1
|
Karris MY, Danilovich M. Editorial: Chronic Pain and Health Disparities in Older Adults With Complex Needs. FRONTIERS IN PAIN RESEARCH 2022; 3:941476. [PMID: 35836738 PMCID: PMC9274255 DOI: 10.3389/fpain.2022.941476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maile Young Karris
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | | |
Collapse
|
2
|
Mantelli S, Jungo KT, Rozsnyai Z, Reeve E, Luymes CH, Poortvliet RKE, Chiolero A, Rodondi N, Gussekloo J, Streit S. How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study. BMC FAMILY PRACTICE 2018; 19:169. [PMID: 30314468 PMCID: PMC6186124 DOI: 10.1186/s12875-018-0856-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/03/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population. METHODS GPs took an online survey that presented case-vignettes of a frail oldest-old patient with and without history of cardiovascular disease (CVD) and asked if they would deprescribe any of seven medications. We calculated percentages of GPs willing to deprescribe at least one medication in the case with CVD and compared these with the case without CVD using paired t-tests. We also included open-ended questions to capture reasons for deprescribing and asked which factors could influence their decision to deprescribe by asking for their agreement on a 5-point-Likert-scale. RESULTS Of the 282 GPs we invited, 157 (56%) responded: 73% were men; mean age was 56. In the case-vignette without CVD, 98% of GPs deprescribed at least one medication (usually cardiovascular preventive medications) stating it had no indication nor benefit. They would lower the dose or prescribe pain medication as needed to reduce side effects. Their response was much the same when the patient had a history of CVD. GPs reported they were influenced by 'risk' and 'benefit' of medications, 'quality of life', and 'life expectancy', and prioritized the patient's wishes and priorities when deprescribing. CONCLUSION Swiss GPs were willing to deprescribe cardiovascular preventive medication when it lacked indication but tended to retain pain medication. Developing tools for GPs to assist them in balancing the risks and benefits of medication in the context of patient values may improve deprescribing activities in practice.
Collapse
Affiliation(s)
- Sophie Mantelli
- Institute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Katharina Tabea Jungo
- Institute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Zsofia Rozsnyai
- Institute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Geriatric Medicine Research, Dalhousie University and Nova Scotia Health Authority, Halifax, NS Canada
- College of Pharmacy, Dalhousie University, Halifax, NS Canada
| | - Clare H. Luymes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Arnaud Chiolero
- Institute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Nicolas Rodondi
- Institute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sven Streit
- Institute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| |
Collapse
|
3
|
Moschinski K, Kuske S, Andrich S, Stephan A, Gnass I, Sirsch E, Icks A. Drug-based pain management for people with dementia after hip or pelvic fractures: a systematic review. BMC Geriatr 2017; 17:54. [PMID: 28196525 PMCID: PMC5310008 DOI: 10.1186/s12877-017-0446-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/08/2017] [Indexed: 01/17/2023] Open
Abstract
Background Studies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings. Treatment could be surgical or conservative. We also analysed study designs, methods and variables, as well as which assessments were applied to measure pain management and mental status. Method/design The development of this systematic review protocol was guided by the PRISMA-P requirements, which were taken into consideration during the review procedures. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect were searched. Studies published up to January 2016 were included. The data extraction, content and quantitative descriptive analysis were carried out systematically, followed by a critical appraisal. Results Eight of the 13 included studies focusing on patient data showed that people with dementia received less drug-based pain management than people without cognitive impairment. Four studies based on surveys of healthcare professionals stated that cognitive impairment is a major barrier for effective pain management. There was heterogeneity regarding the assessment of the mental status and the pain assessment of the patients. The assessment of the drugs administered in all of the studies working with patient data was achieved through chart reviews. Conclusion People with dementia do not seem to receive the same amount of opioid analgesics after hip fracture as people without cognitive impairment. There is need to enhance pain assessment and management for these patients. Future research should pay more attention to the use of the appropriate items for assessing cognitive impairment and pain in people with dementia. Trial registration This systematic review was registered at Prospero (CRD42016037309); on 11 April 2016, and the systematic review protocol was published (Syst Rev. 5(1):1, 2016).
Collapse
Affiliation(s)
- Kai Moschinski
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Silke Kuske
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Silke Andrich
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Astrid Stephan
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.,Department of Nursing, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Irmela Gnass
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Erika Sirsch
- Faculty of Nursing Science, Vallendar College of Philosophy and Theology (PTHV Catholic University), Palottistraße 3, 56179, Vallendar, Germany
| | - Andrea Icks
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
| |
Collapse
|
4
|
Thé KB, Gazoni FM, Cherpak GL, Lorenzet IC, Santos LAD, Nardes EM, Santos FCD. Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale. EINSTEIN-SAO PAULO 2016; 14:152-7. [PMID: 27462888 PMCID: PMC4943348 DOI: 10.1590/s1679-45082016ao3628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese in demented elderly and to analyze its measurement properties. Methods We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver’s opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again. Results The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach’s alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated. Conclusion The Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese had adequate measuring properties for use with elderly presenting limited communication.
Collapse
Affiliation(s)
- Karol Bezerra Thé
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | |
Collapse
|
5
|
Fin de vie et démence dans les établissements d’hébergement pour personnes âgées dépendantes. MÉDECINE PALLIATIVE : SOINS DE SUPPORT - ACCOMPAGNEMENT - ÉTHIQUE 2015. [DOI: 10.1016/j.medpal.2015.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
6
|
van Dalen-Kok AH, Pieper MJC, de Waal MWM, Lukas A, Husebo BS, Achterberg WP. Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis. BMC Geriatr 2015; 15:49. [PMID: 25928621 PMCID: PMC4409739 DOI: 10.1186/s12877-015-0048-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/01/2015] [Indexed: 12/24/2022] Open
Abstract
Background Pain, neuropsychiatric symptoms (NPS) and functional impairment are prevalent in patients with dementia and pain is hypothesized to be causal in both neuropsychiatric symptoms (NPS) and functional impairment. As the exact nature of the associations is unknown, this review examines the strength of associations between pain and NPS, and pain and physical function in patients with dementia. Special attention is paid to the description of measurement instruments and the methods used to detect pain, NPS and physical function. Methods A systematic search was made in the databases of PubMed (Medline), Embase, Cochrane, Cinahl, PsychINFO, and Web of Science. Studies were included that described associations between pain and NPS and/or physical function in patients with moderate to severe dementia. Results The search yielded 22 articles describing 18 studies, including two longitudinal studies. Most evidence was found for the association between pain and depression, followed by the association between pain and agitation/aggression. The longitudinal studies reported no direct effects between pain and NPS but some indirect effects, e.g. pain through depression. Although some association was established between pain and NPS, and pain and physical function, the strength of associations was relatively weak. Interestingly, only three studies used an observer rating scale for pain-related behaviour. Conclusions Available evidence does not support strong associations between pain, NPS and physical function. This might be due to inadequate use or lack of rating scales to detect pain-related behaviour. These results show that the relationship between pain and NPS, as well as with physical function, is complicated and warrants additional longitudinal evaluation. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0048-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Annelore H van Dalen-Kok
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands.
| | - Marjoleine J C Pieper
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. .,Department of General Practice & Elderly Care Medicine, VU University Medical Centre Amsterdam, van der Boechorststraat 7, Amsterdam, BT, 1081, The Netherlands.
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands.
| | - Albert Lukas
- Malteser Hospital Bonn/Rhein-Sieg, Centre of Geriatric Medicine, Academic Hospital University of Bonn, Von-Hompesch-Straße 1, Bonn, 53123, Germany.
| | - Bettina S Husebo
- Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway. .,Stavanger University Hospital, Bergen, Norway.
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands.
| |
Collapse
|
7
|
Messinger-Rapport BJ, Gammack JK, Thomas DR, Morley JE. Clinical update on nursing home medicine: 2013. J Am Med Dir Assoc 2014; 14:860-76. [PMID: 24286710 DOI: 10.1016/j.jamda.2013.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 12/18/2022]
Abstract
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
Collapse
|
8
|
Pieper MJ, van Dalen-Kok AH, Francke AL, van der Steen JT, Scherder EJ, Husebø BS, Achterberg WP. Interventions targeting pain or behaviour in dementia: a systematic review. Ageing Res Rev 2013; 12:1042-55. [PMID: 23727161 DOI: 10.1016/j.arr.2013.05.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Both pain and challenging behaviour are highly prevalent in dementia, and multiple studies show that some of these behaviours may be correlated. Pain, especially in non-communicative patients, can cause challenging behaviour, and treatment of pain therefore may have an effect on behaviour. This review aims to provide a comprehensive overview of the current state of evidence regarding the effectiveness of interventions targeting pain on the outcome behaviour, and interventions targeting behaviour on pain, in dementia. METHOD PubMed (MEDLINE), EMBASE, COCHRANE, CINAHL, PsychINFO and Web of Science were searched systematically. Studies were included if they focused on an intervention targeting a reduction in the person's distress, pain, and/or behaviour, and included adults with a main diagnosis of dementia. RESULTS Of a total of 893 potentially relevant publications that were identified, 16 publications met the inclusion criteria and were eligible for further analysis; 6 studies focused on a pain intervention targeting behaviour, 1 study focused on a behavioural intervention targeting pain, and 9 studies focused on an intervention targeting both pain and behaviour. CONCLUSION Available evidence suggests that (pain) interventions targeting behaviour, and (behavioural) interventions targeting pain are effective in reducing pain and behavioural symptoms in dementia.
Collapse
|
9
|
|
10
|
|
11
|
Burfield AH, Wan TT, Sole ML, Cooper JW. A study of longitudinal data examining concomitance of pain and cognition in an elderly long-term care population. J Pain Res 2012; 5:61-70. [PMID: 22536093 PMCID: PMC3333796 DOI: 10.2147/jpr.s29655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine if a concomitant relationship exists between cognition and pain in an elderly population residing in long-term care. Background/significance Prior research has found that cognitive load mediates interpretation of a stimulus. In the presence of decreased cognitive capacity as with dementia, the relationship between cognition and increasing pain is unknown in the elderly. Patients and methods Longitudinal cohort design. Data collected from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) from the 2001–2003 annual assessments of nursing home residents. A covariance model was used to evaluate the relationship between cognition and pain at three intervals. Results The sample included 56,494 subjects from nursing homes across the United States, with an average age of 83 ± 8.2 years. Analysis of variance scores (ANOVAs) indicated a significant effect (P < 0.01) for pain and cognition, with protected t test revealing scores decreasing significantly with these two measures. Relative stability was found for pain and cognition over time. Greater stability was found in the cognitive measure than the pain measure. Cross-legged effects observed between cognition and pain measures were inconsistent. A concomitant relationship was not found between cognition and pain. Even though the relationship was significant at the 0.01 level, the correlations were low (r ≤ 0.08), indicating a weak association between cognition and pain. Conclusion Understanding the concomitance of pain and cognition aids in defining additional frameworks to extend models to include secondary needs, contextual factors, and resident outcomes. Cognitive decline, as with organic brain diseases, is progressive. Pain is a symptom that can be treated and reduced to improve resident quality of life. However, cognition can be used to determine the most appropriate method to assess pain in the elderly, thereby improving accuracy of pain detection in this population.
Collapse
Affiliation(s)
- Allison H Burfield
- Gerontology Program, School of Nursing, College of Health and Human Services, University of North Carolina, Charlotte, NC, USA
| | | | | | | |
Collapse
|
12
|
Morley JE. Dementia-Related Agitation. J Am Med Dir Assoc 2011; 12:611-612.e2. [DOI: 10.1016/j.jamda.2011.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 01/05/2023]
|
13
|
Desai AK, Grossberg GT. Palliative and end-of-life care in psychogeriatric patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rapidly growing number of elderly persons and their families are burdened by one or more terminal illnesses in the later years of their life. How best to support their quality of life is a major challenge for healthcare teams. Palliative and end-of-life (PEOL) care is well positioned to respond to this challenge. While the evidence of PEOL is just beginning, much of the suffering can be relieved by what is already known. PEOL care for the elderly needs to go beyond the focus on the patient and should rest on a broad understanding of the nature of suffering that includes family and professional caregivers in that experience of suffering. The dissemination of PEOL care principles should be a public health priority. This article aims to improve understanding of appropriate PEOL care in the elderly and discuss future perspectives.
Collapse
Affiliation(s)
- Abhilash K Desai
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1438 S. Grand Blvd, St Louis, MO 63104, USA
| | | |
Collapse
|
14
|
Abstract
With the advent of the graying of the baby boomers, there is an urgent need to enhance care in the nursing home. This article focuses on the areas where high-quality care can improve outcomes.
Collapse
Affiliation(s)
- Debbie Tolson
- Scottish Centre for Evidence Based Care of Older People, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, UK
| | | |
Collapse
|
15
|
Pieper MJC, Achterberg WP, Francke AL, van der Steen JT, Scherder EJA, Kovach CR. The implementation of the serial trial intervention for pain and challenging behaviour in advanced dementia patients (STA OP!): a clustered randomized controlled trial. BMC Geriatr 2011; 11:12. [PMID: 21435251 PMCID: PMC3072328 DOI: 10.1186/1471-2318-11-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 03/24/2011] [Indexed: 11/23/2022] Open
Abstract
Background Pain (physical discomfort) and challenging behaviour are highly prevalent in nursing home residents with dementia: at any given time 45-80% of nursing home residents are in pain and up to 80% have challenging behaviour. In the USA Christine Kovach developed the serial trial intervention (STI) and established that this protocol leads to less discomfort and fewer behavioural symptoms in moderate to severe dementia patients. The present study will provide insight into the effects of implementation of the Dutch version of the STI-protocol (STA OP!) in comparison with a control intervention, not only on behavioural symptoms, but also on pain, depression, and quality of life. This article outlines the study protocol. Methods/Design The study is a cluster randomized controlled trial in 168 older people (aged >65 years) with mild or moderate dementia living in nursing homes. The clusters, Dutch nursing homes, are randomly assigned to either the intervention condition (training and implementation of the STA OP!-protocol) or the control condition (general training focusing on challenging behaviour and pain, but without the step-wise approach). Measurements take place at baseline, after 3 months (end of the STA OP! training period) and after 6 months. Primary outcome measures are symptoms of challenging behaviour (measured with the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory-Nursing Home version (NPI-NH)), and pain (measure with the Dutch version of the Pain Assessment Checklist for Seniors (PACSLAC-D) and the Minimum Data Set of the Resident Assessment Instrument (MDS-RAI) pain scale). Secondary outcome measures include symptoms of depression (Cornell and MDS-RAI depression scale), Quality of Live (Qualidem), changes in prescriptions of analgesics and psychotropic drugs, and the use of non-pharmacological comfort interventions (e.g. snoezelen, reminiscence therapy). Discussion The transfer from the American design to the Dutch design involved several changes due to the different organisation of healthcare systems. Specific strengths and limitations of the study are discussed. Trial registration Netherlands Trial Register (NTR): NTR1967
Collapse
Affiliation(s)
- Marjoleine J C Pieper
- EMGO+ Institute for Health and Care Research, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.
Collapse
Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
| |
Collapse
|
17
|
Morley JE. Hypertension: Is It Overtreated in the Elderly? J Am Med Dir Assoc 2010; 11:147-52. [DOI: 10.1016/j.jamda.2009.12.081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 02/07/2023]
|
18
|
Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, Ljunggren AE. Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting. Scand J Caring Sci 2010; 24:380-91. [DOI: 10.1111/j.1471-6712.2009.00710.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Herr K, Bursch H, Ersek M, Miller LL, Swafford K. Use of Pain-Behavioral Assessment Tools in the Nursing Home: Expert Consensus Recommendations for Practice. J Gerontol Nurs 2010; 36:3-4. [DOI: 10.3928/00989134-20100108-04] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 10/05/2009] [Indexed: 01/08/2023]
|
20
|
Abstract
BACKGROUND Patients with dementia are often unable to describe their pain because of memory deficiency and speech problems. This may lead to under-diagnosing and suboptimal pain treatment. The article summarises a thesis on development and testing of a new instrument for pain assessment: Mobilisation-Observation-Behavior-Intensity-Dementia (MOBID-2) pain scale. MATERIAL AND METHODS 284 nursing home patients (with and without pain), who had been diagnosed with dementia of different types in various stages, were included in the study. Behaviour and intensity of pain was assessed during video-uptakes of clinical examinations and during regular morning care. Psychometric property testing included assessments of reliability, validity and clinical usefulness for the nursing home staff. RESULTS Observation of pain behaviour during standardised and guided movements, by using the MOBID-2 Pain Scale, provides reliable and valid estimation of intensity of pain associated with the musculoskeletal-system. Pain that is not associated with the musculoskeletal-system is frequently observed, but more challenging to assess. Patients who have severe dementia and/or a combination of Alzheimer's disease and vascular dementia, have a higher risk of suffering from severe and untreated pain than patients without dementia. INTERPRETATION The MOBID-2 pain scale may help to ensure competent pain treatment, and should be available in all Norwegian nursing homes. A multidisciplinary approach is needed for its implementation and use. Physicians in nursing homes should reconsider the staff's observations, perform additional investigations and find the balance between effects and side effects of pain treatment.
Collapse
|
21
|
Morley JE. Phronesis and the Medical Director. J Am Med Dir Assoc 2009; 10:149-52. [DOI: 10.1016/j.jamda.2008.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 12/15/2022]
|
22
|
|
23
|
Morley JE. Rapid Cycles (Continuous Quality Improvement), an Essential Part of the Medical Director's Role. J Am Med Dir Assoc 2008; 9:535-8. [DOI: 10.1016/j.jamda.2008.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
|