Which client is most likely to require a smaller-than-average opioid analgesic dose?

• A. A healthy 30-year-old adult
• B. A client with chronic liver disease
• C. An adolescent
• D. A client who is 86 years old

Answer: (D)

Age-related changes in how the body handles opioids and how sensitive it is to their effects explain why older adults often need smaller doses. In late life, hepatic blood flow and liver mass typically decline, slowing the metabolism of many opioids. Renal function also decreases with age, slowing the clearance of active metabolites and allowing them to accumulate. Body composition shifts—more fat, less lean mass and total body water—alter distribution and can prolong the action of lipophilic opioids. These factors together raise the risk of respiratory depression and excessive sedation from standard doses, so starting with a smaller amount and titrating carefully is essential. Among the options, the client who is 86 years old is most likely to require a smaller-than-average opioid dose due to these age-related changes. The other groups may metabolize opioids more normally or have different considerations, but age-related sensitivity and clearance reduction present the strongest, most consistent reason for dose reduction.