Short of breath and dying: state of the science on opioid agents for the palliation of refractory dyspnea in older adults.

The purpose of this narrative literature review was to describe the state of the science on the effectiveness of opioid medications to palliate dyspnea in older adults with advanced disease. A three-stage critical appraisal process was used to evaluate articles published between 2000-2011 that were retrieved from the CINAHL, Ovid MEDLINE, and PsycINFO databases. Low-dose opioid medication use was associated with statistically significant reductions in dyspnea intensity scores in the majority of studies included in the analysis. Many recent articles on this topic shed light on the importance but underuse of opioid agents to palliate dyspnea, particularly in older adults with advanced chronic illnesses, such as heart failure and chronic obstructive pulmonary disease. ADRA (Assess, Document, Re-assess, Advocate) is a proposed framework that gerontological nurses can use to ensure patients receive adequate symptom management for refractory dyspnea.