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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).
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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
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Kuske S, Moschinski K, Andrich S, Stephan A, Gnass I, Sirsch E, Icks A. Drug-based pain management in people with dementia after hip or pelvic fractures: a systematic review protocol. Syst Rev 2016; 5:113. [PMID: 27412448 PMCID: PMC4944510 DOI: 10.1186/s13643-016-0296-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies show 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 and how drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review is to identify studies addressing drug-based pain management for people with dementia who have had a hip or pelvic fracture for which they had either an operation or conservative treatment. We will analyse to what extent and how the drug-based pain treatment for people with dementia is performed across all settings and how it is assessed in the studies. METHODS The development of this systematic review protocol was guided by the PRISMA-P requirements, which will be taken into consideration during the review procedure. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect will be searched, using keywords such as "analgesia", "dementia", "cognitive impairment", "pain treatment", "hip fracture" or "pelvic fracture". Publications published up to January 2016 will be included. The data extraction and a content analysis will be carried out systematically, followed by a critical appraisal. DISCUSSION This review will provide a valuable overview on the current evidence on drug-based pain management for PwD in all settings who were conservatively treated after a hip or pelvic fracture. The review may expose a need to enhance pain management for PwD. It may also provide motivation for healthcare providers and policymakers to give this topic their attention and to facilitate further research by considering aspects of care transitions in all settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016037309.
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Affiliation(s)
- S Kuske
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany. .,Paul Langerhans Group for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich-Heine-University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany. .,Fliedner Fachhochschule, University of Applied Sciences, Geschwister-Aufricht-Straße 9, 40489, Düsseldorf, Germany.
| | - K Moschinski
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - S Andrich
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Paul Langerhans Group for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich-Heine-University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - A Stephan
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Department of Nursing, RWTH Aachen University Hospital, 52074, Aachen, Germany
| | - I Gnass
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Institute of Nursing Science and Education, Paracelsus Medicine University, Salzburg, Austria
| | - E Sirsch
- Faculty of Nursing Science, Vallendar Philisophic-Theological College, Palottistraße 3, 56179, Vallendar, Germany
| | - A Icks
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Paul Langerhans Group for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich-Heine-University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.,German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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Abstract
Recent literature demonstrates that pain in patients with dementia is often undertreated. This can partially be explained by a lack of training in the possibilities of assessing pain in patients with dementia. Subjective reports are the most valid approach for the assessment of the subjective experience of pain and should therefore be preferred over other methods. The assessment of the context, behavior, and physiological markers is advised if the patient is unable to provide a subjective report. Pain assessment scales are useful for documentation and monitoring.
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Lautenbacher S, Kunz M, Mylius V, Scharmann S, Hemmeter U, Schepelmann K. Mehrdimensionale Schmerzmessung bei Demenzpatienten. Schmerz 2007; 21:529-38. [PMID: 17522898 DOI: 10.1007/s00482-007-0545-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is well known that patients with dementia complain less about pain and receive fewer analgesics than other patients. The question arises of whether disorders associated with dementia change the processing of pain. METHODS A total of 20 patients with dementia and 40 patients with mild cognitive impairment (MCI) as well as 40 healthy control subjects were investigated for their subjective (category scale), facial (FACS) and motor (R-III reflex) pain responses to mechanical and electrical stimuli. RESULTS Patients with dementia did not rate the intensity of the stimuli differently; however, they were less frequently capable of providing ratings. At equal levels of stimulus intensity, demented patients showed stronger facial responses. The R-III reflex thresholds were lowered in demented patients. MCI patients appeared only slightly changed. CONCLUSIONS Our findings suggest that the processing of acute noxious stimuli is intensified in patients with dementia. Against the background of a reduced prescription of analgesics, an under-treatment of pain in patients with dementia might be the consequence.
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Affiliation(s)
- S Lautenbacher
- Physiologische Psychologie, Otto-Friedrich-Universität Bamberg, Markusplatz 3, 96045 Bamberg, Deutschland.
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