Long-Term Effects of Analgesics in a Population of Elderly Nursing Home Residents With Persistent Nonmalignant Pain

Gerontology Division and Harvard Medical School Division on Aging, Beth Israel Deaconess Medical Center, 110 Francis Street, LMOB 1A, Boston, MA, USA.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences (Impact Factor: 5.42). 03/2006; 61(2):165-9. DOI: 10.1093/gerona/61.2.165
Source: PubMed


Little is known about the long-term effects of analgesics on functional status and well-being of nursing home residents with chronic pain.
Using the Minimum Data Set, we performed a longitudinal study of nursing home residents (n = 10,372) with persistent pain. Using propensity score adjustment techniques, we compared the effect of different analgesics on changes in physical, cognitive, emotional, and social functioning, and examined rates of adverse events over a 6-month period.
There was no change in the analgesic class for at least 6 months for 35.4% of residents, including 40% who received no analgesics during this time. Use of nonopioids was 37.9%, short-acting opioids was 18.9%, and long-acting opioids was 3.3%. We found improvement in functional status (adjusted hazard ratio = 1.85; 95% confidence interval [CI], 1.05-3.23) and social engagement (adjusted hazard ratio = 1.58; 95%, CI, 0.99-2.50) with long-acting opioids compared with short-acting opioids. There were no changes in cognitive status or mood status, or increased risk of depression with use of any analgesics, including opioids. There was a trend toward a lower risk of falls with use of any analgesics (adjusted odds ratio = 0.87; 95% CI, 0.70-1.06). Rates of other adverse events (i.e., constipation, delirium, dehydration, pneumonia) were not found to be higher among chronic opioid users compared to those taking no analgesics or nonopioids.
The use of long-acting opioids may be a relatively safe option in the management of persistent nonmalignant pain in the nursing home population, yielding benefits in functional status and social engagement.

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    • "The complete federal database consists of over 1.5 million older adults who live in NHs throughout the United States. Although it is used primarily for clinical purposes, the MDS has also been used for research on cognition and behavioral symptoms in this population [21-23]. Several MDS subscales have been created and evaluated, and have demonstrated acceptable reliability and validity: MDS-Pain severity scale [24], MDS-Depression Rating Scale [25], MDS-Aggression Behavior Scale [26], MDS-Challenging Behavior Profile [27], MDS-Discomfort Behavior Scale [28], MDS-Cognitive Performance Scale [28,29], MDS-index of social engagement [30,31], MDS-Activities of Daily Living scale [32,33], Resident Assessment Instrument-Mental Health [34], and MDS-Change in Health, End-stage disease and Signs and Symptoms [35]. "
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    ABSTRACT: Nursing home residents with dementia gradually lose the ability to process information so that they are less likely to express pain in typical ways. These residents may express pain through disruptive behaviors because they cannot appropriately verbalize their pain experience. The objective of this study was to investigate the effect of pain on disruptive behaviors in nursing home residents with dementia. This is a secondary analysis of the Minimum Data Set (MDS 2.0) assessment data on long-term care from the state of Florida. The data used in this study were the first comprehensive assessment data from NH residents with dementia aged 65 and older (N = 56,577) in Medicare- or Medicaid-certified nursing homes between January 1, 2009 and December 31, 2009. Variables examined were pain, wandering, aggression, agitation, cognitive impairment, activities of daily living impairments, and demographic characteristics. Ordinal logistic regression was used to evaluate the effect of pain on disruptive behaviors. Residents with more severe pain are less likely to display wandering behaviors (OR = .77, 95% CI for OR = [0.73, 0.81]), but more likely to display aggressive and agitated behaviors (OR = 1.04, 95% CI for OR = [1.01, 1.08]; OR = 1.17, 95% CI for OR = [1.13, 1.20]). The relationship between pain and disruptive behaviors depends on the type of behaviors. Pain is positively correlated with disruptive behaviors that do not involve locomotion (e.g., aggression and agitation), but negatively related to disruptive behaviors that are accompanied by locomotion (e.g., wandering). These findings indicate that effective pain management may help to reduce aggression and agitation, and to promote mobility in persons with dementia.
    BMC Geriatrics 02/2013; 13(1):14. DOI:10.1186/1471-2318-13-14 · 1.68 Impact Factor
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    • "Adjuvants such as anxiolytics, antidepressants, hypnotics, etc. may be added at every step of the WHO analgesic ladder. There are only a few published papers describing the use of pain-treatment pharmaceuticals in people with dementia and most of them focus on single groups of analgesics [13] [14] [15] [16] [17]. Moreover, there is limited information on the economical costs of pain treatment in these patients. "
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    ABSTRACT: Background: Pain prevalence is high among elderly people, and equally prevalent in those with dementia. The aim of this study was to describe the use analgesics, as well as the cost of these treatments in old people with dementia. Methods: We used a cross-sectional design using 1186 cases registered by the Registry of Dementias of Girona from 2007 to 2008. All drugs were categorized following the Anatomic Therapeutic Chemical classification and grouped according to the World Health Organization (WHO) analgesic ladder steps. Descriptive statistical methods were used. Results: Analgesics were prescribed to 78.6% (95% CI, 76.2-81.0) of the registered cases. Of them, 80.6% (95% CI, 78.0-83.2) were treated following step 1 of the WHO analgesic ladder, 16.8% (95% CI, 14.4-19.3) following step 2 and 2.6% (95% CI, 1.5-3.6) following step 3. Pain treatment in old people with dementia had a cost of 42.1 € per patient and year, with no significant differences depending on the subtype of dementia. Conclusions: The use of analgesics in our sample was not associated to age or to dementia severity, which are themselves risk factors for increased pain. Moreover, no differences were detected depending on the subtype of dementia.
    The International journal of neuroscience 12/2012; 123(5). DOI:10.3109/00207454.2012.761216 · 1.52 Impact Factor
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    • "This study makes an important contribution to the literature on the dynamics of health status among nursing home residents. Previous studies have examined changes in physical function (Carpenter, Hastie, Morris, Fries, & Ankri, 2006; Finlayson, Mallinson, & Barbosa, 2005; Sloane et al., 2005), pain (Won et al., 2006), and risk factors for decline in health and function (Corbett, Crogan, & Short, 2002; Crogan & Corbett, 2002; McConnell, Pieper, Sloane, & Branch, 2002; Sato, Demura, Minami, & Kasuga, 2002; Saxer, Halfens, Muller, & Dassen, 2005). To our knowledge, however, few studies have examined longitudinal changes in QOL in the nursing home setting. "
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    ABSTRACT: Previous research on nursing home resident quality of life (QOL) has mainly been cross-sectional. This study examined the association between changes in QOL and changes in resident clinical factors. A longitudinal study of resident QOL was conducted in two nursing homes. Self-report interviews using a multidimensional measure of QOL were linked with clinical data from the Minimum Data Set. Five waves of interviews were conducted at 6-month intervals. Residents with one or more Stage II or higher pressure ulcers for two consecutive 6-month periods reported declines in autonomy, security, and spiritual well-being QOL domains; those with declines in physical disability reported declines in the dignity domain. Increases in depressive symptoms were associated with decreases in comfort, meaningful activities, and food enjoyment domains, and increases in pain were associated with decreases in functional competence and dignity domains. There is evidence of an association between physical health and self-reported QOL. However, not every dimension of QOL exhibited the same pattern. Further research is needed on the link between specific clinical factors and aspects of QOL.
    The Gerontologist 11/2008; 48(5):584-92. DOI:10.1093/geront/48.5.584 · 3.21 Impact Factor
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