Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults

Table 1 Management of opioid-related adverse effects in older adults

Adverse effect	Frequency	Management
Constipation	+++	Prescribe laxatives when starting opioids
		Consider oxycodone/naloxone preparation
Nausea	+++	Low doses and slow titration
		To treat with antiemetics
Sedation,	+	Careful review of medications (benzodiazepines, antidepressants, etc.)
mental confusion		Low doses and slow titration
Delirium	+	Careful review of medications (benzodiazepines, antidepressants, etc.)
		Low doses and slow titration
Falls,	+/-	To monitor walking instability and fall risk when initiating opioids
fractures		Careful review of medications
		To prefer long-acting opioids
Respiratory depression	Very rare	Low doses and slow titration
Immunosuppression	Rare	To consider in long-term therapy
Addiction	Very rare	Abuse history
		Use tools to assess risk
		Monitoring patient