Analgesic use among nursing homes residents, with and without dementia, in Poland

Abstract

Many age-associated diseases are accompanied by pain. There is no doubt that pain is underrecognized among elderly nursing home residents and the diagnosing of pain is a real challenge in subjects with dementia. The aim of the study was to characterize analgesic use among nursing home residents and to delineate the putative associations between pain management and cognitive functions of elderly persons. The study involved 392 subjects (males:females – 81:311) with a mean age of 83.6±5.9 years. The residents’ medical files in relation to diagnoses and drug consumption were analyzed, and the screening of cognitive functions was performed using the Mini-Mental State Examination (MMSE). One hundred and thirteen residents (28.8%) received some analgesics. Among them 84 (21.4%) used them routinely, 25 (6.4%) – pro re nata (PRN) and four (1.0%) – both routinely and PRN. Non-opioid analgesics were taken routinely by 53 residents, weak opioids by nine subjects, and one person was receiving strong opioids. Additionally, three individuals were taking a combination preparation of tramadol and acetaminophen. The rate of subjects who were not receiving any pain treatment was higher in residents with MMSE between 0 and 9 points than in those with MMSE between 24 and 30 points (P=0.0151). Furthermore, ten residents (9.1%) with severe dementia were treated with analgesics PRN. The results of our study point to a remarkably low use of analgesics in nursing home residents in Poland and indicate a need to introduce pain evaluation and monitoring of drug treatment appropriateness as a standard procedure in the geriatric assessment in nursing homes.

Prevalence of Chronic Pain, Particularly with Neuropathic Component, and Its Effect on Overall Functioning of Elderly Patients

“…Unfortunately, medical practitioners are often negligent in failing to appropriately administer analgesics to elderly patients with severe pain, and in the present study we found that 4 residents of assisted living communities declared that they did not receive pain medication ‘as needed’. Similar evidence was obtained by Podczaska et al in their survey among assisted living community residents in Poland, finding that only 1 of 3 of them received analgesics, mostly NSAIDs, and only 2 persons out of 113 were taking paracetamol [28]. In the present study, more patients received analgesics with higher paracetamol and opioids consumption, but NSAID use was also common, which is against the chronic pain management guidelines [1].…”

“…Furthermore, Podczaska et al and other authors have pointed out other worrisome trend – people with symptoms of dementia were less likely to receive analgesics than were other older adults [28]. In this study, no relationship between current treatment and AMTS tool score was discovered, but people with severe dementia were not included.…”

Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia

“…Interestingly, in our previous retrospective study of pain treatment in NHR, we showed that less than 15% of those with moderate to severe cognitive impairment were treated for pain. 24 A higher percentage of treated subjects in our current study may suggest that the phenomenon of pain undertreatment in Poland may be on a downward trend due to enhanced efforts regarding education of medical staff on both proper pain diagnosis and treatment. A similar tendency was also observed by Sandvik et al 25 who showed that the analgesic drug prescription increased significantly from 2000 to 2011, especially the use of paracetamol and strong opioids.…”

“…Due to the heterogeneity of different classes of coanalgesics, some of them could be prescribed due to other comorbidities, not necessarily for the treatment of pain; a similar approach has also been applied by other authors. 22 – 24 , 27 , 28 …”

Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries: results of PACE

“…In both countries, opioid prescription per capita was found to be lower than in other West-European countries 18 . Opioid prescription in LTCFs may reflect the low prevalence in both countries 7 , 19 in general. Although death is not often easily predictable in LTCF residents, prevalence of pain increases to 78% and shortness of breath to 52% in the last week of life 16 .…”