Opioids in Older Adults Compendium

Create a monthly report with specific quality metrics about opioid use in older adults. Use report to provide feedback to clinicians about their performance.

Create a clinician-specific list of all patients over age 65 who have recently received an opioid refill. Discuss these lists at the next clinician meeting.

Use data to educate clinicians and staff about opioid use in your older adult population and provide them with monthly updates (e.g., number on long term opioid therapy (LTOT), number co-prescribed opioids & benzodiazepines, and number of patients with ≥50 morphine milligram equivalents (MME)/day).

Stratify opioid use metrics for older adults by race/ethnicity, gender, socio-economic status, sexual orientation, and other key demographic characteristics that are most relevant to the population you serve.

Incorporate data related to the social determinants of health and how they may be affecting outcomes among older adults in your quality improvement efforts

Develop care gap reports (such report identifies missing recommended care services so that the clinician may address them at the next patient visit) for older adults on opioids and design workflows to address them.

Designate a clinician champion to improve guideline-concordant care for managing opioids in older adults.

Establish a multi-disciplinary opioid review committee focused on older adults to review charts/cases and make recommendations for improving opioid medication management.

Educate staff who are unfamiliar with potential risks and misuse of opioids in older adults.

Develop specific workflows to screen for opioid use related risks in older adults, such as falls and cognitive impairment.

Train staff on workflow to screen for falls, cognitive impairment, and other risks in older adults on opioids.

Have a critical review process for new and existing structures, policies and procedures in your clinic that assesses their impact on equity, inclusion, and diversity.

Develop a consensus among clinicians and staff about what to screen for in older adults using opioids, including how often screening should take place, who does the screening, and how it is documented.

Integrate fall risk assessment into routine care for older adults on opioids.

Train clinicians and staff about opioid related risks (e.g., falls) and how to screen for them during a visit.

Discuss results of fall risk assessment with patients and provide them with tools/resources to reduce their risk.

Discuss which patients within your clinic are at elevated risk of adverse effects from opioids and how you might address the risks.

Develop and implement an opioid treatment agreement customized for older adults (e.g., describes specific risks to older adults and incorporates caregivers’ responsibilities).

Educate clinicians and staff about potential signs and symptoms of opioid misuse in the older adult.

Make tools and resources available to patients to help them understand OUD.

Address stigma and bias in the recognition and treatment of OUD among older adults through staff training.

Use templates for documenting patient goals for managing chronic pain.

Train clinicians and staff on patient engagement techniques, such as shared decision-making and goal-oriented care, specific to older adults.

Establish workflows and use templates to elicit and document patient goals for managing chronic pain.

Ensure that any shared decision-making tools and educational resources used in making decisions are available in the appropriate language and literacy level.

Openly discuss the impact of stigma, biases, and assumptions on equity in the use of shared decision making for older adults regarding opioids and/or chronic pain.

Use “teach-back” or other communication techniques to ensure that the patient and/or caregiver clearly understand any change in medications. While “teach back” technique is not specific to older adults or opioids management, it is an evidence-based health literacy intervention.

Identify nonpharmacologic treatment modalities for chronic pain in the older adult population and develop referral workflows and tracking to ensure the referral is completed.

Ensure that clinicians and staff understand, recommend, and utilize evidence-based nonpharmacologic treatments for chronic pain.

Provide patients with information about nonpharmacologic pain treatments (e.g., physical therapy, hydrotherapy, tai-chi, and yoga).

Assess social determinants of health among older adult populations, as they are often a key factor in a successful referral (e.g., transportation, social support, insurance coverage).

Integrate routine medication management and reviews into pain visits:

- screening appropriate for older adults on opioids such as falls risk,

- calculating Morphine Milligram Equivalents,

- monitoring with urine drug testing (UDT),

- assessing pain and function to determine effectiveness of current treatment regimen (including opioid, non-opioid, and nonpharmacological therapies),

- considering naloxone co-prescribing for patients on long-term opioid therapy,

- ordering appropriate labs.

Follow evidence-based guidelines for prescribing, monitoring, de-prescribing and otherwise managing opioids in older adults.

Provide opportunities for clinicians and staff to discuss challenging clinical scenarios about managing opioids with their older adult patients.

Create an after-visit summary for older adults that includes instructions on safe use and storage of opioid medications.

Medication management discussions need to be inclusive of patients and their caregivers and should recognize the experiences and realities that may affect how medication is managed in their own unique situation.

Communication techniques must consider various levels of health literacy, linguistic diversity, and should foster open and approachable discussion.

In addition to oral communication, ensure clinicians and staff have materials available on medication management that have language and photos which are culturally and linguistically representative of the populations they serve and are easy to understand