Propoxyphene Use in the Elderly

This is the authors' abstract. We don't add key points for this paper.

To the Editor: We are writing to comment on the excellent work by Sachin et al.1 Their study found a high prevalence of propoxyphene use in community-dwelling elderly and an even higher use in the institutionalized elderly. It would be good to know whether hospitalized elderly have an equally high prevalence of propoxyphene use. We did a retrospective review of 171 inpatient charts of patients aged 55 and older who were admitted to our geropsychiatric unit from December 1999 to November 2000. The prevalence of propoxyphene use before admission was 1.2% (2/177), and prevalence of propoxyphene at discharge was 0%. Clearly, prevalence of propoxyphene use was much lower in this mostly rural geropsychiatric population. Although the central nervous system–related side effects of dizziness, sedation, and falls are well known, we have also seen agitation due to propoxyphene, especially in the elderly demented patients. We have seen patients' agitation improve after discontinuing propoxyphene. We have also seen better control of patient's pain when we replaced propoxyphene with scheduled doses of other analgesics (such as acetaminophen, tramadol, or low-dose opioids). Untreated or undertreated pain is a well-known cause of agitation in elderly patients with dementia.2 Also, pain is underdiagnosed and undertreated in the elderly in general, especially in residents of long-term care facilities.3 Well-designed studies are needed to extend the findings of this study to hospitalized elderly and to clarify the effect of discontinuing propoxyphene on the morbidity and mortality of elderly patients.