Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis

Knopp-Sihota, Jennifer; MacGregor, Tara; Reeves, Jennifer; Kennedy, Megan; Saleem, Ahsan

doi:10.1016/j.jamda.2022.04.008

Cited by 16 publications

(6 citation statements)

References 78 publications

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“…При неинтенсивной боли (по визуальной аналоговой шкале до 40 мм) следует рассмотреть возможность назначения местных форм нестероидных противовоспалительных препаратов (НПВП) [20]. При интенсивной боли, а также в случае недостаточного эффекта местных форм НПВП следует рассмотреть возможность использования системных форм в минимальных дозах и сроках, необходимых для контроля боли [21,22].…”

Section: особенности терапии хронической боли у пациентов пожилого и ...unclassified

Chronic pain in elderly and senile patients: clinical recommendations and difficulties in real practice

Naumov,

Khovasova,

Polyanskaya

et al. 2023

Russian Medical Inquiry

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Chronic pain syndrome is one of the most common geriatric syndromes, it has an impact on person’s self-management, worsens the life quality and shortens life expectancy. Reduced mobility, the need for external assistance due to chronic pain lead to an increase in the costs of the healthcare system. The peculiarity of the elderly and senile patient management with chronic pain is the need to assess not only the pain syndrome itself, but also polymorbid pathology and other geriatric syndromes that affect the pain pathogenesis. A patient-centered care for elderly persons with chronic pain, developed on the basis of a comprehensive geriatric assessment, should include interventions aimed at correcting geriatric syndromes, the range and activity of movements and the pain negative consequences. The drug treatment of pain syndrome is determined by its intensity and the risks of developing adverse events (especially in the case of nonsteroidal anti-inflammatory drugs). The most correct treatment tactics of chronic pain is the basic therapy indication for diseases that cause the pain development. KEYWORDS: chronic pain, geriatric syndromes, comprehensive geriatric assessment, osteoarthritis, autonomy, mobility, nonsteroidal anti- inflammatory drugs, symptomatic slow-acting drugs. FOR CITATION: Naumov A.V., Khovasova N.O., Polyanskaya A.R., Tokareva L.G., Tkacheva O.N. Chronic pain in elderly and senile patients: clinical recommendations and difficulties in real practice. Russian Medical Inquiry. 2023;7(10):680–686 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-10-11.

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Section: особенности терапии хронической боли у пациентов пожилого и ...unclassified

Chronic pain in elderly and senile patients: clinical recommendations and difficulties in real practice

Naumov,

Khovasova,

Polyanskaya

et al. 2023

Russian Medical Inquiry

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“… 5 , 6 Nonpharmacological interventions offer a promising alternative for pain management in older adults. 7 As the aging population in the United States is expected to more than double by 2050, chronic pain will become a more serious problem in older adults with cognitive impairment. 8 Thus, there is an imperative need to develop scalable behavioral interventions for pain designed for older adults with cognitive concerns.…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic review reported that nondrug interventions such as exercise and acupressure were highly effective in the management of pain in older adults in long-term care. 7 Furthermore, nonpharmacological interventions such as hypnosis, acupuncture, and natural sounds reduced pain intensity for participants in an intensive care unit. 15 Nutrition is also a promising nonpharmacological intervention that has shown benefits for pain.…”

Section: Introductionmentioning

confidence: 99%

Addressing Pain Using a Mediterranean Ketogenic Nutrition Program in Older Adults with Mild Cognitive Impairment

Klejc,

Cruz-Almeida,

Sheffler

2024

JPR

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Chronic pain has negative physical and cognitive consequences in older adults and may lead to a poorer quality of life. Mediterranean ketogenic nutrition (MKN) is a promising nonpharmacological intervention for pain management, but long-term adherence is challenging due to the carbohydrate restrictive diet regimen. The main objective of this study was to evaluate the effects of the pilot MKN Adherence (MKNA) Program on pain in older adults with mild cognitive impairment and to assess whether improvements in self-reported pain were associated with adherence to MKN. Older adults (N = 58) aged 60–85 with possible mild cognitive impairment were randomized to a 6-week MKNA arm or an MKN Education (MKNE) program arm. Both arms received the same nutrition education and group format; however, the MKNA arm received additional motivational interviewing and cognitive behavioral skills to enhance adherence. Changes in self-reported pain (Brief Pain Inventory, Roland Morris, Patient’s Global Impression of Change) and adherence to MKN (ketone levels, self-reported adherence) were assessed at baseline, 6-weeks, and 3-months post intervention. Both arms showed clinically significant reductions in pain. Greater adherence to MKN across the 6-week intervention was associated with higher ratings of pain-related changes on the Patient’s Global Impression of Change scale. Based on these findings, adherence to MKN may promote improvements in self-reported pain in older adults with mild cognitive impairment and findings support the need for future full-scale randomized clinical trials evaluating MKN programs on pain. Trial Registration: Clinicaltrials.gov ID: NCT04817176

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“…For example, the prevalence and chronicity of pain among LTC residents is under-detected and pain is therefore often inadequately managed [ 4 ]. As a result, residents can experience reduced quality of life with impaired physical and cognitive functioning, poor emotional and mental well-being, and increased social isolation [ 5 ]. Polypharmacy (> 9 concurrent medications) and overuse of specific agents such as antipsychotics and opiates are common in LTCs and can increase the risk of adverse events including cerebrovascular accidents, cognitive deterioration, and falls [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)

Hibbert,

Molloy,

Cameron

et al. 2024

BMC Med

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Background This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. Methods Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. Results Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. Conclusions This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.

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Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis

Cited by 16 publications

References 78 publications

Chronic pain in elderly and senile patients: clinical recommendations and difficulties in real practice

Chronic pain in elderly and senile patients: clinical recommendations and difficulties in real practice

Addressing Pain Using a Mediterranean Ketogenic Nutrition Program in Older Adults with Mild Cognitive Impairment

The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)

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