[Pain, fear of falling and functional performance in nursing home residents - a cross-sectional study]

Pain and fear of falling (FOF) are modifiable factors that might play an important role in functional performance of nursing homes residents (NHR). Both factors are characterised by deficits in research and provision of long-term care services. The purpose of this study was to examine the functional performance of NHR with and without pain or FOF. Quantitative data were collected on NHR in Berlin and Brandenburg using a cross-sectional design. The cognitive status was assessed using the Minimental state test. Existing pain and FOF were assessed as a question part of interview. Functional performance was examined using the Barthel Index (BI) the Timed «up & go»-Test. Multiple linear regression analyses were performed to investigate the research question and the influence of additional explanatory variables (age, sex, relevant somatic morbidity). 217 NHR without considerable cognitive impairment (MMST >= 20) participated. 65 % of the NHR suffered from pain and 48 % had FOF. There was a statistically significant association between Pain or FOF und lower functional mobility. With respect to NHR able to walk, there was statistically significant association between Pain or FOF und lower performance in activities of daily living. Possibilities for interventions which might have positive effects on functional performance of NHR are an improved pain treatment and interventions to reduce FOF.

Antipsychotic drugs predominate in pharmacotherapy of nursing home residents with dementia

INTRODUCTION

The aim of this study was to investigate the frequency of benzodiazepines, antidementia and antipsychotic drug prescriptions in nursing home residents (NHR).Data of a German health insurance company were retrospectively analyzed for the year 2008.

METHODS

The study cohort comprised 13,042 NHR (82% women, mean age 83.6 ± 7 years). Following analgetics, antipsychotic drugs were the second most frequently prescribed drug group with 13.3% of all prescriptions. Dementia was diagnosed in 8 017 (61.5%) NHR. Thereof 51.6% received an antipsychotic, 17.3% a benzodiazepine and 15.2% an antidementia pharmaceutical, respectively. 18.1% of NHR with dementia and antipsychotic drug prescriptions were in combined treatment with antidementia pharmaceuticals. The rate of antipsychotic drug prescribing was significantly doubled in NHR with dementia compared to those without this diagnosis (p<0.01); the most frequently prescribed antipsychotics were melperone, risperidone and pipamperone.

DISCUSSION

This study demonstrates the wide-spread use of psychotropic drugs in NHR. Moreover, dementia in NHR was associated with antipsychotic drug prescribing in every second patient. This highlights the need for further studies analyzing alternative treatments for dementia-related symptoms.

Porcine anaesthesia for advanced trauma operative management (atom)

Anaesthesia has been provided for pigs for the Advanced Trauma Operative Management Course which was first held at the Korle Bu Teaching Hospital in February 2005. As of January 2006, 16 animals have been anaesthetized. Acepromazine (1mg/kg) and atropine (0.05mg/kg) were used for premedication. IM ketamine (30mg/kg) and isoflurane (in oxygen) were used for the anaesthesia and the animals were intubated and ventilated with positive pressure ventilation. No neuromuscular blocking agents were used. Morphine (average 3 doses of 10mg) was used for analgesia. Systolic blood pressure ranged between 80mmHg and 115mmHg and diastolic pressure ranged between 45mmHg and 80mmHg. Large amounts of IV fluids were given during the procedure. At the end of surgery, the animals were euthanized by increasing the concentration of isoflurane and administering potassium chloride. Out of the 14 cases reported on, 13 animals survived to the end of all the surgical procedures. 1 animal had a cardiac arrest during the last procedure (inflicting a laceration to the heart) and could not be resuscitated.