1
|
Centmayer R, Leiske M, Lahmann NA. Pain Prevalence and Pain Management in Nursing Home Residents With Cognitive Impairment. Results From Five Multicenter Cross-Sectional Surveys in Germany Between 2014 and 2018. Pain Manag Nurs 2024; 25:487-493. [PMID: 38853041 DOI: 10.1016/j.pmn.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 04/16/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Pain management depends on continuous pain assessment and a pain concept. In particular, pain assessment and treatment are major challenges for nursing home residents (NHR) with cognitive impairment (CI). Many caregivers often lack the knowledge to recognize and appropriately treat pain in this vulnerable group. Little is known about the proportion of NHR who are fundamentally dependent on external assessment for pain due to CI. OBJECTIVE The aim of the study was to determine pain prevalence and management among NHR with and without CI. A second objective was to determine the proportion of NHR who are dependent on external assessment for pain. METHODS Information on pain was collected from 3,437 NHR in multicenter cross-sectional surveys in 51 German nursing homes between 2014 and 2018. The presence of current pain in one-to-one interviews was determined as well as dependencies on third-party information, number of daily pain recordings, and administration of medication for pain. The analysis included a contingency table and log regression analyses. RESULTS Pain prevalence was 24.9% among NHR with severe CI and 40.4% among NHR without CI. Overall, 19.8% of all NHRs relied on a third-party assessment of pain. Significantly, NHR with severe CI were less likely to be classified as having pain (OR 0.51), to be assessed for pain several times a day (OR 0.53) or to receive pain medication (OR 0.55) compared with NHR without CI. No influence on pain management was shown for the type of pain assessment. CONCLUSIONS The study provides evidence of significant deficits in pain management among NHR with moderate and severe CI in nursing homes in Germany. NHR with moderate and severe CI are significantly less likely to be observed for pain or classified as pain sufferers and receive significantly less pain medication than NHR without CI. Intensive training of staff on pain management of NHR with severe CI is recommended.
Collapse
Affiliation(s)
- Rainer Centmayer
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Manfred Leiske
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Axel Lahmann
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
2
|
Robitaille A, Adams M, Heckman G, Norman M, Feldman S, Robert B, Hirdes JP. Pain in Canadian Long-Term Care Homes: A Call for Action. J Am Med Dir Assoc 2024; 25:105204. [PMID: 39142639 DOI: 10.1016/j.jamda.2024.105204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 08/16/2024]
Abstract
Navigating the evaluation and management of pain in long-term care homes is a complex task. Despite an extensive body of literature advocating for a paradigm shift in pain assessment and management within long-term care homes, much more remains to be done. The assessment of pain in long-term care is particularly challenging, given that a substantial proportion of residents live with some degree of cognitive impairment. Individuals living with dementia may encounter difficulties articulating the frequency and intensity of their pain, potentially resulting in an underestimation of their pain. In Canada and in the United States, the interRAI Minimum Data Set 2.0, Minimum Data Set 3.0, and the interRAI Long-Term Care Facilities assessments are administered to capture the presence and intensity of pain. These assessment instruments are used both on admission and quarterly, offering a reliable and validated method for comprehensive assessment. Nonetheless, the daily assessment and documentation of pain across long-term care homes, which is used to inform the interRAI Pain Scale, is not always consistent. The reality is that assessing pain can be inaccurate for several reasons, including the fact that it is rated by long-term care staff with diverse levels of expertise, resources, and education. This call for action explores the current approaches used in pain assessment and management within long-term care homes. The authors not only bring attention to the existing challenges but also emphasize the necessity of considering a more comprehensive assessment approach.
Collapse
Affiliation(s)
- Annie Robitaille
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, ON, Canada; Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Michaela Adams
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, ON, Canada
| | | | - Melissa Norman
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, ON, Canada
| | - Sid Feldman
- Baycrest Health Sciences, Toronto, ON, Canada; The Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Benoit Robert
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, ON, Canada
| | - John P Hirdes
- Faculty of Health, School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
3
|
Holmes A, Wang W, Chang YP. Psychosocial Phenotypes of Older Adults With Pain and Their Associated Clinical Outcomes. J Appl Gerontol 2024:7334648241281148. [PMID: 39226590 DOI: 10.1177/07334648241281148] [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: 09/05/2024] Open
Abstract
A comprehensive understanding of the patterns of psychosocial characteristics in older adults with pain is needed. Our objectives were to (1) identify psychosocial phenotypes (comprising depression, anxiety, affect, self-realization, resilience, and social participation) among older adults with pain and (2) compare pain characteristics, physical health, and cognition among the identified phenotypes. Using cross-sectional 2021 data from the National Health and Aging Trends Study, we performed latent class analysis to identify four psychosocial phenotypes of older adults with pain (N = 1903): Favorable (best psychosocial characteristics, 67.7%), Adverse (worst psychosocial characteristics, 4.9%), Intermediate (moderate scores on psychosocial variables, 12.6%), and Compensated (moderate scores with relatively high self-realization and resilience, 14.9%). Phenotypes with less psychosocial adversity had generally better clinical outcomes. Future research should explore precision pain management interventions in older adults based on their psychosocial phenotypes, longitudinal trajectories of phenotypes, and technology-based, point-of-care clinical insights for pain management.
Collapse
|
4
|
Nunes AP, Yuan Y, Baek J, Pawasauskas J, Hume AL, Liu SH, Lapane KL. Effectiveness of Short-Acting Opioid Escalation vs Initiation of a Long-Acting Opioid in Nursing Home Residents. J Am Med Dir Assoc 2024; 25:105077. [PMID: 38862100 PMCID: PMC11428099 DOI: 10.1016/j.jamda.2024.105077] [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: 02/12/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Modifications to opioid regimens for persistent pain are typically made after an initial period of short-acting opioid (SAO) use. Regimen changes may include an escalation of the SAO dosage or an initiation of a long-acting opioid (LAO) as a switch or add-on therapy. This study evaluates the comparative effectiveness between these alternative regimens in nursing home residents. DESIGN A retrospective observational cohort analysis of US long-stay nursing home residents. SETTING AND PARTICIPANTS Nursing home resident data were obtained from the national Minimum Dataset (MDS) version 3.0 and linked Medicare data, 2011-2016. METHODS Opioid regimen changes were identified using Part D dispensing claims to identify dosage escalation of SAOs, initiation of an LAO, or a switch to an LAO. Outcomes included indices of pain occurrence, frequency, and severity reported on the earliest MDS assessment within 3 months following the opioid regimen change. Resident attributes were described by opioid regimen cohort. Prevalence ratios of pain and depression indices were quantified using doubly robust inverse probability of treatment (IPT)-weighted log-binomial regression. RESULTS The study cohorts included 2072 SAO dose escalations, 575 LAO add-on initiations, and 247 LAO switch initiations. After IPT weighting, we observed comparable effects on pain and mood across the opioid regimen cohorts. A substantial number of residents continued to report frequent/constant pain (36% in SAO Escalation Cohort, 42% in LAO Add-on Cohort, 42% in the LAO Switch Cohort). The distribution of depressive symptoms was similar regardless of the opioid regimen change. CONCLUSIONS AND IMPLICATIONS Initiation of an LAO as an add-on to SAO or a switch from SAO had comparable effects on pain and mood to SAO dose escalation without initiation of an LAO. Although fewer residents reported any pain after the regimen change, persistent pain was reported by most residents.
Collapse
Affiliation(s)
- Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
| | - Yiyang Yuan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Jayne Pawasauskas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Anne L Hume
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA; Department of Family Medicine, Alpert Medical School, Brown University, Memorial Hospital of Rhode Island, Providence, RI, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| |
Collapse
|
5
|
Mills CA, Yeager VA, Unroe KT, Holmes A, Blackburn J. The impact of rural general hospital closures on communities-A systematic review of the literature. J Rural Health 2024; 40:238-248. [PMID: 37985431 DOI: 10.1111/jrh.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/30/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE To compile the literature on the effects of rural hospital closures on the community and summarize the evidence, specifically the health and economic impacts, and identify gaps for future research. METHODS A systematic review of the relevant peer-reviewed literature, published from January 2005 through December 2021, included in the EMBASE, CINAHL, PubMed, EconLit, and Business Source Complete databases, as well as "gray" literature published during the same time period. A total of 21 articles were identified for inclusion. FINDINGS Over 90% of the included studies were published in the last 8 years, with nearly three-fourths published in the last 4 years. The most common outcomes studied were economic outcomes and employment (76%), emergent, and non-emergent transportation, which includes transport miles and travel time (42.8%), access to and supply of health care providers (38%), and quality of patient outcomes (19%). Eighty-nine percent of the studies that examined economic impacts found unfavorable results, including decreased income, population, and community economic growth, and increased poverty. Between 11 and 15.7 additional minutes were required to transport patients to the nearest emergency facility after closures. A lack of consistency in measures and definition of rurality challenges comparability across studies. CONCLUSIONS The comprehensive impact of rural hospital closures on communities has not been well studied. Research shows predominantly negative economic outcomes as well as increased time and distance required to access health care services. Additional research and consistency in the outcome measures and definition of rurality is needed to characterize the downstream impact of rural hospital closures.
Collapse
Affiliation(s)
- Carol A Mills
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Valerie A Yeager
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| | - Kathleen T Unroe
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Ann Holmes
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| | - Justin Blackburn
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| |
Collapse
|
6
|
Shrestha S, Cummings G, Knopp-Sihota J, Devkota R, Hoben M. Factors influencing health-related quality of life among long-term care residents experiencing pain: a systematic review protocol. Syst Rev 2024; 13:49. [PMID: 38303055 PMCID: PMC10832087 DOI: 10.1186/s13643-024-02459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Pain is highly burdensome, affecting over 30% of long-term care (LTC) residents. Pain significantly reduces residents' health-related quality of life (HRQoL), limits their ability to perform activities of daily living (ADLs), restricts their social activities, and can lead to hopelessness, depression, and unnecessary healthcare costs. Although pain can generally be prevented or treated, eliminating pain may not always be possible, especially when residents have multiple chronic conditions. Therefore, improving the HRQoL of LTC residents with pain is a priority goal. Understanding factors influencing HRQoL of LTC residents with pain is imperative to designing and evaluating targeted interventions that complement pain management to improve residents' HRQoL. However, these factors are poorly understood, and we lack syntheses of available research on this topic. This systematic review protocol outlines the methods to identify, synthesize, and evaluate the available evidence on these factors. METHODS This mixed methods review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will systematically search Medline, EMBASE, PsycINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ProQuest Dissertation and Thesis Global from database inception. We will include primary studies and systematically conducted reviews without restrictions to language, publication date, and study design. We will also include gray literature (dissertation and reports) and search relevant reviews and reference lists of all included studies. Two reviewers will independently screen articles, conduct quality appraisal, and extract data. We will synthesize results thematically and conduct meta-analyses if statistical pooling is possible. Residents and family/friend caregivers will assist with interpreting the findings. DISCUSSION This proposed systematic review will address an important knowledge gap related to the available evidence on factors influencing HRQoL of LTC residents with pain. Findings will be crucial for researchers, LTC administrators, and policy makers in uncovering research needs and in planning, developing, and evaluating strategies in addition to and complementary with pain management to help improve HRQoL among LTC residents with pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023405425.
Collapse
Affiliation(s)
- Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Greta Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Health Disciplines, Athabasca University, Edmonton, Alberta, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Dowd LA, Hamada S, Hattori Y, Veal FC, Taguchi R, Sakata N, Jadczak AD, Visvanathan R, Koujiya E, Rajan M, Doube S, Suzuki A, Bernoth M, Rawson H, Maruoka H, Wood A, Wagner J, Hull DA, Katsuhisa M, Turner J, Liau SJ, Reeve E, Bell JS, Cross AJ. A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes. Age Ageing 2024; 53:afae024. [PMID: 38411410 PMCID: PMC10898334 DOI: 10.1093/ageing/afae024] [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: 07/20/2023] [Revised: 11/12/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes. AIMS To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals' perspectives on analgesic use. METHODS Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N = 550) in 2019 and four nursing homes in Tokyo (N = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing. RESULTS Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes. CONCLUSION Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference.
Collapse
Affiliation(s)
- Laura A Dowd
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Felicity C Veal
- Unit for Medication Outcomes Research & Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Reina Taguchi
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Heisei Medical Welfare Group Research Institute, Tokyo, Japan
| | - Agathe D Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Eriko Koujiya
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Madhu Rajan
- Royal Australian College of General Practitioners, Victoria, Australia
- Aged Care GP, Melbourne, Victoria, Australia
| | | | - Ai Suzuki
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Maree Bernoth
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
- Three Rivers Department of Rural Health, Wagga Wagga, New South Wales, Australia
- Murrumbidgee Primary Health Network Aged Care Consortium, Wagga Wagga, New South Wales, Australia
| | - Helen Rawson
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Hiroshi Maruoka
- Yokohama Aobanosato Geriatric Health Services Facility, Yokohama, Japan
| | - Amelia Wood
- Longridge Aged Care, Naracoorte, South Australia, Australia
| | - Jo Wagner
- Australian Nursing and Midwifery Federation (SA Branch), Adelaide, South Australia, Australia
| | - Dee-Anne Hull
- Southern Cross Care (SA, NT and VIC), Glenside, South Australia, Australia
| | - Mizuki Katsuhisa
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Justin Turner
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Centre de Recherche, Institue Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec city, Québec, Canada
| | - Shin J Liau
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Reeve
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia: Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| |
Collapse
|
8
|
Rankin L, Lindkvist M, Backman A, Sköldunger A, Lövheim H, Edvardsson D, Gustafsson M. Pharmacological treatment of pain in Swedish nursing homes: Prevalence and associations with cognitive impairment and depressive mood. Scand J Pain 2024; 24:sjpain-2024-0007. [PMID: 38887790 DOI: 10.1515/sjpain-2024-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Chronic pain is highly prevalent in nursing home residents and often occurs with depression as well as cognitive impairment, which can severely influence and limit the expression of pain. METHODS The present cross-sectional study aimed to estimate the prevalence of pain, depressive mood, and cognitive impairment in association with pharmacological treatment against pain and depressive symptoms among Swedish nursing home residents. RESULTS We found an overall pain prevalence of 52.8%, a prevalence of 63.1% for being in a depressive mood, and a prevalence of cognitive impairment of 68.3%. Among individuals assessed to have depressive mood, 60.5% were also assessed to have pain. The prevalence of pharmacological treatment for pain was 77.5 and 54.1% for antidepressants. Prescription of pharmacological treatment against pain was associated with reports of currently having pain, and paracetamol was the most prescribed drug. A higher cognitive function was associated with more filled prescriptions of drugs for neuropathic pain, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), which could indicate an undertreatment of pain in those cognitively impaired. CONCLUSION It is important to further explore the relationship between pain, depressive mood, and cognitive impairment in regard to pain management in nursing home residents.
Collapse
Affiliation(s)
- Linda Rankin
- Department of Medical and Translational Biology, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | | | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia; Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Maria Gustafsson
- Department of Medical and Translational Biology, Umeå University, Umeå, Sweden
| |
Collapse
|
9
|
Zhang X, Guan C, He J, Wang J. Barriers and facilitators to dementia care in long-term care facilities: protocol for a qualitative systematic review and meta-synthesis. BMJ Open 2023; 13:e076058. [PMID: 37914310 PMCID: PMC10626821 DOI: 10.1136/bmjopen-2023-076058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Long-term care needs for people with dementia are predicted to increase due to increased life expectancy and dementia diagnoses. Most published meta- syntheses of dementia care focus on hospitals or home settings. When focusing on long-term care facilities, most reviews about dementia care only focus on a single outcome, such as feeding, behavioural symptoms management, palliative care and others, which is limited. The present study aims to synthesise qualitative data and examine barriers and facilitators to caring for people with dementia in long-term care facilities. METHODS AND ANALYSIS This is the protocol for our systematic review and meta-synthesis, which describes the design of this study, and we plan to complete the study from October 2023 to November 2024. The systematic review and meta-synthesis will follow the Joanna Briggs Institute (JBI) guidance for systematic reviews of qualitative evidence. Nine databases (five English and four Chinese) were searched, including Embase, Web of Science, Medline, CINAHL, PsycINFO and Wan Fang Data, China National Knowledge Infrastructure, VIP and Chinese Biomedical Medicine, from inception to August 2023. Qualitative and mixed-approach research about barriers and facilitators to caring for people with dementia in long-term care facilities, which are reported in English or Chinese, will be included. Covidence software will help with study selection, assessment and data extraction. The JBI Critical Appraisal Checklist for Qualitative Research (2020) will be used for included studies' quality assessment. Data extraction will be based on the JBI Qualitative Assessment and Review Instrument Data Extraction Tool for Qualitative Research. The JBI aggregation approach will be used to synthesise data. We will use the JBI ConQual tool to assess the credibility and dependability of each synthesised finding to establish confidence in the synthesised findings. All review steps will be managed by two reviewers independently, and disparities will be discussed. If consensus cannot reach a resolution, a third reviewer will be consulted. ETHICS AND DISSEMINATION The present study is a secondary analysis of published qualitative data. So ethical approval is not required. The findings may be disseminated through peer-reviewed publications, conference papers or elsewhere. PROSPERO REGISTRATION NUMBER The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in May 2022, and the registration number is CRD42022326178.
Collapse
Affiliation(s)
- Xi Zhang
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chengguo Guan
- School of Nursing, The Open University of Shaanxi, Xi'an, Shaanxi, China
| | - Jinjie He
- School of Economics and Management, Xi'an University, Xi'an, Shaanxi, China
| | - Jing Wang
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| |
Collapse
|
10
|
Hoben M, Hogan DB, Poss JW, Gruneir A, McGrail K, Griffith LE, Chamberlain SA, Estabrooks CA, Maxwell CJ. Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:3467-3479. [PMID: 37428008 DOI: 10.1111/jgs.18499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/22/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. METHODS This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic. RESULTS Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222). CONCLUSIONS QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.
Collapse
Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
11
|
Cole CS, Blackburn J, Carpenter JS, Chen CX, Hickman SE. Pain and Associated Factors in Nursing Home Residents. Pain Manag Nurs 2023; 24:384-392. [PMID: 37003932 PMCID: PMC10440293 DOI: 10.1016/j.pmn.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Understanding factors associated with risk of pain allows residents and clinicians to plan care and set priorities, however, factors associated with pain in nursing home residents has not been conclusively studied. AIM To evaluate the association between pain and nursing home (NH) resident demographic and clinical characteristics. DESIGN Retrospective analysis of Minimum Data Set 3.0 records of nursing home residents residing in 44 Indiana NHs between September 27, 2011 and December 27, 2019 (N = 9,060). RESULTS Pain prevalence in this sample of NH residents was 23.7%. Of those with pain, 28.0% experienced moderate to severe/frequent pain and 54.6% experienced persistent pain. Risk factors for moderate to severe/frequent pain include female sex; living in a rural setting; intact, mildly, or moderately impaired cognition; arthritis; contracture; anxiety; and depression. In contrast, stroke and Alzheimer's disease and Alzheimer's-disease related dementias (AD/ADRD) were associated with decreased risk of reporting moderate to severe/frequent pain, likely representing both the under-assessment and under-reporting of pain among cognitively impaired NH residents. Risk factors for persistent pain included age <70, Black race, living in a rural location, intact cognition, contracture, and depression. CONCLUSIONS Pain remains a pressing problem for NH residents. In this study, we identified demographic and clinical factors associated with moderate to severe frequent pain and persistent pain. Residents with a diagnosis of AD/ADRD were less likely to report pain, likely representing the difficulty of evaluating pain in these residents. It is important to note that those with cognitive impairment may not experience any less pain, but assessment and reporting difficulties may make them appear to have less pain. Knowledge of factors associated with pain for NH residents has the potential for improving the ability to predict, prevent, and provide better pain care in NH residents.
Collapse
Affiliation(s)
- Connie S Cole
- School of Nursing, Indiana University, Indianapolis, Indiana; School of Medicine, University of Colorado, Aurora, Colorado; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana.
| | - Justin Blackburn
- Richard Fairbanks School of Public Health, Indiana University Purdue University, Indianapolis, Indiana
| | | | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, Indiana
| | - Susan E Hickman
- School of Nursing, Indiana University, Indianapolis, Indiana; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana
| |
Collapse
|
12
|
Cole CS, Carpenter JS, Blackburn J, Chen CX, Jones BL, Hickman SE. Pain trajectories of nursing home residents. J Am Geriatr Soc 2023; 71:1188-1197. [PMID: 36508731 PMCID: PMC10089959 DOI: 10.1111/jgs.18182] [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: 08/11/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding changes in nursing home (NH) resident pain over time would provide a more informed perspective, allowing opportunities to alter the course of illness, plan care, and set priorities. Therefore, the purpose of this analysis was to identify and characterize clinically meaningful, dynamic pain trajectories in NH residents. METHODS Retrospective longitudinal analysis of NH resident pain scores with a length of stay >100 days (N = 4864). Group-based trajectory modeling was applied to Minimum Data Set 3.0 assessments to identify pain trajectories. Trajectories were then characterized using unadjusted and adjusted cross-sectional associations between residents' demographic and clinical characteristics and their pain trajectory. RESULTS We identified four distinct trajectories: (1) consistent pain absence (48.9%), (2) decreasing-increasing pain presence (21.8%), (3) increasing-decreasing pain presence (15.3%), and (4) persistent pain presence (14.0%). Demographics of younger age and living in a rural area were associated with the persistent pain presence trajectory. Clinical variables of obesity and intact cognition were associated with being in the persistent pain presence trajectory. A smaller proportion of residents with moderately or severely impaired cognition were in any of the trajectory groups with pain. CONCLUSIONS We identified and characterized four pain trajectories among NH residents, including persistent pain presence which was associated with demographic characteristics (younger, female, rural) and clinical factors (obese, fracture, contracture). Moreover, residents with a diagnosis of Alzheimer's disease or dementia were less likely to be in any of the three trajectories with pain, likely representing the difficulty in evaluating pain in these residents. It is important that NH staff understand, recognize, and respond to the factors associated with the identified pain trajectories to improve mitigation of potentially persistent pain (e.g., hip fracture, contracture) or improve proxy pain assessment skills for residents at risk for under reporting of pain (e.g., Alzheimer's Disease).
Collapse
Affiliation(s)
- Connie S. Cole
- School of Nursing, Indiana University, Indianapolis, Indiana
- School of Medicine, University of Colorado Anschutz, Aurora, Colorado
- RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana
| | | | - Justin Blackburn
- Richard Fairbanks School of Public Health, Indiana University Purdue University, Indianapolis, Indiana
| | - Chen X. Chen
- School of Nursing, Indiana University, Indianapolis, Indiana
| | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan E. Hickman
- School of Nursing, Indiana University, Indianapolis, Indiana
- RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana
| |
Collapse
|