Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls

Abstract

BackgroundThe evidence of undertreatment of pain in patients with dementia is inconsistent. This may largely be due to methodological differences and shortcomings of studies. In a large cohort of patients with incident dementia and age- and sex-matched controls we examined (1) how often they receive diagnoses indicating pain, (2) how often they receive analgesics and (3) in which agents and formulations.MethodsUsing health insurance claims data we identified 1,848 patients with a first diagnosis of dementia aged ≥ 65 years and 7,385 age- and sex-matched controls. We analysed differences in diagnoses indicating pain and analgesic drugs prescribed between these two groups within the incidence year. We further fitted logistic regression models and stepwise adjusted for several covariates to study the relation between dementia and analgesics.ResultsOn average, patients were 78.7 years old (48% female). The proportions receiving at least one diagnosis indicating pain were similar between the dementia and control group (74.4% vs. 72.5%; p = 0.11). The proportion who received analgesics was higher in patients with dementia in the crude analysis (47.5% vs. 44.7%; OR: 1.12; 95% CI: 1.01-1.24), but was significantly lower when adjusted for socio-demographic variables, care dependency, comorbidities and diagnoses indicating pain (OR: 0.78; 95% CI: 0.68-0.88). Analgesics in liquid form such as metamizole and tramadol were more often used in dementia.ConclusionsOur findings show a comparable documentation of diagnoses indicating pain in persons with incident dementia compared to those without. However, there still seems to be an undertreatment of pain in patients with dementia. Irrespective of dementia, analgesics seem to be more often prescribed to sicker patients and to control pain in the context of mobility.

Who gets dipyrone (metamizole) in Germany? Prescribing by age, sex and region

“…One explanation might be the lack of serious interactions with other drugs or diseases compared to alternatives, an issue highly relevant in older patients using multiple drugs. Furthermore, it is well known that women receive more analgesics including metamizole than men, which was also found in our study. The large regional variations are also of interest.…”

“…We found that every 15th person in this German cohort received at least one prescription of metamizole with increasing prevalence with age. Other studies have also shown that metamizole is commonly prescribed in older persons including nursing home residents . One explanation might be the lack of serious interactions with other drugs or diseases compared to alternatives, an issue highly relevant in older patients using multiple drugs.…”

“…Persons living outside Germany were excluded. We selected metamizole according to the anatomical therapeutic chemical (ATC) code N02BB02 …”

Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany

“…Besides the levels of care dependency indicating physical disabilities we also used the number of prescribed medications as a measure of health status like in a recent paper [26]. It has been shown that the number of distinct medications prescribed performed well as a predictor for health services utilization and mortality in older persons [27].…”

Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings

“…A number of studies internationally have identified that pain is often substantially undertreated or untreated in geriatric patients (Daoust et al, 2014, Lukas et al, 2013, Morrison and Siu, 2000, Niruban et al, 2010, and that people with dementia are significantly less likely to receive analgesia than their cognitively intact counterparts (Closs et al, 2004, Hoffman et al, 2014, Morrison and Siu, 2000. There are particular issues with the management of pain for older patients in acute hospital settings (Atkinson and Almahdi, 2014, Carr et al, 2014, Chang et al, 2010, Lin et al, 2014, Niruban et al, 2010.…”