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Sant AM, Portelli S, Ballard C, Bezzina-Xuereb M, Scerri C, Sultana J. Prevalence of Opioid Use in Nursing Homes Over the Last Decade: A Systematic Literature Review. J Pharm Technol 2024; 40:123-133. [PMID: 38784025 PMCID: PMC11110733 DOI: 10.1177/87551225231217903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background: Despite global concerns of an opioid epidemic, there is no systematic literature review on how frequently these drugs are used in nursing home (NH) populations, including those living with dementia. Objective: This systematic review aims to describe the prevalence and incidence of opioid use in NHs. A secondary objective is to describe the use of these drugs in a subset of NH residents, namely among persons living with dementia. Methods: A systematic literature review was carried out using MEDLINE and Scopus (PROSPERO registration number CRD42021254210). Screening of title and abstract was carried out by 2 persons independently for studies published between January 1, 2011 and May 19, 2021. The main outcomes were annual prevalence, period prevalence, and duration of opioid use. Results: From a total of 178 identified studies, 29 were considered eligible for inclusion. The annual prevalence of any opioid use among all NH residents without any selection criteria ranged from 6.3% to 50% with a median annual prevalence of 22.9% (Q25-Q75: 19.5%-30.2%), based on 17 studies. Five studies measured the annual prevalence in NH residents living with dementia, finding that this ranged from 10% to 39.6%. Conclusions: More evidence is needed quantifying opioid use in NH, especially among persons living with dementia. Given that opioid use in NH is still a problem, implementation of a pain management protocol in NH or nationally would help improve clinical outcomes.
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Affiliation(s)
| | | | - Clive Ballard
- Exeter College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Charles Scerri
- Department of Pathology, The University of Malta, Msida, Malta
| | - Janet Sultana
- Pharmacy Directorate, Mater Dei Hospital, Msida, Malta
- Exeter College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Clinical Pharmacology and Therapeutics, The University of Malta, Msida, Malta
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2
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Helvik AS, Bergh S, Tevik K. A systematic review of prevalence of pain in nursing home residents with dementia. BMC Geriatr 2023; 23:641. [PMID: 37817061 PMCID: PMC10566134 DOI: 10.1186/s12877-023-04340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The prevalence of dementia in nursing home (NH) residents is high, and pain is a troublesome symptom for them. Several studies since 2010 have focused on pain in NH residents with dementia, but there is a lack of systematic reviews on the prevalence of pain in NH residents with dementia. AIM To systematically review observational studies published from 2010 to 2023 on how pain is assessed and prevalence of pain found in NH residents with dementia. METHODS A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, Embase, CINAHL, AgeLine, and Cochrane databases for studies published from January 2010 to August 2023. Studies were included if they were observational studies with a quantitative design where self-report, staff assessment, and/or chart review were used to define the prevalence of pain in samples or subsamples of NH residents with dementia. RESULTS Of 184 studies considered, 25 were included. The studies assessed pain as daily, present, clinically relevant, chronic, intermittent, persistent pain and/or if pain affected quality of life. The prevalence of pain was high in most studies of NH residents with dementia independent of whether pain was reported as presence of pain or clinically relevant pain, but the prevalence varied from 8.6% to 79.6%. This prevalence was quite stable across the NH stay, but higher towards the end of life (up to 80.4%). Study designs and methodologies differed considerably. About half relied on an observational assessment inventory. CONCLUSION The number of studies focusing on pain in NH residents with dementia was restricted and methodologies differed considerably. Relatively few studies used an observational assessment inventory. In view of the fact that residents with dementia may have difficulties communicating pain, clinicians should pay attention to pain in these residents, systematically and reliably uncover pain by use of observational inventories, and subsequently treat pain to secure high quality care.
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Affiliation(s)
- Anne-S Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Jiang H, Qiu J, Deng X, Li D, Tao T. Potential active compounds and common mechanisms of Evodia rutaecarpa for Alzheimer's disease comorbid pain by network pharmacology analysis. Heliyon 2023; 9:e18455. [PMID: 37529338 PMCID: PMC10388172 DOI: 10.1016/j.heliyon.2023.e18455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023] Open
Abstract
Evodia rutaecarpa (Evodia) is a Chinese herbal medicine with analgesic and anti-neurodegenerative properties. However, whether Evodia compounds can be applied for the comorbid pain of Alzheimer's disease (AD) and the underlying mechanisms remain unclear. Herein, 137 common targets of Evodia between AD and pain were predicted from drug and disease target databases. Subsequently, protein-protein interaction (PPI) network, protein function module construction, and bioinformatics analyses were used to analyze the potential relationship among targets, pathways, and diseases. Evodia could simultaneously treat AD comorbid pain through multi-target, multi-component, and multi-pathway mechanisms, and inflammation was an important common phenotype of AD and pain. The relationship between important transcription factors such as RELA, NF-κB1, SP1, STAT3, and JUN on IL-17, TNF, and MAPK signaling pathways might be potential mechanisms of Evodia. Additionally, 10 candidate compounds were predicted, and evodiamine might be the effective active ingredient of Evodia in treating AD or pain. In summary, this study provided a reference for subsequent research and a novel understanding and direction for the clinical use of evodiamine to treat AD patients with comorbid pain.
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Affiliation(s)
- Huiyi Jiang
- Department of Anesthesiology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Department of Anesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Jiamin Qiu
- Department of Anesthesiology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Department of Anesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Xin Deng
- Department of Anesthesiology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Department of Anesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Danping Li
- Department of Anesthesiology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Department of Anesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Tao Tao
- Department of Anesthesiology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Department of Anesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, China
- Department of Anesthesiology, Zhujiang hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
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4
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Pu L, Chen H, Jones C, Moyle W. Family Involvement in Pain Management for People Living With Dementia: An Integrative Review. JOURNAL OF FAMILY NURSING 2023; 29:43-58. [PMID: 35898190 DOI: 10.1177/10748407221114502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This review aimed to synthesize current evidence on family involvement in pain management for people living with dementia from the perceptions of family carers and health care professionals. An integrative review was conducted using CINAHL, Embase, PubMed, PsycINFO and Cochrane Library electronic databases. The Mixed Methods Appraisal Tool was used to appraise the articles, followed by thematic analysis. Twelve studies were included and four themes were identified: (1) The roles and responsibilities of family carers; (2) Enablers and barriers for pain identification; (3) Strategies and concerns for pain management; and (4) Lack of staff education and communication with health care providers. Family carers play an important role in pain assessment and management for people living with dementia, but they cannot be actively involved in this process due to a lack of communication with health care providers. An integrated approach that includes education and communication with family carers and health care providers is needed.
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Affiliation(s)
- Lihui Pu
- Griffith University, Nathan Queensland, Australia
| | | | - Cindy Jones
- Bond University, Robina Queensland, Australia
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5
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Smith TO, Lockey D, Johnson H, Rice L, Heard J, Irving L. Pain management for people with dementia: a cross-setting systematic review and meta-ethnography. Br J Pain 2023; 17:6-22. [PMID: 36815066 PMCID: PMC9940246 DOI: 10.1177/20494637221119588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Pain management for people with dementia is challenging. There is limited understanding on the experiences of pain management from people with dementia, but also from those who support them. This study synthesised the qualitative evidence to explore the perspectives of people with dementia, their family, friends, carers and healthcare professionals to pain management. Methods A systematic literature review was undertaken of published and unpublished literature databases (to 01 November 2021). All qualitative research studies reporting the perspectives of people with dementia, their family, friends, carers and healthcare professionals to managing pain were included. Eligible studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative appraisal tool. A meta-ethnography analysis approach was adopted, with findings assessed against the GRADE-CERQual framework. Results Of the 3994 citations screened, 33 studies were eligible. Seven themes were identified from the data. There was moderate evidence from six studies indicating inequity of pain management for people with dementia. There was moderate evidence from 22 studies regarding anxieties on cascading pain information. There was moderate evidence from nine studies that familiarisation of the person with pain, their preferences, routines and behaviours were key factors to better pain management. Consistently, carers and healthcare professionals had a low opinion of the management of pain for people with dementia, with tensions over the 'best' treatment options to offer. This was associated with poor training and understanding on how pain 'should' be managed. Conclusion The findings highlight the challenges faced by people with dementia and pain, and those who support them. Improvements in education for people who support these individuals would be valuable across health and social care pathways. Supporting family members and relatives on pain experiences and treatment options could improve awareness to improve quality of life for people with dementia and pain and those who support them.
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Affiliation(s)
- Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dawn Lockey
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - Helen Johnson
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - Lauren Rice
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - Jay Heard
- Physiotherapy Department, Lewisham and Greenwich NHS Trust, Lewisham, University Hospital Lewisham, London, UK
| | - Lisa Irving
- Physiotherapy Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
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6
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Helvik AS, Bergh S, Kabukcuoğlu K, Šaltytė Benth J, Lichtwarck B, Husebø B, Tevik K. Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home - A longitudinal study. PLoS One 2022; 17:e0279909. [PMID: 36584218 PMCID: PMC9803316 DOI: 10.1371/journal.pone.0279909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023] Open
Abstract
The overall aim was to explore the prevalence and persistent regular prescription of opioids and paracetamol among nursing home (NH) residents with dementia at admission and over time. A total of 996 residents with dementia, mean (SD) age 84.5 (7.6) years and (36.1% men), were included at admission (A1). Yearly assessments were performed for two years (A2 and A3) or until death. Pain was assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale. Information regarding prescription of analgesics, general physical health, personal activities of daily living, severity of dementia, neuropsychiatric symptoms, and prescription of psychotropic drugs was collected. A generalized linear mixed model was used to explore whether pain severity was associated with persistent and persistent prescription of opioids and/or paracetamol across timepoints. At A1, 495 of 996 (49.7%) NH residents were prescribed analgesics and prevalence increased at the follow-ups (A2: n = 630, 65.1%; A3: n = 382, 71.2%). Paracetamol was the most frequently prescribed analgesic at all assessments (A1: 45.5%; A2: 59.5%; A3: 67.1%). Opioid prescriptions were quite prevalent (A1: 18.1%; A2: 25.1%; A3: 28.3%), with odds approximately 13 times (OR = 13.3, 95% CI 6.8-26.0) and 9 times (OR = 8.6, 95% CI 3.7-20.3) higher for prescription at follow-up A2 and A3, respectively, relative to prescription at A1. In adjusted analyses, higher pain intensity and poor physical health were associated with prescription and persistent prescription of opioids and paracetamol. In conclusion, prevalence and persistent prescription of analgesics were high in NH residents with dementia. The odds for the prescription of opioids at follow-up were high if prescribed at baseline. Interdisciplinary collaboration, routine assessment of pain at admission and regularly thereafter, and systematic drug reviews are essential to adequately assess and treat pain in NH residents with dementia.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- * E-mail:
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Kamile Kabukcuoğlu
- Faculty of Nursing, Akdeniz University, Campus Antalya, Antalya, Türkiye
| | - Jūratė Šaltytė Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Lichtwarck
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bettina Husebø
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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7
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Kelleher JE, Weedle P, Donovan MD. The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes. PHARMACY 2021; 9:pharmacy9040160. [PMID: 34698248 PMCID: PMC8544697 DOI: 10.3390/pharmacy9040160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusions: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.
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Affiliation(s)
- Jayne E. Kelleher
- Peter Weedle Allcare Pharmacy, P51HCP4 Cork, Ireland; (J.E.K.); (P.W.)
| | - Peter Weedle
- Peter Weedle Allcare Pharmacy, P51HCP4 Cork, Ireland; (J.E.K.); (P.W.)
| | - Maria D. Donovan
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12YN60 Cork, Ireland
- Correspondence:
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8
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Pringle J, Mellado ASAV, Haraldsdottir E, Kelly F, Hockley J. Pain assessment and management in care homes: understanding the context through a scoping review. BMC Geriatr 2021; 21:431. [PMID: 34275442 PMCID: PMC8286436 DOI: 10.1186/s12877-021-02333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, 2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the contexts that might influence its management. Methods Scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were also screened, and website searches carried out of key organisations. Conversations with 16 local care home managers were included to gain an understanding of their perspective. Results Inclusion criteria were met by 109 studies. Three overarching themes were identified: Staff factors and beliefs - in relation to pain assessment and management (e.g. experience, qualifications) and beliefs and perceptions relating to pain. Pain assessment – including use of pain assessment tools and assessment/management for residents with cognitive impairment. Interventions - including efficacy/effects (pharmaceutical/non pharmaceutical), and pain training interventions and their outcomes. Overall findings from the review indicated a lack of training and staff confidence in relation to pain assessment and management. This was particularly the case for residents with dementia. Conclusions Further training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02333-4.
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Affiliation(s)
- Jan Pringle
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK.
| | | | | | - Fiona Kelly
- School of Health Sciences, Queen Margaret University, Edinburgh, East Lothian, UK
| | - Jo Hockley
- Usher Institute, University of Edinburgh, Edinburgh, UK
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9
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Bao Z, Landers M. Non-pharmacological interventions for pain management in patients with dementia: A mixed-methods systematic review. J Clin Nurs 2021; 31:1030-1040. [PMID: 34254373 DOI: 10.1111/jocn.15963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, summarise and compare evidence from studies related to the non-pharmacological interventions used to manage pain in patients with dementia. Secondly, this study aims to provide evidence on the effectiveness of non-pharmacological interventions used to manage pain in patients with dementia. BACKGROUND The number of people diagnosed with dementia is rising rapidly in the context of ageing. Pain is considered to be one of the most common neuropsychiatric symptoms of dementia. To date, little research has focused on non-pharmacological interventions to manage pain in patients with dementia. Therefore, a systematic review on the non-pharmacological interventions used to manage pain in patients with dementia and how effective these interventions are, is warranted. METHOD The extensive search strategy included electronic database searches for CINAHL, MEDLINE and PsycINFO from January 2009 to February 2020. A mixed-methods systematic review was undertaken in accordance with the PRISMA statement and relevant papers were chosen based on inclusion criteria and quality assessment measures. Eligibility criteria defined the characteristics of inclusion studies using the PICO framework. Results were extracted to a synthesis table. The quality appraisal was conducted using JBI and CASP checklist. RESULTS Eight studies met the inclusion criteria. These included six randomised controlled trials, one quasi-experimental study and one qualitative descriptive study. The current review identified various non-pharmacological interventions for pain management in patients with dementia including singing, painting, massage, ear acupressure, play activities program and robot. The most common intervention was massage while the most effective intervention was play activities program. All studies provided evidence that non-pharmacological interventions have an effect on pain management in patients with dementia or that there was a tendency for non-pharmacological intervention to reduce pain in patients with dementia. Overall, the quality of the included studies was interpreted as strong (n = 8). CONCLUSIONS Overall, interactive pharmacological interventions were more effective than non-interactive non-pharmacological interventions. While this review highlighted a limited number of studies investigating the use of non-pharmacological interventions to manage pain in patients with dementia, it did however uncover a range of non-pharmacological interventions used to manage pain in these patients along with their level of effectiveness. RELEVANCE TO CLINICAL PRACTICE Further research is required to explore which non-pharmacological interventions are most effective in the management of pain in patients with varying degrees of cognitive impairment. Further qualitative research is also needed to explore nurses' views on the use of non-pharmacological interventions to manage pain in patients with dementia.
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Affiliation(s)
| | - Margaret Landers
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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10
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Manias E, Bucknall T, Hutchinson A, Dow B, Borrott N. Resident and family engagement in medication management in aged care facilities: a systematic review. Expert Opin Drug Saf 2021; 20:1391-1409. [PMID: 34058923 DOI: 10.1080/14740338.2021.1935862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Medication-related harms may occur if residents and families are not involved when important medication decisions are made. We examined how residents and families engage in the management of residents' medications in aged care facilities.Areas covered: A systematic review was undertaken, which was registered with PROSPERO (CRD42020152700). Electronic databases were searched from inception until 27 August 2020 using MEDLINE/PubMed, CINAHL, PsycINFO and EMBASE. Data synthesis was undertaken using thematic analysis.Expert opinion: Forty studies were included. Communication tended to be unidirectional comprising consultations where residents and families provided medication information to health care providers or where health care providers provided medication information to residents and families. Many challenges prevailed that prevented effective engagement, including families' hesitation about making decisions, and the lack of adequately-trained health care providers. Testing of interventions often did not include residents or families in developing these interventions or in examining how they participated in medication decisions following implementation of interventions. Areas for improvement comprise actively involving residents and families in planning interventions for resident-centered care. Health care providers need to have greater appreciation of families' ability to detect dynamic changes in residents' behavior, which can be used to enable optimal alterations in medication therapy.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia.,Foundational Chair in Nursing and Director of Nursing Research, Alfred Health, Prahran, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Victoria, Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Victoria, Australia.,School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Narelle Borrott
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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11
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Barry HE, McGrattan M, Ryan C, Passmore AP, Robinson AL, Molloy GJ, Darcy CM, Buchanan H, Hughes CM. 'I just take them because I know the people that give them to me': A theory-informed interview study of community-dwelling people with dementia and carers' perspectives of medicines management. Int J Geriatr Psychiatry 2021; 36:883-891. [PMID: 33368704 DOI: 10.1002/gps.5488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/22/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Identify facilitators and barriers to successful medicines management for people with dementia (PwD) in primary care from the perspectives of community-dwelling PwD and carers. METHODS Semi-structured interviews conducted with PwD and carers in Northern Ireland. The 14-domain Theoretical Domains Framework guided data collection and analysis. Interviews explored participants' experiences and perceptions of medicines management. PwD also completed the Beliefs about Medicines Questionnaire indicating their level of agreement with statements about medicines. Qualitative data were analysed using the framework method and content analysis. Quantitative data were analysed descriptively. RESULTS Eighteen PwD and 15 carers were interviewed. PwD believed they were competent with medicines management ('beliefs about capabilities'). Most PwD reported having strategies to prompt them to take their medicines ('memory, attention and decision processes'). Carers played an important role in supporting PwD with medicines management ('social influences') and monitoring adherence ('behavioural regulation') and anticipated having to take on a greater role as patients' cognitive impairment worsened ('beliefs about consequences'). Participants highlighted assistance provided by community pharmacies with medicines acquisition and delivery ('environmental context and resources') and placed great trust in primary healthcare professionals ('social influences'). PwD had positive attitudes towards medication and believed strongly in the necessity of their medicines. CONCLUSIONS This is the first study to use a theoretical approach to explore medicines management for community-dwelling PwD. The findings provide new insights into the critical role of carers in facilitating optimal medicines management and will inform future intervention development, in which carers' needs assessment and involvement will be key.
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Affiliation(s)
| | | | - Cristín Ryan
- The School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - A Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Belfast Health & Social Care Trust, Belfast, UK
| | - A Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Ireland
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12
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Jonsdottir T, Gunnarsson EC. Understanding Nurses' Knowledge and Attitudes Toward Pain Assessment in Dementia: A Literature Review. Pain Manag Nurs 2020; 22:281-292. [PMID: 33334680 DOI: 10.1016/j.pmn.2020.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain is underrecognized and undertreated in patients with dementia. It has been suggested that nurses' attitudinal barriers may contribute to the challenges surrounding pain assessment and management in dementia. AIMS This integrative literature review aims to identify and explore nurses' knowledge and attitudes towards pain assessment in older people with dementia and how it may affect pain management in this patient group. METHOD Electronic searches were conducted in Web of Science, MEDLINE, Scopus, ProQuest, PubMed, and EBSCOhost from January 2008 to December 2018 for articles specifically focusing on nurses' knowledge and attitudes towards pain assessment in older patients with dementia. RESULTS Ten studies were included in the review after meeting the inclusion criteria. Data extracted from each study included study design, aims and objectives, setting/sample, findings, and limitations. Patients with dementia are at greater risk of experiencing underassessment, undertreatment, and delayed treatment of pain due to nurses' knowledge deficits and uncertainty in the decision-making process. Nurses see providing comfort and reducing pain as ethical obligation. However, they find pain assessment a challenge due to the complexity of recognizing painful behaviors, and difficulty differentiating between pain and behavioral disturbances in dementia. Poor multidisciplinary communication, time constraints, and workload pressure, as well as uncertainty about opioid use, are important barriers to effective pain assessment and management among patients with dementia. CONCLUSION It is essential that nurses gain confidence in distinguishing signs and symptoms of pain from behavioral changes in dementia. It is important to improve interdisciplinary communication and to get physicians to listen and prioritize pain assessment and management.
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Affiliation(s)
- Thorbjorg Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland; School of Health Sciences, Faculty of Nursing, University of Akureyriv/Nordurslod, Akureyri, Iceland.
| | - Esther Christina Gunnarsson
- Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland; The National University Hospital of Iceland, Eiriksgata, Reykjavik, Iceland
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13
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Tobis S, Neumann-Podczaska A, Yermukhanova L, Sultanova G, Kurmanalina G, Kimatova K, Dworacka M, Wieczorowska-Tobis K. Pain in People with Advanced Dementia: The Opinions of Kazakh Medical Students. J Pain Res 2020; 13:3307-3314. [PMID: 33324091 PMCID: PMC7732167 DOI: 10.2147/jpr.s276479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The medical students’ attitude toward pain in people with advanced dementia, while constituting an important factor in care, has rarely been assessed to date. The aim of our study was thus to perform such assessment in medical students in Kazakhstan, to enable an improvement of the existing curriculum (like we previously did in Poland). Materials and Methods We analyzed the knowledge about pain using a short anonymous questionnaire, which was completed by 112 students of the Medical University of Aktobe, Kazakhstan. Results On average, students listed symptoms of 1.4 ± 1.2 (out of 6 analyzed) pain areas (median 2.0). The symptoms related to changes in mental status were suggested the most often (57 students: 50.9%). The students who indicated these symptoms also listed a higher number of symptoms from the remaining domains (1,1 ± 1.0 [median 1.0] vs 0.6 ± 0.8 [median 0.0]; p<0.01). Observational methods in the assessment of the severity of pain in people with dementia were indicated by 44 students (39.3%), but only one participant (0.9%) was able to name an observational scale for pain assessment. Correct answers regarding pain treatment rules were presented by 18 students (16.0%), and the answers of the next 47 participants (42.0%) were very general but suggested the same treatment no matter what the cognitive status. Conclusion The study revealed gaps in the knowledge of Kazakh medical students regarding pain in advanced stages of dementia. Demographic changes, combined with the coexistence of pain with dementia, indicate that medical students worldwide must have sufficient knowledge and skills to adequately care for the continually growing number of people with these conditions. It is imperative in countries like Kazakhstan, where the dementia burden was unrecognized until now, but it will blow up in the near future.
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Affiliation(s)
- Slawomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Neumann-Podczaska
- Geriatric Unit, Department and Chair of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Lyudmila Yermukhanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Gulnara Sultanova
- West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Gulnara Kurmanalina
- Department of Internal Medicine, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Kerbez Kimatova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Marzena Dworacka
- Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Wieczorowska-Tobis
- Geriatric Unit, Department and Chair of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Dube CE, Morrison RA, Mack DS, Jesdale BM, Nunes AP, Liu SH, Lapane KL. Prevalence of Pain on Admission by Level of Cognitive Impairment in Nursing Homes. J Pain Res 2020; 13:2663-2672. [PMID: 33116808 PMCID: PMC7586014 DOI: 10.2147/jpr.s270689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To provide contemporary estimates of pain by level of cognitive impairment among US nursing home residents without cancer. METHODS Newly admitted US nursing home residents without cancer assessed with the Minimum Data Set 3.0 at admission (2010-2016) were eligible (n=8,613,080). The Cognitive Function Scale was used to categorize level of cognitive impairment. Self-report or staff-assessed pain was used based on a 5-day look-back period. Estimates of adjusted prevalence ratios (aPR) were derived from modified Poisson models. RESULTS Documented prevalence of pain decreased with increased levels of cognitive impairment in those who self-reported pain (68.9% no/mild, 32.9% severe) and those with staff-assessed pain (50.6% no/mild, 37.2% severe staff-assessed pain). Relative to residents with no/mild cognitive impairment, pharmacologic pain management was less prevalent in those with severe cognitive impairment (self-reported: 51.3% severe vs 76.9% in those with no/mild; staff assessed: 52.0% severe vs 67.7% no/mild). CONCLUSION Pain was less frequently documented in those with severe cognitive impairment relative to those with no/mild impairments. Failure to identify pain may result in untreated or undertreated pain. Interventions to improve evaluation of pain in nursing home residents with cognitive impairment are needed.
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Affiliation(s)
- Catherine E Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Reynolds A Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Deborah S Mack
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Abstract
Older adults living in long-term care (LTC) settings experience a higher incidence of chronic pain than those living in the community and are prescribed opioids at approximately twice the rate. Opioids are effective in managing pain in LTC residents, who are often not candidates for nonopioid pharmacological or nonpharmacological therapies. The recent Centers for Disease Control and Prevention guideline for opioid stewardship recommends conservative opioid prescribing and discourages long-term opioid use for chronic pain management, raising concern that pain may not be adequately treated for LTC residents. The Society for Post-Acute and Long-Term Care Medicine recently published a policy statement that addresses responsible opioid stewardship in LTC. The current article describes clinical guidelines and standards that can guide LTC nurses in assessing, treating, and monitoring opioid use so that residents have diminished pain without significant adverse events. [Journal of Gerontological Nursing, 45(9), 5-10.].
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16
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Nasu K, Konno R, Fukahori H. End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review. Int J Nurs Pract 2019; 26:e12771. [PMID: 31364244 DOI: 10.1111/ijn.12771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/03/2019] [Accepted: 06/15/2019] [Indexed: 12/19/2022]
Abstract
AIM To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. BACKGROUND Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. DESIGN Qualitative systematic review. DATA SOURCES Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. METHODS The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. RESULTS Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. CONCLUSION Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.
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Affiliation(s)
- Katsumi Nasu
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rie Konno
- School of Nursing, Hyogo University of Health Sciences, Hyogo, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
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Iaboni A, Campitelli MA, Bronskill SE, Diong C, Kumar M, Maclagan LC, Gomes T, Tadrous M, Maxwell CJ. Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study. CMAJ Open 2019; 7:E582-E589. [PMID: 31551235 PMCID: PMC6759016 DOI: 10.9778/cmajo.20190052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. METHODS We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. RESULTS Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). INTERPRETATION Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes.
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Affiliation(s)
- Andrea Iaboni
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Michael A Campitelli
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Susan E Bronskill
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Christina Diong
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Matthew Kumar
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Laura C Maclagan
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Tara Gomes
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Mina Tadrous
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Colleen J Maxwell
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.
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Wergeland Sørbye L, Steindal SA, Kalfoss MH, Vibe OE. Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018. Health Serv Insights 2019; 12:1178632919834318. [PMID: 31043789 PMCID: PMC6446440 DOI: 10.1177/1178632919834318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/16/2019] [Indexed: 11/16/2022] Open
Abstract
In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents' needs for opioids is a challenge for palliative care nurses, both ethically and legally.
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Affiliation(s)
| | | | - Mary H Kalfoss
- Faculty of Health, VID Specialized University, Oslo, Norway
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19
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Dillane I, Doody O. Nursing people with intellectual disability and dementia experiencing pain: An integrative review. J Clin Nurs 2019; 28:2472-2485. [PMID: 30786087 DOI: 10.1111/jocn.14834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/09/2019] [Accepted: 02/09/2019] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES To explore the current evidence of nurses caring for people with intellectual disability and dementia who experience pain. BACKGROUND People with intellectual disability are ageing and are experiencing age-related health conditions including dementia and conditions associated with pain, but at an earlier age. Addressing the needs of people with intellectual disability who develop dementia is a new challenge for nurses. DESIGN An integrative literature review. METHODS A systematic search of databases: CINAHL, MEDLINE, PsycINFO, Cochrane, EMBASE, Academic Search Complete, Scopus and Web of Science between 27 October 2017-7 November 2017. Hand searching and review of secondary references were also undertaken. Quality appraisal (Crowe Critical Appraisal Tool), thematic data analysis (Braun and Clarke, Qualitative Research in Psychology, 3, 2006, 77) and reporting using the PRISMA guidelines. RESULTS Seven papers met the inclusion criteria, and three themes emerged from this review: nurses knowledge of ageing, dementia and pain; recognising pain in people with intellectual disability and dementia; and the role of nurse education. People with intellectual disability and dementia have difficulty communicating their pain experience compounded by pre-existing communication difficulties. CONCLUSIONS A pain experience can present similar to behavioural and psychological symptoms of dementia, and diagnostic overshadowing often occurs whereby a pain need is misinterpreted as behavioural and psychological symptoms resulting in inappropriate treatment. Nurses need greater knowledge about the presence of pain and potential causes in people with intellectual disability and dementia, and education can be effective in addressing this knowledge deficit. RELEVANCE TO CLINICAL PRACTICE Pain assessment tools for people with intellectual disability and dementia need to include behavioural elements, and baseline assessments are required to identify changes in presentation. Nurses need to recognise and respond to pain based on the evidence in order to deliver quality care.
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Affiliation(s)
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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20
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Jennings AA, Linehan M, Foley T. The knowledge and attitudes of general practitioners to the assessment and management of pain in people with dementia. BMC FAMILY PRACTICE 2018; 19:166. [PMID: 30301471 PMCID: PMC6178252 DOI: 10.1186/s12875-018-0853-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/26/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain in people with dementia is underdiagnosed and undertreated. General practitioners (GPs) play a pivotal role in dementia care but their perspectives on pain in people with dementia remains under-researched. The aim of this study was to explore GPs' knowledge and attitudes towards pain assessment and management in people with dementia. METHODS This was a descriptive cross-sectional study. A questionnaire was adapted from a previous study and piloted with 5 GPs. The questionnaire was posted to a census sample of all GPs in Cork city and county in the southern region of Ireland. The questionnaire collected demographic information, responses to a series of Likert-type statements assessing GPs' knowledge and attitudes, and provided an opportunity for the GP to give qualitative feedback on their experiences of managing pain in dementia. SPSS v25 was used for statistical analysis. Qualitative responses were thematically analysed. RESULTS Of the 320 questionnaires posted, 157 completed questionnaires were returned (response rate of 49%). The sample was representative of GPs nationally in terms of years in GP practice and practice location. Over two-thirds (108/157) of respondents had a nursing home commitment. Only 10% of respondents (16/157) were aware of any dementia-specific pain assessment tools. The larger the nursing home commitment of the GP the more likely they were to be familiar with these tools (p = 0.048). The majority of respondents (113/157) believed people with dementia could not self-report pain. Respondents were uncertain about the safety of using opioid medications to treat pain in people with dementia with only 51.6% agreeing that they were safe. The qualitative comments highlighted the importance the GPs placed on surrogate reports of pain, GPs' uncertainty regarding the value of formal pain assessment tools and the challenges caused by under-resourcing in general practice. CONCLUSION This study has highlighted aspects of pain assessment and management in dementia that GPs find challenging. Guidance on pain assessment and management in people with dementia do not appear to be translating into clinical practice. The findings will inform educational interventions being developed by our research team as part of the implementation of the Irish national dementia strategy. The knowledge and attitudes of general practitioners to the assessment and management of pain in people with dementia.
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Affiliation(s)
- Aisling A Jennings
- Department of General Practice, Western Gateway Building, University College Cork, Cork, Ireland
| | - Maura Linehan
- Department of General Practice, Western Gateway Building, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, Western Gateway Building, University College Cork, Cork, Ireland
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Walsh KA, Sinnott C, Fleming A, Mc Sharry J, Byrne S, Browne J, Timmons S. Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study. J Am Med Dir Assoc 2018; 19:948-958.e12. [PMID: 30241987 DOI: 10.1016/j.jamda.2018.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions. DESIGN Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF). SETTING AND PARTICIPANTS A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland. MEASURES Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed. RESULTS Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants' effort to achieve "a fine balance" between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes ("human suffering"; "the interface between resident and nursing home"; and "power and knowledge: complex stakeholder dynamics"), which conceptualize how different nursing homes strike this "fine balance." CONCLUSIONS Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that "fine balance" and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention.
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Affiliation(s)
- Kieran A Walsh
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.
| | - Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Aoife Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - Jenny Mc Sharry
- Health Behavior Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Lin PC, Li CH, Chou PL, Chen YM, Lin LC. Prevalence of pain-related diagnoses in patients with dementia: a nationwide study. J Pain Res 2018; 11:1589-1598. [PMID: 30214270 PMCID: PMC6126483 DOI: 10.2147/jpr.s172875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purposes To investigate the prevalence of pain-related diagnoses in patients with dementia and evaluate the association of pain-related diagnoses with demographic characteristics and dementia subtypes. Patients and methods In this population-based retrospective cohort study, participants were recruited from a cohort of 2 million people randomly sampled from the general population in the National Health Insurance Research Database of Taiwan from 2000 to 2013. The index year was defined as the period of 1 year from the date of the first diagnosis of dementia. Results The study group comprised 28,450 patients with the dementia subtypes of vascular dementia, Alzheimer’s disease, or other dementia subtypes. The mean age of patients with dementia was 76.75 years. Of all patients with dementia, 49.07% had at least one pain-related diagnosis documented in their outpatient or inpatient claim records within the index year. The top three pain-related diagnoses were osteoarthritis (29.27%), headache (12.53%), and osteoporosis (11.43%). Musculoskeletal diagnosis was more likely in female patients with vascular dementia. Although patients with vascular dementia had a significantly lower prevalence of pain-related diagnosis, they had a significantly higher risk of 1-year mortality than patients with other dementia subtypes. Conclusion During the index year, 49.07% of patients with dementia had at least one pain-related diagnosis. To investigate the differences of the use of pain medication in patients with different dementia subtypes and the difference of pain-related diagnosis and treatment in patients with and without dementia, future studies are recommended.
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Affiliation(s)
- Pei-Chao Lin
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Hsun Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ling Chou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Mei Chen
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,International Medical Service Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Chan Lin
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan,
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La Frenais FL, Bedder R, Vickerstaff V, Stone P, Sampson EL. Temporal Trends in Analgesic Use in Long-Term Care Facilities: A Systematic Review of International Prescribing. J Am Geriatr Soc 2018; 66:376-382. [PMID: 29274247 PMCID: PMC5838548 DOI: 10.1111/jgs.15238] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To explore global changes in the prescription of analgesic drugs over time in the international long-term care (LTC) population. DESIGN Systematic review. SETTING We included original research articles in English, published and unpublished, that included number of participants, country and year(s) of data collection, and prescription of analgesics (analgesics not otherwise specified, opioids, acetaminophen; scheduled only, or scheduled plus as needed (PRN)). PARTICIPANTS LTC residents. MEASUREMENTS We searched PubMed, EMBASE, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Cochrane, Web of Science, Google Scholar, using keywords for LTC facilities and analgesic medication; hand-searched references of eligible papers; correspondence. Studies were quality rated using an adapted Newcastle-Ottawa scale. Pearson correlation coefficients were generated between percentage of residents prescribed an analgesic and year of data collection. If available, we investigated changes in acetaminophen and opioid prescriptions. RESULTS Forty studies met inclusion criteria. A moderate correlation (0.59) suggested that scheduled prescription rates for analgesics have increased over time. Similar findings were reflected in scheduled prescriptions for acetaminophen and opioids. No increase was seen when analyzing scheduled plus PRN analgesics. Use of opioids (scheduled plus PRN) appears to have increased over time. CONCLUSION Worldwide, use of opioids and acetaminophen has increased in LTC residents. Research is needed to explore whether this reflects appropriate pain management for LTC residents and if PRN medication is used effectively.
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Affiliation(s)
- Francesca L. La Frenais
- Division of PsychiatryUniversity College LondonLondonUnited Kingdom
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Rachel Bedder
- Division of PsychiatryUniversity College LondonLondonUnited Kingdom
- Institute of Cognitive NeuroscienceUniversity College LondonLondonUnited Kingdom
| | - Victoria Vickerstaff
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Patrick Stone
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Elizabeth L. Sampson
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
- Barnet Enfield and Haringey Mental Health Trust Liaison TeamNorth Middlesex University HospitalLondonUnited Kingdom
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Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications. J Am Med Dir Assoc 2017; 18:453.e1-453.e6. [DOI: 10.1016/j.jamda.2017.01.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 01/08/2023]
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Chow S, Chow R, Lam M, Rowbottom L, Hollenberg D, Friesen E, Nadalini O, Lam H, DeAngelis C, Herrmann N. Pain assessment tools for older adults with dementia in long-term care facilities: a systematic review. Neurodegener Dis Manag 2016; 6:525-538. [PMID: 27855532 DOI: 10.2217/nmt-2016-0033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The aim of this review is to document pain assessment tools used primarily for older adults in long-term care facilities and compare self-report and observer-rated tools. METHODS A literature search was conducted in Ovid MEDLINE®, Embase, Cochrane and PsycINFO. Keywords included 'dementia', 'pain management' and 'managing pain'. RESULTS Of 1033 references, 23 articles were selected for inclusion. Six tools were self-rated and 18 tools were administered by an observer. 13 studies evaluated the reliability/validity of their scales; four studies compared different scales against each other. CONCLUSION Self-report should be the first-line approach when possible, with observational assessment used as a supplementary tool. Reliable observational tools have been shortened, and shown to maintain high reliability/validity, and positive psychometric properties.
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Affiliation(s)
- Selina Chow
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Ronald Chow
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Michael Lam
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Leigha Rowbottom
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Drew Hollenberg
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Erika Friesen
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Olivia Nadalini
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Henry Lam
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Carlo DeAngelis
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Sunnybrook Health Sciences Centre, University of Toronto, Room FG19, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Abstract
BACKGROUND Despite the numerous warnings of European and national drug agencies as well as clinical guidelines since the year 2004, psychotropic drugs are still frequently used in dementia. A systematic review comparing the use of psychotropic drugs in nursing homes from different European countries is lacking. OBJECTIVE The aim of this study was to examine prescription rates of psychotropic drug use in nursing home patients between different Western European countries since the first warnings were published. METHODS A literature review was performed and the various psychotropic prescribing rates in European nursing homes were investigated. The prescription rates of antipsychotic and antidepressants were pooled per country. Other classes of psychotropic drugs could not be pooled because of the limited number of studies found. RESULTS Thirty-seven studies on antipsychotic drug use and 27 studies on antidepressant drug use conducted in 12 different European countries. The antipsychotic use in nursing homes ranged from 12% to 59% and antidepressant use from 19% to 68%. The highest rates of antipsychotic drug prescription were found in Austria, Ireland, and Belgium while for antidepressants in Belgium, Sweden, and France. CONCLUSIONS Despite warnings about the side effects and recommendation to focus on non-pharmacological interventions, antipsychotics and antidepressants are commonly used drugs in nursing homes. The data suggest that Norway does best with regards having a low antipsychotic drug usage. Studies are needed to explain the differences between Norway and other European countries.
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La Frenais F, Stone P, Sampson EL. Analgesic prescribing in care home residents: how epidemiological studies may inform clinical practice. Pain Manag 2016; 6:561-568. [PMID: 27383004 DOI: 10.2217/pmt-2016-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Care home residents are often frail with multiple comorbidities and cognitive impairment, most commonly caused by dementia. This population is under-represented in clinical trials, leading to a lack of valid and reliable evidence to inform clinicians' prescribing practice. This paper summarizes how epidemiological research conducted in similar populations can inform pain management by describing pain prevalence, risk factors, typical features and functional consequences. This evidence can help overcome the numerous barriers to optimal pain management in care home residents.
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Affiliation(s)
- Francesca La Frenais
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield & Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK
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Bauer U, Pitzer S, Schreier MM, Osterbrink J, Alzner R, Iglseder B. Pain treatment for nursing home residents differs according to cognitive state - a cross-sectional study. BMC Geriatr 2016; 16:124. [PMID: 27317390 PMCID: PMC4912815 DOI: 10.1186/s12877-016-0295-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/31/2016] [Indexed: 11/23/2022] Open
Abstract
Background Communication skills are known to decrease with advancing cognitive impairment. Analgesic treatment in long-term care may be deficient due to the residents’ impaired ability to communicate their pain and needs. Undertreated pain frequently leads to rising BPSD in residents with cognitive impairment, resulting in a treatment with antipsychotics. Aim of this study was the analysis of differences in assessment and pharmacological treatment of pain in nursing home residents relative to their cognitive state and ability to articulate pain. Methods Data stems from the baseline of a non-experimental pre-post-study in 12 Austrian nursing homes. Residents’ pain prevalence in relation to pain assessment and cognitive decline was assessed, data on medical diagnoses and prescriptions were retrieved from the nursing homes’ documentation (n = 425). Residents were first divided into two groups: Residents with MMSE ≥ 18 were selected into group CUS (cognitively unimpaired/slightly impaired), residents with MMSE ≤ 17 were selected into group CI (cognitively moderately to severely impaired). CI residents were then sub-grouped according to their ability to communicate pain via the Verbal Rating Scale (VRS) (i.e. group CI-V, group CI-NV). Pain behavior of CI residents was assessed with a modified German version of PAINAD. Group differences were tested with ANOVA and H-test, 95 % confidence intervals were calculated and associations were tested with log-binomial regression. Results Pain prevalence in CI residents irrespective of their ability to communicate pain was 80 % and exceeded the CUS group prevalence significantly by 14 %. CI residents had significantly less analgesic prescriptions. Furthermore, CI residents have a significantly higher risk of getting no analgesics when in pain than CUS residents (CI-V: RR =2.6, CI-NV: RR =3.4). Use of antipsychotics was high in all groups (49 – 65 %) with more prescriptions in the cognitively impaired group. Conclusion Results point toward an underuse of pain medication in cognitively impaired residents, especially those unable to communicate pain verbally. The implementation of standardized pain assessments adapted to the cognitive abilities of residents may foster the recognition of pain, warrant optimized pain management, reduce inadequate medication and consequently raise the chance of equally effective pain treatment regardless of cognitive state.
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Affiliation(s)
- Ulrike Bauer
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria.
| | - Stefan Pitzer
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria
| | - Maria Magdalena Schreier
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria
| | - Reinhard Alzner
- Department of Geriatric Medicine, Christian Doppler Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, A-5020, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, A-5020, Salzburg, Austria
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de Tommaso M, Arendt-Nielsen L, Defrin R, Kunz M, Pickering G, Valeriani M. Pain in Neurodegenerative Disease: Current Knowledge and Future Perspectives. Behav Neurol 2016; 2016:7576292. [PMID: 27313396 PMCID: PMC4904074 DOI: 10.1155/2016/7576292] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/18/2016] [Accepted: 05/08/2016] [Indexed: 12/26/2022] Open
Abstract
Neurodegenerative diseases are going to increase as the life expectancy is getting longer. The management of neurodegenerative diseases such as Alzheimer's disease (AD) and other dementias, Parkinson's disease (PD) and PD related disorders, motor neuron diseases (MND), Huntington's disease (HD), spinocerebellar ataxia (SCA), and spinal muscular atrophy (SMA), is mainly addressed to motor and cognitive impairment, with special care to vital functions as breathing and feeding. Many of these patients complain of painful symptoms though their origin is variable, and their presence is frequently not considered in the treatment guidelines, leaving their management to the decision of the clinicians alone. However, studies focusing on pain frequency in such disorders suggest a high prevalence of pain in selected populations from 38 to 75% in AD, 40% to 86% in PD, and 19 to 85% in MND. The methods of pain assessment vary between studies so the type of pain has been rarely reported. However, a prevalent nonneuropathic origin of pain emerged for MND and PD. In AD, no data on pain features are available. No controlled therapeutic trials and guidelines are currently available. Given the relevance of pain in neurodegenerative disorders, the comprehensive understanding of mechanisms and predisposing factors, the application and validation of specific scales, and new specific therapeutic trials are needed.
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Affiliation(s)
- Marina de Tommaso
- Neurophysiopathology of Pain Section, SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | | | - Ruth Defrin
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Miriam Kunz
- Department of General Practice, Section Gerontology, University Medical Center Groningen, Groningen, Netherlands
| | - Gisele Pickering
- CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France
- Inserm, CIC 1405, Neurodol 1107, 63003 Clermont-Ferrand, France
| | - Massimiliano Valeriani
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
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Barry HE, Parsons C, Passmore AP, Hughes CM. Exploring the prevalence of and factors associated with pain: a cross-sectional study of community-dwelling people with dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:270-282. [PMID: 25708056 DOI: 10.1111/hsc.12204] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 06/04/2023]
Abstract
Few pain studies have made community-dwelling people with dementia (PWD) their focus. The aim of this study was to determine the prevalence of pain among this patient population and to explore medication use. Moreover, we sought to investigate patient and caregiver variables associated with the presence of pain. Community-dwelling PWD and their caregivers were recruited between May 2009 and July 2012 from outpatient memory clinics in Northern Ireland to take part in a face-to-face structured interview with a researcher. Patients' cognitive status and presence of depression were established. A full medication history was taken. Both patients and caregivers were asked to rate patients' pain, at the time of the interview and on an average day, using a 7-point verbal descriptor scale. From the 206 patients who were eligible to take part, 75 patient-caregiver dyads participated in the study (participation rate = 36.4%). The majority of patients (92.0%) had dementia classed as mild or moderate. Pain was commonly reported among the sample, with 57.3% of patients and 70.7% of caregivers reporting patient pain on an average day. Significant differences were found between patients' and caregivers' reports of pain. Two-fifths of patients (40.0%) were prescribed analgesia. Antipsychotic, hypnotic and anxiolytic drug use was low, whereas antidepressant drugs were prescribed more commonly. Presence of pain was unaffected by dementia severity; however, the use of prescribed analgesic medication was a significant predictor of the presence of pain in these patients, whether reported by the patient or their caregiver 'right now' or 'on an average day' (P < 0.001). Patient and caregiver recruitment was challenging, and remains a barrier to research in this area in the future.
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Affiliation(s)
- Heather E Barry
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Carole Parsons
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - A Peter Passmore
- Department of Geriatric Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Carmel M Hughes
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Jordan S, Gabe-Walters ME, Watkins A, Humphreys I, Newson L, Snelgrove S, Dennis MS. Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS One 2015; 10:e0140203. [PMID: 26461064 PMCID: PMC4603896 DOI: 10.1371/journal.pone.0140203] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/21/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring. DESIGN Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care. SETTING Five UK private sector care homes. PARTICIPANTS 41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine. INTERVENTION Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step. OUTCOMES Problems addressed and changes in medicines prescribed. DATA COLLECTION AND ANALYSIS Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site. RESULTS Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22). CONCLUSION The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines. TRIAL REGISTRATION ISRCTN 48133332.
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Affiliation(s)
- Susan Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | | | - Alan Watkins
- College of Medicine, Swansea University, Swansea, Wales
| | - Ioan Humphreys
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Louise Newson
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales
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Palliative care as a primary therapeutic approach in advanced dementia: a narrative review. Clin Ther 2014; 36:1512-7. [PMID: 25457122 DOI: 10.1016/j.clinthera.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE The goal of this narrative review was to identify and summarize the ways in which palliative care could benefit patients who have advanced dementia. METHODS This case-based discussion article examines current literature on palliative care for dementia. FINDINGS Dementia is an incurable, progressive disease that affects millions of subjects. The prevalence has grown in the last decade and is projected to continue on this trajectory. In the later stages of dementia, subjects require increasing levels of care due to severe cognitive and functional impairment. Although the field of palliative medicine focuses on improving the quality of life of patients with life-limiting illnesses, many patients with advanced dementia do not receive palliative care services. IMPLICATIONS Palliative care has been shown to improve patient and caregiver satisfaction, quality of life, and symptom burden at the end of life. Patients with advanced dementia would benefit from increased access to palliative care.
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