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Liu HY, Wang HP, Seak CJ, Wu CC, Hsu YH, Lee SH, Lin YE, Wang YT, Shyu YIL. Influences of Cognitive Function and Depressive Symptoms on Pain Trajectories During the First Year Following Hip Fracture Surgery: A Prospective Cohort Study. J Am Med Dir Assoc 2024; 25:104-111. [PMID: 37926427 DOI: 10.1016/j.jamda.2023.09.030] [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: 12/27/2022] [Revised: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The purposes of this study were to explore trajectories for patterns of postoperative pain intensity during the first year following hip fracture surgery and the relationships between pain trajectory groups, cognitive impairment, and depressive symptoms. DESIGN A prospective cohort correlational study. SETTING AND PARTICIPANTS A total of 325 patients aged 60 years or older who had received hip fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020. METHODS Data were collected before hospital discharge and at 1, 3, 6, and 12 months postdischarge. Pain intensity was measured using a numeric rating scale; cognitive function was measured with the Taiwan version of the Mini-Mental State Examination; and depressive symptoms were measured by the Geriatric Depression Scale-Short Form. Patients with similar postoperative pain trajectories were categorized into groups and compared with group-based trajectory modeling. Cognitive impairment and depressive symptoms associated with each group were identified by logistic regression. RESULTS Three different pain trajectory groups were identified: drastic decline-minimum pain (47.7%), gentle decline-mild pain (45.5%), and slight decline-moderate pain (6.8%). Patients with cognitive impairment [odds ratio (OR) 11.01, 95% CI 2.99-10.51] and at risk for depression (OR 49.09, 95% CI 10.46-230.30) were more likely to be in the moderate pain group than the minimum pain group. Patients with cognitive impairment (OR 2.07, 95% CI 1.25-3.42) were more likely to be in the mild pain group than the minimum pain group. Patients at risk for depression (OR 9.68, 95% CI 3.16-29.63) were more likely to be in the moderate pain group than the mild pain group. CONCLUSIONS AND IMPLICATIONS Identifying postoperative pain trajectories can provide insight into the most appropriate pain management for older persons following hip fracture surgery. Attention should focus on assessments for cognitive impairment and risk of depression to prevent persistent postoperative pain. Future studies of older patients with clinically diagnosed cognitive impairment and depression are suggested.
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Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Ping Wang
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; Center for Quality Management, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chi-Chuan Wu
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yi-Ting Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Neurology, Dementia Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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Marchesi N, Fahmideh F, Pascale A, Allegri M, Govoni S. Neuropathic Pain in Aged People: An Unresolved Issue Open to Novel Drug Approaches, Focusing on Painful Diabetic Neuropathy. Curr Neuropharmacol 2024; 22:53-64. [PMID: 37550909 DOI: 10.2174/1570159x21666230807103642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/17/2023] [Accepted: 03/15/2023] [Indexed: 08/09/2023] Open
Abstract
A majority of older patients suffer from neuropathic pain (NP) that significantly alters their daily activities and imposes a significant burden on health care. Multiple comorbidities and the risk of polypharmacy in the elderly make it challenging to determine the appropriate drug, dosage, and maintenance of therapy. Age-dependent processes play a contributing role in neuropathy given that diabetic neuropathy (DN) is the most common form of neuropathy. This narrative review is mainly focused on the drug treatment approach for neuropathy-associated pain in aged people including both drugs and dietary supplements, considering the latter as add-on mechanism-based treatments to increase the effectiveness of usual treatments by implementing their activity or activating other analgesic pathways. On one hand, the limited clinical studies assessing the effectiveness and the adverse effects of existing pain management options in this age segment of the population (> 65), on the other hand, the expanding global demographics of the elderly contribute to building up an unresolved pain management problem that needs the attention of healthcare providers, researchers, and health authorities as well as the expansion of the current therapeutic options.
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Affiliation(s)
- Nicoletta Marchesi
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Foroogh Fahmideh
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Alessia Pascale
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Massimo Allegri
- Ensemble Hospitalier de la Cote - Centre Lemanique d'antalgie et Neuromodulation, Morges, Switzerland
| | - Stefano Govoni
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
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Wu SH, Lin CF, Lu IC, Yeh MS, Hsu CC, Yang YH. Association between pain and cognitive and daily functional impairment in older institutional residents: a cross-sectional study. BMC Geriatr 2023; 23:756. [PMID: 37980463 PMCID: PMC10657596 DOI: 10.1186/s12877-023-04337-8] [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: 11/02/2021] [Accepted: 09/20/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Pain is often neglected in disabled older population, especially in Taiwan where the population of institutional residents is rapidly growing. Our study aimed to investigate pain prevalence and associated factors among institutional residents to improve pain assessment and management. METHODS This nationwide study recruited 5,746 institutional residents in Taiwan between July 2019 and February 2020. Patient self-report was considered the most valid and reliable indicator of pain. A 5-point verbal rating scale was used to measure pain intensity, with a score ranging from 2 to 5 indicating the presence of pain. Associated factors with pain, including comorbidities, functional dependence, and quality of life, were also assessed. RESULTS The mean age of the residents was 77.1 ± 13.4 years, with 63.1% of them aged over 75 years. Overall, 40.3% of the residents reported pain, of whom 51.2% had moderate to severe pain. Pain was more common in residents with comorbidities and significantly impacted emotions and behavior problems, and the mean EQ5D score, which is a measure of health-related quality of life (p < .001). Interestingly, pain was only related to instrumental activities of daily living (IADL) and not activities of daily living (ADL). On the other hand, dementia was significantly negatively associated with pain (p < .001), with an estimated odds of 0.63 times (95% CI: 0.53-0.75) for the presence of pain when compared to residents who did not have dementia. CONCLUSIONS Unmanaged pain is common among institutional residents and is associated with comorbidities, IADL, emotional/behavioral problems, and health-related quality of life. Older residents may have lower odds of reporting pain due to difficulty communicating their pain, even through the use of a simple 5-point verbal rating scale. Therefore, more attention and effort should be directed towards improving pain evaluation in this vulnerable population .
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Affiliation(s)
- Sheng-Hua Wu
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Fen Lin
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
| | - I-Cheng Lu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Kaohsiung, Taiwan
| | - Ming-Sung Yeh
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chin-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan.
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.
- Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, No. 68, Jhonghua 3Rd Road, Cianjin District, Kaohsiung, 80145, Taiwan.
- Post Baccalaureat Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Song Y, Bolt S, Thorne T, Norton P, Poss J, Fu F, Squires J, Cummings G, Estabrooks CA. Nursing assistants' use of best practices and pain in older adults living in nursing homes. J Am Geriatr Soc 2023; 71:3413-3423. [PMID: 37565426 DOI: 10.1111/jgs.18527] [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: 10/26/2022] [Revised: 06/15/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Inadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels. METHODS We performed a cross-sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument-Minimum Data Set [RAI-MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI-MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self-report scales and aggregated to the unit level. Two-level random-intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home. RESULTS Of the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01-1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents. CONCLUSIONS We observed that higher unit-level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Sascha Bolt
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Jeff Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Fangfang Fu
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Greta Cummings
- College of Health Sciences, University of Alberta, Edmonton, Canada
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Dowd LA, Cross AJ, Liau SJ, Jadczak AD, Visvanathan R, Veal FC, Bell JS. Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services. Drugs Aging 2023; 40:449-459. [PMID: 37147416 DOI: 10.1007/s40266-023-01025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). OBJECTIVE The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. METHODS Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. RESULTS Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20-2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12-2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29-0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. CONCLUSIONS Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions.
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Affiliation(s)
- Laura A Dowd
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Shin J Liau
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Agathe D Jadczak
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Felicity C Veal
- Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
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Coll AM, Jones R. Pain assessment and management for people with dementia in the community. Nurs Stand 2023; 38:64-68. [PMID: 36843353 DOI: 10.7748/ns.2023.e12091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/28/2023]
Abstract
People with dementia commonly experience pain, but it is often unrecognised, unrelieved and remains an underlying issue as the condition progresses. As a result, pain management for people with dementia is inadequate. Community nurses have a fundamental role in the assessment and management of pain and in supporting family carers. This article details the causes and effects of pain in people with dementia, explains the components of a holistic approach to individualised pain assessment, and describes various pharmacological and non-pharmacological interventions that can be used to manage pain in this population.
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Affiliation(s)
- Anne-Marie Coll
- Faculty of Life Science and Education, University of South Wales, Pontypridd, Wales
| | - Rebecca Jones
- District Nursing Service, Cwm Taf Morgannwg University Health Board, Bridgend, Wales
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Liao YJ, Jao YL, Berish D, Hin AS, Wangi K, Kitko L, Mogle J, Boltz M. A Systematic Review of Barriers and Facilitators of Pain Management in Persons with Dementia. THE JOURNAL OF PAIN 2023; 24:730-741. [PMID: 36634886 DOI: 10.1016/j.jpain.2022.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/07/2022] [Accepted: 12/24/2022] [Indexed: 01/10/2023]
Abstract
Approximately 50% of persons living with dementia experience pain, yet it is frequently undetected and inadequately managed resulting in adverse consequences. This review aims to synthesize evidence on the barriers and facilitators of pain management in persons living with dementia. PubMed, CINAHL, PsycINFO, and Web of Science datasets were used for article searching. Inclusion criteria were peer-reviewed original articles written in English that examined the barriers and facilitators of pain management for persons living with dementia. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. A total of 26 studies were selected, including 18 qualitative and 3 quantitative (all high quality), as well as 5 mixed methods studies (low-to-high quality). Results were categorized into intrapersonal, interpersonal, environmental, and policy categories. Factors that impact pain management in dementia include cognitive and functional impairment, healthcare workers' knowledge, collaboration and communication, healthcare workers' understanding of patients' baseline behaviors, observation of behaviors, pain assessment tool use, pain management consistency, staffing level, pain guideline/policy, and training. Overall, pain management is challenging in persons living with dementia. The results indicate that there is a need for multi-component interventions that involves multidisciplinary teams to improve pain management in persons living with dementia at the intrapersonal, interpersonal, environmental, and policy levels. PERSPECTIVES: This review systematically synthesized barriers and facilitators of providing pain management in persons living with dementia. Results were presented in intrapersonal, interpersonal, environmental, and policy categories and suggests that multicomponent interventions involving multidisciplinary teams are needed to systematically improve pain management in persons living with dementia.
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Affiliation(s)
- Yo-Jen Liao
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania.
| | - Ying-Ling Jao
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Diane Berish
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Angelina Seda Hin
- Pennsylvania State University, College of Health and Human Development, University Park, Pennsylvania
| | - Karolus Wangi
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Lisa Kitko
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
| | - Jacqueline Mogle
- Clemson University, Department of Psychology, Clemson, South Carolina
| | - Marie Boltz
- Pennsylvania State University, Nese College of Nursing, University Park, Pennsylvania
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Spichiger F, Volken T, Bosshard G, Zigan N, Blanc G, Büscher A, Nagl-Cupal M, Bernard M, Rubli Truchard E, Larkin P, Koppitz A. Pain Interventions for people with dementia: a quasi-experimental study. BMC Palliat Care 2022; 21:228. [PMID: 36581883 PMCID: PMC9798691 DOI: 10.1186/s12904-022-01118-9] [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] [Received: 06/15/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. METHODS Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. RESULTS We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. CONCLUSION This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. TRIAL REGISTRATION The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726).
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Affiliation(s)
- Frank Spichiger
- HES-SO, School of Health Sciences Fribourg, Institute of Applied Health Research, Route des Arsenaux 16a, 1700 Fribourg, Switzerland ,grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Institute of Higher Education and Research in Healthcare, Route de la Corniche 10, Lausanne, 1010 Switzerland
| | - Thomas Volken
- grid.19739.350000000122291644ZHAW School of Health Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland
| | - Georg Bosshard
- Alters- und Pflegezentrum Bruggwiesen, Märtplatz 19, 8307 Effretikon, Switzerland
| | - Nicole Zigan
- grid.19739.350000000122291644ZHAW School of Health Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland
| | - Geneviève Blanc
- Berner Bildungszentrum Pflege, Freiburgstrasse 133, 3008 Bern, Switzerland
| | - Andreas Büscher
- grid.434095.f0000 0001 1864 9826Osnabrück University of Applied Sciences, Faculty of Business Management and Social Sciences, Caprivistraße 30A, 49076 Osnabrück, Germany
| | - Martin Nagl-Cupal
- grid.10420.370000 0001 2286 1424University of Vienna, Institute of Nursing Science, Alser Strasse 23, 1080 Vienna, Austria
| | - Mathieu Bernard
- grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Palliative and Supportive Care Service, Avenue Pierre-Decker 5, 1011 Lausanne, Switzerland
| | - Eve Rubli Truchard
- grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Palliative and Supportive Care Service, Avenue Pierre-Decker 5, 1011 Lausanne, Switzerland ,grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Service of Geriatric Medicine and Geriatric Rehabilitation, Avenue Pierr-Decker 5, 1011 Lausanne, Switzerland
| | - Philip Larkin
- grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Institute of Higher Education and Research in Healthcare, Route de la Corniche 10, Lausanne, 1010 Switzerland ,grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Palliative and Supportive Care Service, Avenue Pierre-Decker 5, 1011 Lausanne, Switzerland
| | - Andrea Koppitz
- HES-SO, School of Health Sciences Fribourg, Institute of Applied Health Research, Route des Arsenaux 16a, 1700 Fribourg, Switzerland
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Tsai YIP, Browne G, Inder KJ. Documented nursing practices of pain assessment and management when communicating about pain in dementia care. J Adv Nurs 2022; 78:3174-3186. [PMID: 35436007 PMCID: PMC9545301 DOI: 10.1111/jan.15251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/16/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate nurses' documented practice when communicating about pain for people with dementia in hospital. DESIGN Retrospective medical record review. METHOD Medical records were retrieved from four inpatient units in a district and a tertiary teaching hospital of people aged 65 years and over with documented dementia. Data were extracted on nurses' documented pain assessment and management. Pain frequency and association between patient self-report, pain scores, cognition levels and analgesics used during hospitalization were analysed using descriptive and inferential statistics. Multivariate regression examined patient characteristics, pain characteristics and length of hospital stay. RESULTS One-hundred patient records met the inclusion criteria between 1 January and 31 August 2017. Sixty-six percent of patients with dementia had pain documented at least once during hospitalization with 58% reported as moderate to severe pain intensity. Patients' pain severity during admission was associated with their length of hospital stay. Ninety-three percent of nurses used a self-reporting pain tool and 7% used an observational pain tool. Pain scores were not associated with patients' cognition level, nurses' pain reports or analgesic management. CONCLUSION Pain frequently occurs in people with dementia during hospitalization. Fragmented pain reporting influences the translation of pain messages. Disproportionate pain tool application and non-association between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical use of pain tools and practice gap between pain assessment and management in dementia care. IMPACT Pain was regularly assessed by nurses and implemented as a fifth vital sign for people with dementia in hospitals. However, the high frequency of pain affects care outcomes. Areas for improvement include nursing practice of pain assessment and management in dementia care in hospitals. Further understanding of the usefulness of pain tools and the efficacy of pain scores when communicating about pain in dementia care in hospitals is required.
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Affiliation(s)
- Yvette I-Pei Tsai
- School of Nursing & Midwifery, University of Newcastle, Newcastle, Australia
| | - Graeme Browne
- School of Nursing & Midwifery, University of Newcastle, Newcastle, Australia
| | - Kerry Jill Inder
- School of Nursing & Midwifery, University of Newcastle, Newcastle, Australia
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Effect of Auricular Acupressure on Acute Pain in Nursing Home Residents with Mild Dementia: A Single-Blind, Randomized, Sham-Controlled Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6406383. [PMID: 35310034 PMCID: PMC8930222 DOI: 10.1155/2022/6406383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/29/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022]
Abstract
Introduction Acute pain is a prevalent problem for dementia residents in nursing homes. A variety of intervention strategies have been applied to address this problem. However, there remains an issue of inadequate pain control. This study aims to explore the analgesic efficacy of auricular acupressure (AA) for dementia residents with acute pain in nursing homes. Methods A multicenter, single-blind, randomized, and sham-controlled clinical trial was performed in three nursing homes in Yinchuan, China. All of the 206 eligible patients with acute pain were randomly divided into two groups for real AA therapy or sham AA (at sham point stimulation) therapy. The primary outcome was measured with a face pain scale revised (FPS-R) score before the procedure, 5 min after the start of the intervention, and 5 min after finishing the procedure. Secondary outcomes covered three physiological parameters, adverse reactions observed, satisfaction level of caregivers, acceptance of patients, and additional use of analgesics. Results There was a significant difference in pain scores based on FPS-R between the two groups (p < 0.01). Pain score in the true AA group was 1.84 ± 0.23, compared with 2.22 ± 0.81 in the sham AA group. No adverse events were found during the whole procedure for all patients. The satisfaction level of caregivers and acceptance of patients in the real AA group were significantly higher than those in the sham AA group. Conclusion This study shows that real AA was an alternative analgesic modality in reducing acute pain in patients with mild dementia.
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Vaughan CL, Bruno V. What neurologists wish palliative care physicians knew. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:93-104. [PMID: 36055723 DOI: 10.1016/b978-0-323-85029-2.00005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the incidence of neurologic (particularly neurodegenerative) diseases continues to rise, so too will the palliative needs in this patient population. To appropriately care for these patients and families, neurologists and palliative care providers will need to strengthen collaboration. Palliative care providers not formally trained in neurology may feel ill-equipped to manage some of the distinct neuropalliative care needs of these patients. Here, we provide insights into the unique characteristics of patients with neurologic disease and emphasize the relevance of the palliative care skillset in this population to aid the collaboration between palliative care providers and neurologists.
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Affiliation(s)
- Christina L Vaughan
- Department of Neurology and Medicine, Anschutz Medical Center, University of Colorado, Aurora, CO, United States; Department of Neurology, VA Eastern Colorado Health System, Aurora, CO, United States.
| | - Veronica Bruno
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Dowd LA, Cross AJ, Veal F, Ooi CE, Bell JS. A Systematic Review of Interventions to Improve Analgesic Use and Appropriateness in Long-Term Care Facilities. J Am Med Dir Assoc 2021; 23:33-43.e3. [PMID: 34710365 DOI: 10.1016/j.jamda.2021.09.024] [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: 06/22/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To systematically review the effectiveness of interventions to improve analgesic use and appropriateness in long-term care facilities (LTCFs). DESIGN Systematic review. SETTING AND PARTICIPANTS MEDLINE, Embase, PsycINFO, and CINAHL Plus were searched from inception to June 2021. Randomized controlled trials (RCTs), controlled and uncontrolled prospective interventions that included analgesic optimization, and reported postintervention change in analgesic use or appropriateness in LTCFs were included. METHODS Screening, data extraction, and quality assessment were performed independently by 2 review authors. RESULTS Eight cluster RCTs, 2 controlled, and 6 uncontrolled studies comprising 9056 residents across 9 countries were included. The 16 interventions included education (n = 13), decision support (n = 7), system modifications (n = 6), and/or medication review (n = 3). Six interventions changed analgesic use or appropriateness, all of which included prescribers, 5 involved multidisciplinary collaboration, and 5 included a component of education. Education alone changed analgesic use and appropriateness in 1 study. Decision support was effective when combined with education in 3 interventions. Overall, 13 studies reported analgesic optimization as part of pain management interventions and 3 studies focused on medication optimization. Two pain management interventions reduced the percentage of residents reporting pain not receiving analgesics by 50% to 60% (P = .03 and P < .001, respectively), and 1 improved analgesic appropriateness (P = .03). One reduced nonsteroidal anti-inflammatory drugs (NSAIDs) (P < .001) and another resulted in 3-fold higher odds of opioid prescription in advanced dementia [95% confidence interval (CI) 1.1-8.7]. One medication optimization intervention reduced NSAID prescription (P = .036), and another reduced as-needed opioid (95% CI 8.6-13.8) and NSAID prescription (95% CI 1.6-4.2). CONCLUSIONS AND IMPLICATIONS Interventions involving prescribers and enhanced roles for pharmacists and nurses, with a component of education, are most effective at changing analgesic use or appropriateness. Interventions combining education and decision support are also promising. Medication review interventions can change analgesic prescription, although there is currently minimal evidence in relation to possible corresponding improvements in resident-related outcomes.
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Affiliation(s)
- Laura A Dowd
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.
| | - Amanda J Cross
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Felicity Veal
- Unit for Medication Outcomes Research & Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia
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Felton N, Lewis JS, Cockburn SJ, Hodgson M, Dawson S. Pain Assessment for Individuals with Advanced Dementia in Care Homes: A Systematic Review. Geriatrics (Basel) 2021; 6:geriatrics6040101. [PMID: 34698157 PMCID: PMC8544573 DOI: 10.3390/geriatrics6040101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Pain is prevalent in older people, especially in those with advanced dementia who have communication impairments. Although pain is recognised to be present in this population, it is often under-assessed and ineffectively managed. The assessment of pain in advanced dementia is extremely challenging and complex, particularly in institutional settings such as care homes. This study systematically reviews the literature to examine and characterise the evidence for the use of pain assessment tools in care homes with individuals living with advanced dementia. Relevant publications were sourced from electronic bibliometric medical databases including AMED, CINAHL Plus, Medline, PsycINFO, EMBASE, TRIP Pro, Google Scholar, and HINARI. The database search was supplemented by screening citations and reference lists, in addition to a grey literature searches. The search identified 2221 studies, among which 26 were included in the review. The majority of the studies were observational, which created a rich source of data to create four major themes. The findings were informed and shaped by working with key stakeholders to develop a conceptual model that can contribute to developing evidence-based practice. This highlights the importance of a comprehensive, multi-disciplinary approach to pain assessment in this population, which is beyond the use of tools.
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Affiliation(s)
- Nansi Felton
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
- Correspondence:
| | - Jennifer S. Lewis
- School for Health and Social Wellbeing, University of the West of England, Bristol BS16 1DD, UK;
- National Complex Regional Pain Syndrome Service, Pain Specialty, Royal United Hospitals NHS Trust, Bath BA1 3NG, UK
| | - Sarah-Jane Cockburn
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
- Doctoral College, Department of Psychology, University of Southampton, Building 44, Highfield Campus, Southampton SO17 1BJ, UK
| | - Margot Hodgson
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
| | - Shoba Dawson
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK;
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