Disparities in pain management between cognitively intact and cognitively impaired nursing home residents.

School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA. <>
Journal of Pain and Symptom Management (Impact Factor: 2.74). 04/2008; 35(4):388-96. DOI: 10.1016/j.jpainsymman.2008.01.001
Source: PubMed

ABSTRACT This study tests the association between residents' cognitive impairment and nursing homes' pain management practices. We used chart abstraction to collect data on 551 adults in six North Carolina nursing homes. From the standard data collected in the Minimum Data Set, 24% of residents experienced pain in the preceding week. Reports of pain decreased as cognitive abilities declined: nurses completing the Minimum Data Set reported pain prevalence of 34%, 31%, 24%, and 10%, respectively, for residents with no, mild, moderate, and severe cognitive impairment (P<0.001), demonstrating a "dose-response"-type result. Eighty percent of cognitively intact residents received pain medications, compared to 56% of residents with severe impairment (P<0.001). Cognitively impaired residents had fewer orders for scheduled pain medications than did their less cognitively impaired peers. Yet the presence of diagnoses likely to cause pain did not vary based on residents' cognitive status. We conclude that pain is underrecognized in nursing home residents with cognitive impairment and that cognitively impaired residents often have orders for "as needed" analgesics when scheduled medications would be more appropriate.

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    • "Therefore, the authors wanted to compare pain reports for residents provided by the residents themselves , the care home staff and relatives. Analgesic drugs can often be under used or prescribed inappropriately , for example, 'when required' instead of regularly scheduled (Nygaard and Jarland, 2005; Reynolds et al., 2008). It has been reported that psychoactive drugs, which may be indicated in certain circumstances for the short-term management of behavioural and psychiatric symptoms associated with dementia, could mask behaviours that are indicative of pain (Cipher et al., 2006). "
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    ABSTRACT: Objectives This study aims to determine pain frequency amongst care home residents with dementia, to investigate variables associated with pain, to explore analgesic use among residents and to seek residents' relatives' views on provision of care and management of pain by the care home.Methods Structured face-to-face interviews were conducted with residents, nursing staff and relatives from nine dementia care homes in Northern Ireland, between May 2010 and March 2012. Demographic information was collected from participants, neuropsychiatric tests were used to assess residents' cognitive functioning, medication use was determined from care home records and residents' pain was assessed using a verbal descriptor scale. Relatives' views were sought on care provision and management of pain.ResultsForty-two residents, 16 nurses/care assistants and 35 relatives participated; the participation rate of residents was low (27.6%). Most residents were suffering moderate–severe dementia, and some residents (26.2%) were unable to provide a self-report of pain. A significantly higher proportion of relatives (57.1%) deemed residents to be experiencing pain at the time of the interview, compared with residents (23.8%, p = 0.005) and nurses/care assistants (42.9%, p = 0.035). Most residents (88.1%) were prescribed with analgesia; non-opioid analgesics were most commonly prescribed. High proportions of residents were prescribed with psychoactive medications. Antipsychotic drug use was associated with presence of pain (p = 0.046).Conclusions This study has reinforced the challenge of assessing and managing pain in this resident population and highlighted issues to be addressed by long-term care providers and clinicians. Participation of people with dementia, and their families, in healthcare research needs to be improved. Copyright © 2014 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 04/2014; 30(1). DOI:10.1002/gps.4111 · 3.09 Impact Factor
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    • "In Relieving Pain in America, the Institute of Medicine (IOM) acknowledges that chronic pain is a disease and not just a symptom of other conditions (Institute of Medicine, 2011). The IOM report further addresses disparities in care for older adults and recognizes that undertreated pain may lead to depression and anxiety, decreased quality of life, and functional impairment (Ferrell, 1995; Hutt et al., 2006; Reynolds et al., 2008). Yet, pain assessment among the elderly population has not come without its challenges. "
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    ABSTRACT: This study explored the following issues related to pain management among nursing home (NH) residents: 1) communication patterns between NH residents and certified nursing assistants (CNAs) about pain; 2) how race and ethnicity influence NH residents' pain experiences; and 3) CNAs' personal experiences with pain that may affect their empathy toward the resident's pain experience. The study consisted of a convenience sample of four focus groups (n = 28) from a NH in central Florida. A content analysis approach was used. Data were analyzed with the use of Atlas.ti version 6.2. The content analysis identified four main themes: 1) attitudes as barriers to communication about resident pain care; 2) cultural, religious, and gender influences of resident pain care by CNAs; 3) the role of empathy in CNAs care of residents with pain; and 4) worker strategies to detect pain. Attitudes among CNAs about resident cognitive status and perceived resident burden need to be recognized as barriers to the detection and reporting of pain by CNAs and should be addressed. In addition, NHs should consider a person-centered approach to pain that is culturally competent given the cultural influences of both residents and staff. Finally, educational programs for CNAs that include empathy-inducing scenarios could potentially improve the care provided by CNAs when dealing with residents' pain.
    Pain management nursing: official journal of the American Society of Pain Management Nurses 03/2014; 15(1):87-96. DOI:10.1016/j.pmn.2012.06.008 · 1.79 Impact Factor
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    • "Thus, appropriate use of drugs and treating comorbidity represent an important public health issue. Currently, pain is believed to be undertreated in the elderly and especially in people with dementia [2] [3], an assumption corroborated by a number of small case-control studies [4] [5] [6] [7] [8] [9]. Reasons for undertreatment are not well understood. "
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    ABSTRACT: Background Pain is believed to be undertreated in patients with dementia; however, no larger studies have been conducted. The aim was to investigate prevalent use of opioids in elderly with and without dementia in the entire elderly population of Denmark. Method A register-based cross-sectional study in the entire elderly (≥65 years) population in 2010 was conducted. Opioid use among elderly with dementia (N = 35,455) was compared with elderly without (N = 870,645), taking age, sex, comorbidity, and living status into account. Results Nursing home residents (NHRs) used opioids most frequently (41%), followed by home-living patients with dementia (27.5%) and home-living patients without dementia (16.9%). Buprenorphine and fentanyl (primarily patches) were commonly used among NHRs (18.7%) and home-living patients with dementia (10.7%) but less often by home-living patients without dementia (2.4%). Conclusions Opioid use in the elderly Danish population was frequent but particularly in patients with dementia and NHR, which may challenge patient safety and needs further investigation.
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