Examples of physiological changes associated with aging which may influence to effects of analgesics (Coldrey et al. 2011; AGS 2009)

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... study is part of a research program on pain management ("Pain Alleviation and its Effectiveness") in the Department of Nursing Science at the University of Eastern Finland (http://www.uef.fi/hoitot/tutkimusohjelma). A number of physiological changes associated with aging (Table 1) may lead to alterations in the pharmacokinetics and pharmacodynamics of analgesics (Camacho-Soto, Sowa & Weiner 2011;Coldrey, Upton & Macintyre 2011;AGS 2009). The distribution of the drug is altered because an increase in fat to lean body weight ratio and a decrease in intracellular body water causing prolonged half time and accumulation of the lipophilic drugs (Coldrey, Upton & Macintyre 2011;AGS 2009). ...

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... opioids include codeine, tramadol and buprenorphine. The potential adverse effects of weak opioids are presented in Table 10. Tramadol is a typical centrally acting analgesic (Coldrey, Upton & Macintyre 2011). ...

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... though these are effective analgesics, they may not provide adequate pain relief if used as the sole agents for the management of moderate to severe acute pain in the currently recommended doses ( Thevenin et al. 2008). Tramadol causes less respiratory depression and constipation than other opioids ( Macintyre et al. 2010); however, its use is associated with postoperative delirium (Table 10), (Brouquet et al. 2010). Significant respiratory depression has only been described in patients with severe renal failure (Barnung SK, Treschow M & Borgbjerg 1997). ...

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... shows a distinct benefit in improving neuropathic pain symptoms, which is considered a result of its specific pharmacological profile ( Pergolizzi et al. 2008). Buprenorphine-related adverse effects (Table 10) include, e.g., constipation, nausea, vomiting, allergic reactions (to transdermal patch), drowsiness, confusion, and respiratory effects (Naing, Aung & Yeoh 2012). In the case of all opioids apart from buprenorphine, the half-life of the active drug and metabolites is increased with advanced age and in patients with renal dysfunction ( Pergolizzi et al. 2008). ...

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... is recommended as a first-line analgesic for treatment of pain in older people because it is safe in doses smaller than 4g per day ( Abdulla et al. 2013;AGS 2009;. Paracetamol can be routinely used on a regular basis for relieving postoperative pain ( Griffiths et al. 2012;Jahr et al. 2012;Björkelund et al. 2010;Macintyre et al. 2010;Cuvillon et al. 2007;Myles & Power 2007) (Table 11). However, in geriatric care, this adverse effect can be avoided, when administering drugs in therapeutic doses (≤4g/24 hours) ( Abdulla et al. 2013; AGS 2009). ...

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... in geriatric care, this adverse effect can be avoided, when administering drugs in therapeutic doses (≤4g/24 hours) ( Abdulla et al. 2013; AGS 2009). Adverse effects of NSAIDs are significant and may limit their use (Table 12) . According to previous studies, a five to seven day use of certain classical NSAIDs in older people may result in gastroduodenal ulceration rates in the range of 20- 40% (Shug & Manopas 2007). ...

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... To find out which model predicts the factors associated to nurses' opinion of sufficient pain management. The study consisted of five substudies (Table 14). In papers I and II the study population consisted of all the respondents. ...

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... response rates were 53% (Article I), 52% (Article II), and 54% (Article III and IV). The response rates per each hospital are presented in Table 13. 1 ...

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... addition, there were questions concerned with the operational prerequisites offered by employers and expectations of nurses to overcome the barriers to postoperative pain management in hip fracture patients with dementia. The first part of the questionnaire focused on demographic information (For detailed information, see Table 15 and Appendix 1), including hospital, gender, age, occupation, work experience in current unit and work experience in health care, contract, employment arrangements and work shifts. Other background information included participation in update training, opinions regarding the primary aim of pain management and the sufficiency of postoperative pain management (See Table 16). ...

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... first part of the questionnaire focused on demographic information (For detailed information, see Table 15 and Appendix 1), including hospital, gender, age, occupation, work experience in current unit and work experience in health care, contract, employment arrangements and work shifts. Other background information included participation in update training, opinions regarding the primary aim of pain management and the sufficiency of postoperative pain management (See Table 16). In addition, respondents were asked about participation in the administration of analgesics (Appendix 1). ...

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... of < 0.05 was considered to be statistically significant.The structure validity of the subscale "nursing practices in postoperative pain management in hip fracture patients with dementia" (Article I) was evaluated by explorative factor analysis and reliability by the means of Spearman correlation coefficients for both total scale and subscales (Article I and II). The specific research themes, data, analysis and reporting of this study are indicated in Table 14. Postoperative pain management practices in patients with dementia (Article I) The Two Independent Samples T-test and Analysis of Variance were used to investigate whether there were significant differences in the responses of the nurses based on background variables. ...

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... one third of the nurses had work experience of less than five years in their current unit. The detailed characteristics of the study (I-IV) participants are presented in Table 15 Table 15. Characteristics of the respondents in articles I-IV (n, %). ...

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... of the respondents in articles I-IV (n, %). (40) 152 (46) 46 (14) 131 (40) 151 (46) ..37 (14) 118 (44) 111 (42) 37 (14) 117 (44) ˡOther: three students and a physiotherapist Over half of the participants were of the opinion that postoperative pain management is sufficient in hip fracture patients with dementia (Table 16). The majority of the nurses also agreed that slight pain that does not prevent normal functioning, is the primary aim of postoperative pain management. ...

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... differences were found in age groups, work experience in health care and in current unit. Nurses younger than 36 years, and those with less than five years of work experience in their current unit or in health care, stated significantly more often that pain management is sufficient in hip fracture patients with dementia as compared with other groups (See Table 17). ..32 (70) ..76 (60) ..62 (42) 0.001 ...

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... results (Table 18) indicate that preferred methods in pain management among nurses in their units were "hip-fracture specific pain management practices", i.e., repositioning, helping with daily activities and cold applications. The most common analgesic administration practices included providing pain medication prior to painful events, before physical activity and regularly. ...

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... barriers to postoperative pain management in hip fracture patients with dementia were asked about with an open-ended question (Table 19). -related barriers to postoperative pain management in hip fracture patients with dementia as a result of an analysis of the open ended-question Potential patient related barriers to pain management in hip fracture patients with dementia Behavior Consequences Problems with swallowing Inability to swallow oral analgesics. ...

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... model for nurses' opinion that pain management in hip fracture patient is sufficient was created by analyzing the variables associated with this opinion (Table 21). According to the logistic regression analysis, applying "analgesics treatment practices" in the current unit (OR 3.64, 95% CI 2.02-6.55) ...

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... in work experience in the current unit (OR per 1 years decrease) (OR 0.96, 95% CI 0.94-0.99) was significantly associated with the opinion that pain management is sufficient (Table 18). Less often identified barriers (OR 0.43, 95% CI 0.24-0.78) ...