Prevalence of Analgesic Use and Pain in People with and without Dementia or Cognitive Impairment in Aged Care Facilities: A Systematic Review and Meta-Analysis

Tan, Edwin C.K.; Jokanovic, Natali; Koponen, Marjaana; Thomas, Dennis; Hilmer, Sarah N.; Bell, J. Simon

doi:10.2174/157488471003150820144958

Cited by 71 publications

(72 citation statements)

References 25 publications

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“…In older people in the community and in residential aged care, the prevalence of pain has been reported to range from 20 to 46 % and from 28 to 73 %, respectively [25,43,44]. The prevalence of pain in our study was consistent with previous reports.…”

Section: Discussionsupporting

confidence: 92%

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Wimmer

Johnell

Fastbom

et al. 2015

Eur J Clin Pharmacol

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Older people with probable difficulties managing complex regimens, including those with impaired dexterity and living in institutional settings, had the most complex medication regimens even after adjusting for receipt of help to sort medications. The strong correlation between regimen complexity and number of medications suggests that clinicians could use a person's number of medications to target interventions to reduce complexity.

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Section: Discussionsupporting

confidence: 92%

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Wimmer

Johnell

Fastbom

et al. 2015

Eur J Clin Pharmacol

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“…45,46 On the other hand, the lower prevalence of opioid use may indicate the clinical reality of the benefits of reducing sedative ADRs in vulnerable persons with AD. The prevalence and duration of concomitant BZDR and opioid use were higher among persons without AD than among those with AD, although BZDR use was more common in the AD group.…”

Section: Discussionmentioning

confidence: 99%

Concomitant use of benzodiazepines and opioids in community‐dwelling older people with or without Alzheimer's disease—A nationwide register‐based study in Finland

Karttunen

Taipale

Hamina

et al. 2018

Int J Geriat Psychiatry

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Objective The study aims to determine the prevalence of concomitant use of benzodiazepines and opioids among community‐dwelling older people with or without Alzheimer's disease (AD). An additional aim was to describe the factors associated with prolonged concomitant use, and the most commonly used combinations of these drugs. Methods This study utilized data from the register‐based Medication Use and Alzheimer's disease (MEDALZ) study, including all community‐dwelling residents of Finland who received a clinically verified AD diagnosis between 2005 and 2011 (n = 70 718) and their matched comparison persons without AD. After exclusion of individuals who were hospitalized throughout the follow‐up, 69 353 persons with and 69 353 without AD were included in this study. Results Benzodiazepines and related drugs (BZDRs) were used by 28 475 (41.1%) of those with and 24 506 (35.3%) of those without AD. Prolonged (greater than or equal to 90 days) concomitant use of BZDRs and opioids was more common among BZDR users without AD (N = 3936; 16.1%) than among those with AD (N = 2963; 10.4%). A shorter duration of concomitant use (1‐89 days) revealed similar results, N = 3821; 15.6% and N = 3008; 10.6%, respectively. Prolonged concomitant use of BZDRs and opioids was associated with female sex, low socioeconomic position, most of the common comorbidities and history of substance abuse or long‐term benzodiazepine use. The most commonly used combinations were Z‐drug (31.7%) or benzodiazepine (29.9%) with a weak opioid. Conclusions Despite the recommendations and risks, the prevalence of concomitant BZDR and opioid use was common in older persons with or without AD. It is important to develop strategies to reduce unnecessary concomitant use of these drugs.

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“…This will include a dementia-specific, clinician-administered observational scale (Pain Assessment in Advanced Dementia (PAINAD) Scale) and a resident self-report scale (FACES Pain Scale Revised (FPS-R)). The resident self-report scale will be used in addition to the observational scale because observational scales may underestimate pain in people with dementia 6 19. The scales will be administered when each resident is at rest.…”

Section: Methodsmentioning

confidence: 99%

Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol

et al. 2014

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IntroductionPeople living with dementia may experience and express pain in different ways to people without dementia. People with dementia are typically prescribed fewer analgesics than people without dementia indicating a potential difference in how pain is identified and treated in these populations. The objectives of this study are to (1) investigate the prevalence of analgesic load, pain and daytime sedation in people with and without dementia in Australian residential aged care facilities (RACFs), and (2) investigate the clinical and diagnostic associations between analgesic load, pain and daytime sedation in people with and without dementia in Australian RACFs.Methods/analysisThis will be a cross-sectional study of 300 permanent residents of up to 10 low-level and high-level RACFs in South Australia with and without dementia. Trained study nurses will administer validated and dementia-specific assessments of self-reported and clinician-observed pain, sedation and other clinical and humanistic outcomes. Medicine-use data will be extracted directly from each resident's medication administration chart. Binary and multinominal logistic regression will be used to compute unadjusted and adjusted ORs and 95% CIs for factors associated with pain, analgesic load and daytime sedation. These factors will include dementia severity, behavioural and psychological symptoms, quality of life, resident satisfaction, attitudes towards medicines, activities of daily living and nutritional status.Ethics and disseminationInstitutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences and in peer-reviewed journal articles. The findings of this study will allow for a better understanding of the prevalence and factors associated with analgesic use, pain and other outcomes in residential care. The findings of this study will be used to inform the development and implementation of strategies to improve the quality of life of people with dementia.

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Prevalence of Analgesic Use and Pain in People with and without Dementia or Cognitive Impairment in Aged Care Facilities: A Systematic Review and Meta-Analysis

Cited by 71 publications

References 25 publications

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Concomitant use of benzodiazepines and opioids in community‐dwelling older people with or without Alzheimer's disease—A nationwide register‐based study in Finland

Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol

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