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Santos KC, Durkee-Neuman E, Ong A, Sin MK. Pain Management in Cognitively Impaired Older Adults. INTERNATIONAL JOURNAL OF NURSING AND HEALTH CARE RESEARCH 2024; 7:1528. [PMID: 38919605 PMCID: PMC11197985 DOI: 10.29011/2688-9501.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND Pain identification and management in cognitively impaired older adults, especially those with major neurocognitive disorder, are challenging because of communication barriers and health care providers who are unaccustomed to the patient's baseline behavioral and psychological conditions. MANAGEMENT CONSIDERATIONS Appropriately distinguishing pain-associated behaviors separate from dementia, utilizing effective assessment tools, and administering proper interventions and medications to treat pain promptly for this population need to be considered. CONCLUSIONS Nurses play critical roles in implementing various evidence-based assessment tools to assess pain and choosing appropriate pain management interventions by training and supporting other nurses to use these assessment tools and develop their critical assessment skills to quickly identify pain and evaluate pain management interventions.
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Affiliation(s)
- Kristine Cara Santos
- Kristine Cara Santos, DNP, RN: Nurse practitioner, Evergreen Health, Kirkland, WA
| | - Elizabeth Durkee-Neuman
- Elizabeth Durkee-Neuman, BSN, RN: Registered nurse, Country Doctor Community Health Centers, Seattle, WA
| | - Adeline Ong
- Adeline Ong: Nursing student, College of Nursing Seattle University, Seattle, WA
| | - Mo-Kyung Sin
- Mo-Kyung Sin, PhD, RN, FGSA, FAAN: Professor, College of Nursing Seattle University, Seattle, WA
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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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Riffin C, Brody L, Mukhi P, Herr K, Pillemer K, Rogers M, Henderson CR, Reid MC. Establishing the Feasibility and Acceptability of a Caregiver Targeted Intervention to Improve Pain Assessment Among Persons With Dementia. Innov Aging 2023; 7:igad074. [PMID: 38094933 PMCID: PMC10714902 DOI: 10.1093/geroni/igad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Despite its prevalence and impact, pain is underdetected and undermanaged in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial evaluating the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention that provides training in observational pain assessment and coaching in pain communication techniques. Research Design and Methods Family caregivers of persons with comorbid pain and moderate-to-advanced dementia were randomly assigned to PICT (n = 19) or a control condition (n = 15). Caregivers in the PICT group participated in four weekly sessions delivered by telephone with a trained interventionist; caregivers in the control group received an information pamphlet about pain and dementia. All participants completed surveys at baseline and 12 weeks. Caregivers in the intervention group also completed semistructured interviews at 12 weeks. Quantitative data were analyzed using descriptive statistics and t tests; qualitative data were analyzed using content analysis. Results All participants (100%) in the PICT group completed the intervention and most completed the 12-week assessment (94%). PICT randomized caregivers reported that the intervention helped them to feel more confident in their ability to recognize (67%) and communicate about pain symptoms (83%). At 12 weeks, caregivers in the PICT group showed a statistically significant improvement in self-efficacy in pain-related communication. In qualitative interviews, caregivers emphasized the utility of PICT's components, including pain assessment tools, and offered considerations for future enhancements, such as technology-based adaptations and integration within care delivery systems. Discussion and Implications This pilot trial demonstrates that PICT is feasible to implement, acceptable to caregivers, and has the potential to improve confidence in recognizing and communicating about pain. Results support conducting a fully powered efficacy trial, an important step toward future integration into real-world care delivery. Clinical Trial Registration Number NCT03853291.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Madeline Rogers
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - M Cary Reid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Ma JH, Liu YF, Hong H, Li CJ, Cui F, Mu DL, Wang DX. Effect of acute pain on the association between preoperative cognitive impairment and postoperative delirium: a secondary analysis of three trials. Br J Anaesth 2023; 130:e272-e280. [PMID: 35933172 DOI: 10.1016/j.bja.2022.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/25/2022] [Accepted: 06/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The association between preoperative cognitive impairment, postoperative pain, and postoperative delirium in older patients after noncardiac surgery is not known. METHODS This was a secondary analysis of datasets from three previous studies. Patients aged ≥55 yr who underwent elective noncardiac surgery were enrolled. Preoperative cognitive impairment was defined as Mini-Mental State Examination <27. Pain intensity with movement was assessed using an 11-point numeric rating scale at 12-h intervals during the first 72 h after surgery; time-weighted average (TWA) pain score was calculated. Primary outcome was the occurrence of delirium within the first 5 postoperative days. Mediation analysis was used to investigate the relationships between cognitive impairment, pain score, and delirium. RESULTS A total of 1497 patients were included. Prevalence of preoperative cognitive impairment was 40.3% (603/1497). Patients with cognitive impairment suffered higher TWA pain score within 72 h (4 [3-5] vs 3 [2-5], P=0.004) and more delirium within 5 days (12.9% [78/603] vs 4.9% [44/894], P<0.001) when compared with those without. Total and direct associations between cognitive impairment and delirium were (adjusted β) 8.3% (95% confidence interval [CI], 4.8-12.0%; P<0.001) and 7.8% (95% CI, 4.4-12.0%; P<0.001), respectively. A significant indirect association with acute pain was observed between cognitive impairment and delirium (adjusted β=0.4%; 95% CI, 0.1-1.0%; P=0.006), accounting for 4.9% of the total effect. CONCLUSIONS The association between preoperative cognitive impairment and delirium is significantly mediated by acute pain in patients after noncardiac surgery. Considering the small effect size, clinical significance of this mediation effect requires further investigation.
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Affiliation(s)
- Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Ya-Fei Liu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Hong Hong
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Chun-Jing Li
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Fan Cui
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Dong-Liang Mu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China.
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland, OH, USA
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Unneby A, Olofsson B, Lindgren BM. The Femoral Nerve Block Setting the Agenda for Nursing Care of Older Patients With hip Fractures-A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231177533. [PMID: 37273549 PMCID: PMC10233567 DOI: 10.1177/23779608231177533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Hip fractures among older people are common worldwide, and it is often associated with preoperative pain. Due to increased comorbidity and high age, traditional pain relief can be a challenge. An alternative to traditional pain relief is a femoral nerve block, which is safe and suitable for anesthesia and analgesia for hip fractures among patients with or without dementia. It is essential to provide adequate pain management, and nurses report negative attitudes toward opioids and seem to prefer alternative pain management. To our knowledge, no study has focused on staff's experiences of nursing care for patients treated with femoral nerve block. Aim To describe staff's experiences providing nursing care in preoperative pain and pain management to older patients with a hip fracture who received a femoral nerve block. Design A qualitative exploratory design. Method Semistructured interviews with 19 nurses or assistant nurses in an orthopedic ward or emergency department. They were experienced in caring for patients with hip fractures who received treatment with a femoral nerve block. The interviews were subjected to qualitative content analysis. Results Staff described the femoral nerve block as setting the agenda when caring for older patients with hip fractures in the preoperative phase. The outcome of the femoral nerve block affected nursing care, depending on if the femoral nerve block was successful or not. Nursing care requires timing, with a need for staff orienting to time and customizing their communication. Further, staff faced ethical challenges regarding doing good and not harm, relieving pain, and avoiding side effects. Conclusions The femoral nerve block was an important issue for nursing staff in patients with hip fractures in the preoperative phase. Our results point toward the benefits of giving femoral nerve blocks as soon as possible to facilitate nursing care, however, this should be studied in future research.
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Affiliation(s)
- Anna Unneby
- Department of Nursing, Umeå
University, Umeå, Sweden
- Department of Surgical and Perioperative Science
Orthopedics, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Umeå
University, Umeå, Sweden
- Department of Surgical and Perioperative Science
Orthopedics, Umeå University, Umeå, Sweden
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Benhamed A, Boucher V, Emond M. Pain management in emergency department older adults with pelvic fracture: still insufficient. CAN J EMERG MED 2022; 24:245-246. [PMID: 35403990 DOI: 10.1007/s43678-022-00299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Axel Benhamed
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine d'urgence, CHU de Québec, Université Laval, Québec, QC, Canada.,Hospices Civils de Lyon, Centre Hospitalier Universitaire Édouard Herriot, 69003, Lyon, France
| | - Valérie Boucher
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marcel Emond
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada. .,Département de Médecine d'urgence, CHU de Québec, Université Laval, Québec, QC, Canada. .,CHU de Québec - Hôpital de L'Enfant-Jésus, , rue, H-608, Québec, 1401, 18G1J 1Z4, Canada.
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Sakata N, Okumura Y, Ogawa A. Postoperative Pain Treatment in Patients with Dementia: A Retrospective Observational Study. Drugs Aging 2022; 39:305-311. [PMID: 35362866 DOI: 10.1007/s40266-022-00932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inadequate postoperative analgesia has been noted in patients with dementia, but this topic has only been studied in hip fractures. This study aimed to examine whether the duration of postoperative analgesia associated with three surgical procedures was shorter in patients with dementia than in those without dementia. METHODS This retrospective observational study was based on a nationwide discharge database of acute care hospitals in Japan and included patients aged ≥ 65 years diagnosed with lung cancer, rectal cancer, or hip fracture, who underwent surgery in 366 hospitals between April 2013 and September 2018. The primary outcome was the incidence of injectable analgesic use during the postoperative hospital stay. The number of person-days of opioid, non-steroidal anti-inflammatory drug, or acetaminophen use was calculated for patients with and without dementia after each surgery using generalized estimating equations to obtain the age-adjusted incidence per 100 person-days. RESULTS Among the 32,379 patients included, 4828 (14.9%) had dementia. The duration of opioid administration per 100 person-days was 14% shorter in patients with dementia than in those without dementia after open rectal cancer surgery (incidence rate ratio [IRR] 0.86; 95% confidence interval [CI] 0.74-1.00) and 20% shorter in patients with dementia after open lung cancer surgery (IRR 0.80; 95% CI 0.70-0.91). In patients who underwent thoracoscopic lung cancer surgery, laparoscopic rectal cancer surgery, or hip replacement surgery, the duration of opioid administration was shorter in patients with dementia than in those without dementia, but the difference was not statistically significant. CONCLUSIONS The length of postoperative opioid administration after lung and rectal cancer surgery was reduced in patients with dementia, suggesting that the duration of postoperative analgesia in patients with dementia may be insufficient. More careful pain assessment and management of postoperative analgesia in these patients may be necessary.
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Affiliation(s)
- Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Setagaya Memorial Hospital, Tokyo, Japan
| | - Yasuyuki Okumura
- Initiative for Clinical Epidemiological Research, 1-2-5 Nakamachi, Machida, Tokyo, 194-0021, Japan.
| | - Asao Ogawa
- Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan
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Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052799. [PMID: 35270492 PMCID: PMC8910143 DOI: 10.3390/ijerph19052799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022]
Abstract
This study reports the characteristics of patients with dementia or cognitive impairment hospitalized with a proximal femur fracture requiring surgery. Methods: Multicentric descriptive longitudinal study conducted in three traumatology units, representing high-technology public hospitals across Spain. Data collection took place between August 2018 and December 2019 upon admission to hospital, discharge, one month and three months after discharge. Results: Study participants (n = 174) were mainly women (81.6%), and the mean age was 90.7± 6.3 years old. Significant statistical differences were noted in the decline of functional capacity at baseline and one month later, and after three months they had still not recovered. Malnutrition increased from baseline to the one-month follow-up. The use of physical restraints increased during hospitalization, especially bilateral bedrails and a belt in the chair/bed. After one month, 15.2% of patients had pressure ulcers. Although pain decreased, it was still present after three months. Conclusion: Hospitalization after hip surgery for elderly people with dementia or cognitive impairment negatively impacted their global health outcomes such as malnutrition and the development of pressure ulcers, falls, functional impairment and the use of physical restraints and pain management challenges. Hospitals should implement policy-makers’ strategic dementia care plans to improve their outcomes.
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Ruel M, Boussat B, Boudissa M, Garnier V, Bioteau C, Tonetti J, Pailhe R, Gavazzi G, Drevet S. Management of preoperative pain in elderly patients with moderate to severe cognitive deficits and hip fracture: a retrospective, monocentric study in an orthogeriatric unit. BMC Geriatr 2021; 21:575. [PMID: 34666691 PMCID: PMC8524930 DOI: 10.1186/s12877-021-02500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients with cognitive deficits are 3 times more likely to suffer a hip fracture than geriatric patients of the same age group without cognitive deficits. The persistence of perioperative pain following hip fracture is a risk factor for the occurrence of delirium, poor functional prognosis, and the development of secondary chronic pain. Patients with cognitive deficits receive 20 to 60% less analgesics than those without cognitive deficits. Our retrospective descriptive monocentric study was performed in an orthogeriatric unit on a cohort of elderly patients hospitalized for hip fracture. The aim of the study was to compare the quantity of strong opioids delivered in a morphine sulfate equivalent daily during the preoperative period after a hip fracture between cognitively intact patients and those with cognitive deficits. Results Our total population of 69 patients had a median age of 90 years old, and 46% of these patients had moderate or severe cognitive deficits. During the preoperative period, the same quantity of strong opioids was administered to both groups of patients (13.1 mg/d versus 10.8 mg/d (p = 0.38)). Patients with moderate to severe cognitive deficits more often experienced delirium during their hospitalization (p < 0.01) and received more psychotropic drugs in the first 3 postoperative days (p = 0.025). Conclusions We reported that with standardized pain management in an orthogeriatric unit, patients aged 75 years and older received the same daily average quantity of strong opioids during the preoperative period regardless of the presence of cognitive deficits.
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Affiliation(s)
- Mathilde Ruel
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France.
| | - Bastien Boussat
- Public Health Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Mehdi Boudissa
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Virginie Garnier
- Geriatric Department, University Hospital Grenoble Alpes, Grenoble, France
| | | | - Jérôme Tonetti
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Régis Pailhe
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Gaëtan Gavazzi
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France
| | - Sabine Drevet
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France
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Bauer S, Hödl M, Eglseer D. Association between malnutrition risk and pain in older hospital patients. Scand J Caring Sci 2021; 35:945-951. [PMID: 33119916 PMCID: PMC8451812 DOI: 10.1111/scs.12915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/03/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe the prevalence of malnutrition risk and pain in older hospital patients and characterise the association between these two problems. RESEARCH METHODS AND PROCEDURES The study includes a secondary data analysis of data collected in two cross-sectional studies. Data collection was performed in 2017 and 2018 using a standardised and tested questionnaire. The study protocol was approved by an ethical committee. RESULTS Data from 3406 patients were analysed. Among the participants, 24.6% of the patients were at risk of malnutrition, and 59.6% of the patients reported feeling pain. A significantly higher number of patients with pain (26.4%) were at risk of malnutrition than patients without pain (22.1%). The multivariate logistic regression analysis showed that patients with severe/very severe or unbearable pain were 1.439 times more likely to develop a risk of malnutrition than patients without pain. Patients with cancer or diseases of the digestive system were twice as likely to develop malnutrition than those without these diseases. CONCLUSIONS The results of this study show that older patients with severe pain are at higher risk of developing a risk of malnutrition than those without pain, although the study design (cross-sectional) does not imply causality. Therefore, special efforts should be made to assess pain in these patients to reduce the negative consequences of this pain, such as malnutrition.
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Affiliation(s)
- Silvia Bauer
- Institute of Nursing ScienceMedical University of GrazGrazAustria
| | - Manuela Hödl
- Institute of Nursing ScienceMedical University of GrazGrazAustria
| | - Doris Eglseer
- Institute of Nursing ScienceMedical University of GrazGrazAustria
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Parkman S, Mastel-Smith B, McGuire A, Duke G. Insights to Identifying and Managing Pain in Persons With Dementia in Long-Term Care: A Mixed Methods Study Comparing the Abbey Pain Scale and Pain Assessment in Advanced Dementia Scale. J Gerontol Nurs 2021; 47:21-30. [PMID: 33497447 DOI: 10.3928/00989134-20210113-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
Pain is usually identified by specific behaviors driven by the need for relief; however, persons with dementia present a unique challenge for nurses in assessing and managing pain. The aim of this mixed methods study was to explore the relationship between two observational pain scales, expressed need-driven behaviors, and likelihood of medication administration for persons with dementia. The qualitative strand examined nurses' perceptions regarding facilitators and barriers to pain scale use. Quantitative data analysis indicated the Abbey Pain Scale was significantly correlated with behaviors (r[26] = 0.41, p < 0.05) and approached significance with medication administration (r[26] = 0.35, p = 0.067). Qualitative analysis identified three core themes: (a) Challenges in Assessing Persons With Dementia for Pain; (b) Facilitators and Barriers to Pain Management; and (c) Difficulty Caring for Persons With Dementia. Clinical implications suggest the need for a systematic, consistent method of observing pain-related behaviors in persons with dementia. [Journal of Gerontological Nursing, 47(2), 21-30.].
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Allard C, Pardo E, de la Jonquière C, Wyniecki A, Soulier A, Faddoul A, Tsai ES, Bonnet F, Verdonk F. Comparison between femoral block and PENG block in femoral neck fractures: A cohort study. PLoS One 2021; 16:e0252716. [PMID: 34086782 PMCID: PMC8177466 DOI: 10.1371/journal.pone.0252716] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described "Pericapsular Nerve Group (PENG) Block" with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture. MATERIALS AND METHODS We conducted a comparative observational study at a university hospital (Saint Antoine Hospital, Sorbonne University, Paris, France), where the PENG block was introduced in August 2019. We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or PENG block before their surgery. The primary outcome was the comparison of cumulative postoperative morphine consumption 48 hours after surgery. RESULTS Demographics, medical charts, and perioperative data of 42 patients were reviewed: 21 patients before (Femoral group) and 21 patients after the introduction of PENG block (PENG group) in clinical practice. Thirteen total hip arthroplasties (THA) and eight hemi arthroplasties (HA) were included in each group. Demographics were also comparable. The median, postoperative, morphine equivalent consumption at 48 hours was 10 [0-20] mg and 20 [0-50] mg in Femoral and PENG groups respectively (p = 0.458). No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay. The postoperative muscle strength of the quadriceps was greater in the PENG group than in the Femoral group (5/5 vs. 2/5, p = 0.001). CONCLUSION In the management of hip fractures, PENG block is not associated in our study with a significant change in postoperative morphine consumption, compared to femoral block. However, it does significantly improve the immediate mobility of the operated limb, making it appropriate for inclusion in enhanced recovery programs after surgery.
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Affiliation(s)
- Céline Allard
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Pardo
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Christophe de la Jonquière
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Wyniecki
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Soulier
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annibal Faddoul
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eileen S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Francis Bonnet
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
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13
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Inoue R, Nishizawa D, Hasegawa J, Nakayama K, Fukuda KI, Ichinohe T, Mieda T, Tsujita M, Nakagawa H, Kitamura A, Sumikura H, Ikeda K, Hayashida M. Effects of rs958804 and rs7858836 single-nucleotide polymorphisms of the ASTN2 gene on pain-related phenotypes in patients who underwent laparoscopic colectomy and mandibular sagittal split ramus osteotomy. Neuropsychopharmacol Rep 2021; 41:82-90. [PMID: 33476460 PMCID: PMC8182957 DOI: 10.1002/npr2.12159] [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: 12/07/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Opioids are widely used as effective analgesics, but opioid sensitivity varies widely among individuals. The underlying genetic and nongenetic factors are not fully understood. Based on the results of our previous genome‐wide association study, we investigated the effects of single nucleotide polymorphisms (SNPs) of the astrotactin 2 (ASTN2) gene on pain‐related phenotypes in surgical patients. Methods We investigated the effects of two SNPs, rs958804 T/C and rs7858836 C/T, of the ASTN2 gene on eight and seven pain‐related phenotypes in 350 patients who underwent laparoscopic colectomy (LAC) and 358 patients who underwent mandibular sagittal split ramus osteotomy (SSRO), respectively. In both surgical groups, intravenous fentanyl patient‐controlled analgesia (PCA) was used for postoperative analgesia, and 24‐hour postoperative PCA fentanyl use was the primary endpoint. Results The association analyses among the two SNPs and pain‐related traits showed that 24‐hour fentanyl use was significantly associated with the two SNP genotypes in both surgical groups. The Mann‐Whitney test showed that 24‐hour fentanyl use was lower in patients with the C allele than in patients with the TT genotype of the rs958804 T/C SNP (P = .0019 and .0200 in LAC and SSRO patients, respectively), and it was lower in patients with the T allele than in patients with the CC genotype of the rs7858836 C/T SNP (P = .0017 and .0098 in LAC and SSRO patients, respectively). Conclusion The two SNPs of the ASTN2 gene were consistently associated with fentanyl requirements after two different types of surgery. These findings may contribute to personalized pain control. We investigated the effects of two SNPs, rs958804 T/C and rs7858836 C/T, which are located in the same LD block of the ASTN2 gene, on pain‐related phenotypes in two groups of patients who underwent laparoscopic colectomy and mandibular sagittal split ramus osteotomy. We found that these SNPs consistently reduced fentanyl requirements for postoperative analgesia, possibly by enhancing the analgesic effect of fentanyl.![]()
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Affiliation(s)
- Rie Inoue
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Junko Hasegawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kyoko Nakayama
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ken-Ichi Fukuda
- Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
| | - Tatsuya Ichinohe
- Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan
| | - Miki Tsujita
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideyuki Nakagawa
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akira Kitamura
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroyuki Sumikura
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
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14
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Kruthiventi SC, Laporta ML, Deljou A, Knopman DS, Petersen RC, Schroeder DR, Sprung J, Weingarten TN. Preoperative cognitive impairment associated with oversedation during recovery from anesthesia. J Anesth 2020; 34:390-396. [PMID: 32222908 DOI: 10.1007/s00540-020-02764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Our objective was to examine the association between preoperative cognitive status and postoperative recovery from anesthesia. METHODS We included patients (70-91 years old) from the Mayo Clinic Study of Aging who received general anesthesia and were admitted to the postanesthesia care unit from January 1, 2010 through April 30, 2018. Procedures were categorized according to patient's preoperative cognitive status: cognitive impaired (CI) and cognitive unimpaired (CU). Perioperative records were reviewed and analyses were performed with generalized estimating equations. RESULTS A total of 896 procedures from 611 patients were included, with 203 (22.7%) procedures in the CI group. Compared to CU procedures, CI procedures had higher rates of moderate-deep sedation during anesthesia recovery (52 [25.6%] vs. 103 [14.9%]; odds ratio [OR], 1.91; 95% CI, 1.30-2.80; P < 0.01), postoperative pulmonary complications (22 [10.8%] vs. 34 [4.9%]; OR, 2.36[1.22-4.54]; P = 0.01), and postoperative delirium (32 [16.2%] vs. 24 [3.5%]; OR, 5.33 [2.88-9.86]; P < 0.01). When moderate-deep sedation during anesthesia recovery was a covariate, both CI (OR, 3.02[1.60-5.70]; P < 0.01) and moderate-deep sedation (OR, 3.94[2.19-7.11]; P < 0.01) were associated with delirium. In multivariable analysis, postoperative pulmonary complications were associated with moderate-deep sedation (OR, 2.14[1.18-3.87]; P = 0 .01) but not with CI (OR, 1.49 [0.76-2.92]; P = 0 .25). CONCLUSIONS Cognitive impairment was associated with higher rates of moderate-deep residual sedation during anesthesia recovery and delirium, while moderate-deep sedation was associated with higher rates of pulmonary complications and delirium. We speculate that tailoring the anesthetic to facilitate faster emergence for CI patients could improve complication rates.
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Affiliation(s)
- S Chandralekha Kruthiventi
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Atousa Deljou
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - David S Knopman
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ronald C Petersen
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Darrell R Schroeder
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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15
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Pergolizzi JV, Raffa RB, Paladini A, Varrasi G, LeQuang JA. Treating pain in patients with dementia and the possible concomitant relief of symptoms of agitation. Pain Manag 2019; 9:569-582. [DOI: 10.2217/pmt-2019-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dementia is an irreversible, progressive form of cognitive dysfunction that can affect memory, learning ability, thinking, orientation, comprehension, calculation, linguistic skills and executive function but which does not impair consciousness. Pain prevalence is high among the elderly who are also at elevated risk for dementia. Pain control for dementia patients is important but can be challenging for clinicians as cognitive deficits can make it difficult to identify, localize and assess pain. Cerebral changes associated with dementia may change how people process and experience pain in ways that are not entirely elucidated. Agitation is a frequent symptom of dementia and may be associated with untreated pain as agitation and aggression symptoms decrease when pain is effectively addressed.
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Affiliation(s)
| | - Robert B Raffa
- University of Arizona, Department of Pharmacy, Tucson, AZ 85721, USA
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16
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Zwakhalen S, Docking RE, Gnass I, Sirsch E, Stewart C, Allcock N, Schofield P. Pain in older adults with dementia : A survey across Europe on current practices, use of assessment tools, guidelines and policies. Schmerz 2019; 32:364-373. [PMID: 29931391 DOI: 10.1007/s00482-018-0290-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings. METHODS A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom. RESULTS Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70-80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management. CONCLUSION Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.
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Affiliation(s)
- S Zwakhalen
- School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - R E Docking
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - I Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - E Sirsch
- Faculty of Nursing Science, Philosophisch-Theologische Hochschule Vallendar (Catholic University), Vallendar, Germany
| | - C Stewart
- NHS Research Scotland, The Golden Jubilee National Hospital, Clydebank, UK
| | - N Allcock
- Professional and Clinical Development Lead, InHealth Pain Management Solutions Limited, Barnsley, UK
| | - P Schofield
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
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17
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[Multidisciplinary geriatric rehabilitation in the patient with hip fracture and dementia]. Rev Esp Geriatr Gerontol 2018; 54:220-229. [PMID: 30606498 DOI: 10.1016/j.regg.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022]
Abstract
Hip fracture and dementia rates increase with age, and both groups of patients suffer increased morbidity and mortality and functional impairment. The management of these patients is a challenge for the orthogeriatric and rehabilitation team process, as despite the evidence on the benefit, the results analysed are still worse than in patients without cognitive impairment. For this reason, and due to the limitation in health resources, many of them have problems in accessibility to them, or are limited to a less intense rehabilitation. There are insufficient studies on the best rehabilitation interventions in this group of patients, but it is suggested: 1) to use a multidisciplinary rehabilitation model adapted to the patient with dementia, and 2) to redefine results of the rehabilitation of these patients not only in terms of functional improvement, without highlighting other concepts, such as quality of life, decrease in complications or improved social support.
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18
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Drebenstedt C, Schuler M. [Status and perspectives of pain and pain therapy in old age : Plea for better care of geriatric pain patients]. Z Gerontol Geriatr 2017; 50:680-684. [PMID: 28936636 DOI: 10.1007/s00391-017-1306-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Corinna Drebenstedt
- St. Marien Hospital Friesoythe, St. Marien-Str. 1, 26169, Friesoythe, Deutschland.
| | - Matthias Schuler
- Diakonissenkrankenhaus Mannheim, Speyerer Str. 91-93, 68163, Mannheim, Deutschland
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19
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Jones J, Sim TF, Hughes J. Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management-A Narrative Review of Current Practices. PHARMACY 2017; 5:E30. [PMID: 28970442 PMCID: PMC5597155 DOI: 10.3390/pharmacy5020030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023] Open
Abstract
Elderly people are susceptible to both falls and cognitive impairment making them a particularly vulnerable group of patients when it comes to pain assessment and management in the emergency department (ED). Pain assessment is often difficult in patients who present to the ED with a cognitive impairment as they are frequently unable to self-report their level of pain, which can have a negative impact on pain management. This paper aims to review how cognitive impairment influences pain assessment in elderly adults who present to the ED with an injury due to a fall. A literature search of EMBASE, ProQuest, PubMed, Science Direct, SciFinder and the Curtin University Library database was conducted using keyword searches to generate lists of articles which were then screened for relevance by title and then abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. The literature reports that ED staff commonly use visual or verbal analogue scales to assess pain, but resort to their own intuition or physiological parameters rather than using standardised observational pain assessment tools when self-report of pain is not attainable due to cognitive impairment. While studies have found that the use of pain assessment tools improves the recognition and management of pain, pain scores are often not recorded for elderly patients with a cognitive impairment in the ED, leading to poorer pain management in this patient group in terms of time to analgesic administration and the use of strong opioids. All healthcare professionals involved in the care of such patients, including pharmacists, need to be aware of this and strive to ensure analgesic use is guided by appropriate and accurate pain assessment in the ED.
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Affiliation(s)
- Joshua Jones
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Tin Fei Sim
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Jeff Hughes
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
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