Through a moderated, three-part discussion, this session will focus on opioid use disorder (OUD) in older adults, judicious opioid prescribing among older adults, and related topics specific to providing care to such patients in the nursing home and subacute rehabilitation setting. The first portion of the discussion will describe the epidemiology of opioid use and OUD among older adults, and then will use case-based learning to (a) define and apply diagnostic criteria for OUD and opioid withdrawal and (b) describe treatment options for OUD with special considerations in the geriatric population. The second part of the discussion will use case-based learning to describe strategies for judicious opioid prescribing in the older adult, including indications for prescribing opioids, risk mitigation strategies such as mood and substance use screenings and naloxone, appropriate use of urine drug monitoring, appropriate use of prescription database monitoring, tapering guidelines, and considerations for prescribing opioids in the setting of cognitive impairment, multi-morbidity, and polypharmacy. The third portion of the discussion will focus on regulatory and logistical challenges to the provision of such care to older adults in subacute rehabilitation and long-term care settings, as well as opportunities for practice improvement through interdisciplinary approaches for identifying individuals at risk for opioid-related adverse events, applying a chronic disease model for managing patients with OUD in these settings, and navigating challenges related to multiple transitions in care.
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