Pain treatment for nursing home residents differs according to cognitive state – a cross-sectional study

Abstract

BackgroundCommunication skills are known to decrease with advancing cognitive impairment. Analgesic treatment in long-term care may be deficient due to the residents’ impaired ability to communicate their pain and needs. Undertreated pain frequently leads to rising BPSD in residents with cognitive impairment, resulting in a treatment with antipsychotics. Aim of this study was the analysis of differences in assessment and pharmacological treatment of pain in nursing home residents relative to their cognitive state and ability to articulate pain.MethodsData stems from the baseline of a non-experimental pre-post-study in 12 Austrian nursing homes. Residents’ pain prevalence in relation to pain assessment and cognitive decline was assessed, data on medical diagnoses and prescriptions were retrieved from the nursing homes’ documentation (n = 425). Residents were first divided into two groups: Residents with MMSE ≥ 18 were selected into group CUS (cognitively unimpaired/slightly impaired), residents with MMSE ≤ 17 were selected into group CI (cognitively moderately to severely impaired). CI residents were then sub-grouped according to their ability to communicate pain via the Verbal Rating Scale (VRS) (i.e. group CI-V, group CI-NV). Pain behavior of CI residents was assessed with a modified German version of PAINAD. Group differences were tested with ANOVA and H-test, 95 % confidence intervals were calculated and associations were tested with log-binomial regression.ResultsPain prevalence in CI residents irrespective of their ability to communicate pain was 80 % and exceeded the CUS group prevalence significantly by 14 %. CI residents had significantly less analgesic prescriptions. Furthermore, CI residents have a significantly higher risk of getting no analgesics when in pain than CUS residents (CI-V: RR =2.6, CI-NV: RR =3.4). Use of antipsychotics was high in all groups (49 – 65 %) with more prescriptions in the cognitively impaired group.ConclusionResults point toward an underuse of pain medication in cognitively impaired residents, especially those unable to communicate pain verbally. The implementation of standardized pain assessments adapted to the cognitive abilities of residents may foster the recognition of pain, warrant optimized pain management, reduce inadequate medication and consequently raise the chance of equally effective pain treatment regardless of cognitive state.

Depression and cognitive impairment among newly admitted nursing home residents in the USA

“…Sixty-one percent of the 1.4 million nursing homes residents in the USA in 2014 had moderate or severe cognitive impairment (Centers for Medicare and Medicaid Services, 2015a). Cognitive impairment is associated with negative outcomes such as low levels of thriving, pain, and intentional self-harm (Patomella et al, 2016;Björk et al, 2016;Bauer et al, 2016;Neufeld et al, 2015). Cognitive impairment has also been shown to be inversely associated with receipt of depression treatment in nursing homes (Brown et al, 2002).…”

Mobilitätseinschränkungen bei Altenheimbewohnern

“…Die Schmerzprävalenz liegt hier bei bis zu 79,5 % [4, 13,23], mit häufig zugrunde liegenden muskuloskeletalen, gastrointestinalen oder kardialen Erkrankungen [4,23]. Ergebnisse aus 13 deutschen Altenpflegeeinrichtungen zeigen, dass Schmerz vor allem in den unteren Extremitäten sowie bei Bewegung/Belastung auftritt und bei 75 % der Bewohner chronisch ist [13].…”

“…60 %, 400.000 in Deutschland) haben zudem kognitive Einschränkungen, mit stetig steigendem Anteil [15]. Schmerz und kognitive Einschränkung treten vielfach gemeinsam auf [2,10] und Schmerz wird aufgrund der verminderten Mitteilungsfähigkeit [4,13,19] nicht ausreichend erkannt und somit nur unzureichend oder gar nicht therapiert [4,6,17].…”

Palliativversorgung in Pflegeheimen

“…titelten Sandgathe Husebø u. Husebø [24] vor 15 Jahren und führten zahlreiche Argumente ins Feld, die die Bedeutung von Palliative Care im Pflegeheim unterstreichen und bis heute nicht an Gültigkeit verloren haben: Pflegeheimbewohner sind zumeist komplex krank [20], viele von ihnen leiden an Demenz und können Schmerzen nur schwer artikulieren [19], weshalbBewohnermitmittelgradiger bis schwerer kognitiver Beeinträchtigung ein erhöhtes Risiko einer schmerztherapeutischen Unterversorgung aufweisen [3]. Wissenslücken in Palliative Care bei Pflegekräften und Hausärzten (z.…”