Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review

Rekatsina, Martina; Paladini, Antonella; Viswanath, Omar; Urits, Ivan; Myrcik, Dariusz; Pergolizzi, Joseph V.; Breve, Frank; Varrassi, Giustino

doi:10.1007/s40122-022-00376-y

Cited by 9 publications

(7 citation statements)

References 81 publications

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“…However, the finding that being prescribed analgesics was associated with poorer QoL may necessitate that pain treatment in NH residents with dementia is given broader attention by healthcare professionals. Interdisciplinary awareness of challenges related to pain [ 94 ] and collaboration between nurses, physicians, and pharmacists are essential to effectively assessing and treating pain, to evaluating the effect of pain treatment, and to identifying potential side effects [ 34 ]. The application of criteria-based screening tools such as the STOPP/START criteria (Screening Tool of Older Person’s Prescriptions/Screening Tools to Alert Doctors to Right Treatment) [ 78 ] and the Norwegian General Practice–Nursing Home criteria (NORGEP-NH) [ 77 ] may contribute to appropriate prescription and deprescription of analgesics to NH residents with dementia.…”

Section: Discussionmentioning

confidence: 99%

Pain and quality of life in nursing home residents with dementia after admission – a longitudinal study

Helvik,

Bergh,

Šaltytė Benth

et al. 2023

BMC Health Serv Res

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Background Pain in nursing home (NH) residents with dementia is commonly reported and may affect Quality of Life (QoL) negatively. Few longitudinal studies have explored how pain and QoL develop in NH residents with dementia starting from their admission to the NH. Aim The aim was to explore pain, QoL, and the association between pain and QoL over time in persons with dementia admitted to a NH. Methods A convenience sample, drawn from 68 non-profit NHs, included a total of 996 Norwegian NH residents with dementia (mean age 84.5 years, SD 7.6, 36.1% men) at NH admission (A1), with annual follow-ups for two years (A2 and A3). Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively, at all assessments. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the prescription of psychotropic drugs and analgesics (opioids and/or paracetamol) were also assessed at all assessments. Results Mean (SD) MOBID-2 pain intensity scores were 2.1 (2.1), 2.2 (2.2), and 2.4 (2.1) at A1, A2, and A3, respectively. Participants who were prescribed analgesics had higher pain intensity scores at all assessments than participants not prescribed analgesics. The mean (SD) QUALID scores at each assessment were 19.8 (7.1), 20.8 (7.2), and 22.1 (7.5) at A1, A2, and A3, respectively. In the adjusted linear mixed model, higher pain intensity score, prescription of opioids, and prescription of paracetamol were associated with poorer QoL (higher QUALID total score and higher scores in the QoL dimensions of sadness and tension) when assessed simultaneously. No time trend in QoL was found in these adjusted analyses. Conclusion NH residents with dementia who have higher pain intensity scores or are prescribed analgesics are more likely to have poorer QoL. Clinicians, NH administrators, and national healthcare authorities need to look into strategies and actions for pharmacological and non-pharmacological pain treatment to reduce pain intensity while simultaneously avoiding negative side effects of pain treatment that hamper QoL.

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Section: Discussionmentioning

confidence: 99%

Pain and quality of life in nursing home residents with dementia after admission – a longitudinal study

Helvik,

Bergh,

Šaltytė Benth

et al. 2023

BMC Health Serv Res

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“…Appropriate analgesia may reduce pain and its associated cognitive impairment. The lack of sensitivity of the medical staff in recognizing pain based on non-verbal cues/pain-related behavior in people suffering from cognitive impairment is a known cause of suboptimal pain management in this population [ 48 , 49 ]. Untreated pain is considered to be one of the causes of challenging behavior, such as agitation or aggression in people with dementia [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

The role of qualification and quality management in the prescription of antipsychotics and potentially inappropriate medication (PIM) in nursing home residents in Germany: results of the HIOPP-3-iTBX study

Stolz,

Krause,

Junius-Walker

et al. 2023

Aging Clin Exp Res

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Background Nursing home residents (NHR) show high rates of polypharmacy. The HIOPP-3-iTBX study is the first cRCT on medication optimization in nursing homes (NH) in Germany. The intervention did not result in a reduction of PIM and/or antipsychotics. This analysis looks at structure quality in the HIOPP-3-iTBX study participants. Aims Evaluation of structure quality as part of a cluster-randomized controlled intervention study. Methods Structure quality in multiprofessional teams from n = 44 NH (n = 44 NH directors, n = 91 family doctors (FD), and n = 52 pharmacies with n = 62 pharmacists) was assessed using self-designed questionnaires at baseline. Main aspects of the questionnaires related to the qualification of participants, quality management, the medication process and size of the facilities. All completed questionnaires were included. number of PIM/antipsychotics was drawn from the baseline medication analysis in 692 NHR. Data were analyzed by descriptive statistics and mixed model logistic regression. Results The presence of a nurse with one of the additional qualifications pain nurse or Zertifiziertes Curriculum (Zercur) Geriatrie in the participating NH was associated with a lower risk for the prescription of PIM/antipsychotics. No association between any characteristic in the other participants at baseline was observed. Conclusions and discussion The results support the known role of nursing qualification in the quality and safety of care. Further studies need to look more closely at how use is made of the additional qualifications within the multiprofessional teams. Perspectively, the results can contribute to the development of quality standards in NH in Germany.

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“…Constant stimulation, including activities that promote awareness of dates, times, places, and people (such as relatives or family members), can contribute to improved cognitive function in older adult patients during the postoperative period (Kotekar et al, 2018 ). Moreover, practicing relaxation techniques, such as body scans, can help patients concentrate and effectively manage pain, leading to enhanced cognitive perception and reduced symptoms of forgetfulness during the postoperative period (Rekatsina et al, 2022 ). However, no significant difference in cognitive recovery was observed between the groups during the second week of the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Enhancing recovery in older patients undergoing abdominal surgery: Examining the effect of a preoperative preparation program using a quasi-experimental design

Penphumphuang,

Matchim,

Mahawongkhajit

et al. 2023

Belitung Nurs J

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Background: Older adult patients often experience delayed postoperative recovery due to a lack of self-efficacy in engaging in physical activities during early rehabilitation. Concurrently, family caregivers play a crucial role in caring for older adults. However, the extent of family involvement in improving self-efficacy and facilitating recovery following major abdominal surgeries in older adults remains largely unexplored. Objective: This study aimed to examine the effect of a preoperative preparation program on the recovery of older patients undergoing major abdominal surgeries. Methods: A quasi-experimental study with a two-group, pretest-posttest design was conducted. The participants included 60 older adult patients undergoing abdominal surgeries at Thammasat University Hospital, Thailand, between September 2019 and March 2020. Participants were selected by purposive sampling with the inclusion criteria and were assigned to the experimental (n = 30) or the control (n = 30) groups using matched pair according to the type of operation. The control group received standard care, while the intervention group underwent a two-week preoperative preparation program developed based on self-efficacy theory and family support. Data were collected using validated tools. Recovery was assessed at one week and two weeks after surgery. Descriptive statistics, as well as dependent and independent t-tests, were used for data analysis. Results: The results revealed that the intervention group had significantly higher mean recovery scores than the control group at one week (M = 56.93, SD = 16.42; M = 44.60, SD = 16.30, t = -2.92, df = 58, p <0.01) and two weeks after surgery (M = 66.64, SD = 8.63; M = 61.68, SD = 7.86, t= -2.33, df = 58, p <0.05) when comparing between the two groups. Conclusion: The preoperative preparation program effectively enhanced recovery one week and two weeks after surgery. The study findings can be valuable for nurses in implementing the preoperative preparation program to facilitate recovery among older adult patients undergoing abdominal surgeries.

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Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review

Cited by 9 publications

References 81 publications

Pain and quality of life in nursing home residents with dementia after admission – a longitudinal study

Pain and quality of life in nursing home residents with dementia after admission – a longitudinal study

The role of qualification and quality management in the prescription of antipsychotics and potentially inappropriate medication (PIM) in nursing home residents in Germany: results of the HIOPP-3-iTBX study

Enhancing recovery in older patients undergoing abdominal surgery: Examining the effect of a preoperative preparation program using a quasi-experimental design

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