Opioid Use in the Critically Ill Geriatric Patient

Older adult prevalence in intensive care units (ICU) is rising. Pre-ICU opioid exposure and in-ICU opioid use are both extremely prevalent for older ICU patients. But older adults greatly differ from their younger counterparts in terms of opioid pharmacokinetics and pharmacodynamics, in their response to pain and in their response to opioids in general. Consensus guidelines recommend opioid use for moderate to intense pain analgesia in ICU. Opioids are, with reason, part of the plan for older adults too, although physicians need to be cautious in the agent choice and dosage in the older adult ICU population. Individualizing treatment is a key message of this chapter and we will introduce some age-related specificities surrounding opioid use and pain experience for older ICU patients.