramadol, or morphine) is not encouraged. However, the non-drug options can be difficult for the oldest old to try. We know that doctors prescribe opioid medication to this age group, but these medicines can have side effects which affect daily activities and could lead to falls, confusion and hospital admission.

Currently, research has only investigated the experiences of people who are younger than 85, and nothing is known about people in this older age group who are not receiving end-of-life care. This research has suggested that people can find opioid medication “a salvation and a curse”, and there are lots of things which can affect people's choices to take medication, like side effects, stress, and opinions of people around them. Research also suggests that there can sometimes be unintentional communication difficulties between patients and doctors when talking about pain management options. Where opioid medication is still being prescribed to the oldest old, it is important for prescribers to understand how it affects the people who take it so that patients can make informed decisions about their healthcare. Before we can help with this, we need to understand what patients, carers and their doctors think about opioid medications and how the medication affects the lives and circumstances of the people who take them.

We will interview patients and their family members or carers, and their doctors. We will ask patients and their carers about their medication, and about the appointments they have with their doctors. We will then interview their doctors or prescribers about their thoughts and experiences of prescribing opioid medications. This information will help us to understand how opioids are prescribed to the oldest old, and how they affect their daily life. With the help of our patient and public involvement team, we will develop a list of prompts for patients and their carers to use when speaking to their doctor about their pain. We will also develop a checklist for doctors to use to help ensure that patient and carer views are heard during consultations about opioid medication. We will also share our results more widely within the research community to be used to develop future research to improve pain management in the oldest old.

Amount awarded: £89,119