Quality of Life and Pain Medication Use in Persons With Advanced Dementia Living in Long-Term Care Facilities

Dam, Paulien H. van; Caljouw, Monique A. A.; Slettebø, Dagrun D.; Achterberg, Wilco P.; Husebø, Bettina S.

doi:10.1016/j.jamda.2019.02.019

Cited by 18 publications

(29 citation statements)

References 43 publications

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“…This supports previous studies, which have found pain to be associated with NPS and poor QoL. 5,50 However, it was unexpected that no significant differences were found between patients' QoL scores concerning those with pain using analgesics and those with pain not using analgesics, as the aim with analgesic prescription is to reduce the patient's pain and improve their QoL. In future studies, this could be an important focus point when investigating the effect of long-term analgesic use in NH patients.…”

Section: Discussionsupporting

confidence: 90%

Managing Pain and Psychosis Symptoms in Nursing Home Patients: Results from a Cluster-Randomized Controlled Trial (COSMOS)

Habiger

Achterberg

Flo

et al. 2021

Journal of the American Medical Directors Association

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Objectives: In nursing homes (NHs), 30% to 60% of patients experience daily pain and >80% have dementia. This can lead to neuropsychiatric symptoms, including psychosis symptoms such as delusion. We investigated if there was a relationship between pain and psychosis symptoms over time. We also aimed to investigate the effect of a multicomponent intervention (COSMOS) on pain, psychosis symptoms, and analgesic prescription. Design: COSMOS is a cluster-randomized, single blinded, controlled trial. Each NH unit was defined as a cluster and randomized to either the COSMOS intervention or care as usual. The COSMOS intervention is a multicomponent intervention, consisting of staff training in communication, pain treatment, medication review, organization of activities, and safety. The intervention lasted for 4 months with a follow-up at month 9. Setting and Participants: Sixty-seven units from 33 Norwegian NHs in 8 municipalities. The study included 723 patients aged !65 years, residing at the NH !2 weeks before inclusion. Patients with a life expectancy <6 months were excluded. Measures: Pain was measured using the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale. Psychosis symptoms were measured using the Neuropsychiatric InventoryeNH version. Measurements were performed at baseline, and months 4 and 9. Results: Multilevel Mixed-Effect statistical analysis found that psychosis symptoms as a group (odds ratio [OR] 2.03, P ¼ .009), and delusion (OR 2.12, P ¼ .007) were associated with pain over time. No significant intervention effect on psychosis symptoms was observed. Compared with the control group, people with dementia in the intervention group experienced less musculoskeletal pain (b: À0.47, P ¼ .047). Analgesic prescription was not affected by the intervention. Conclusion and Implications:Pain is associated with psychosis symptoms, and pain assessment should be done when making treatment decisions on psychosis symptoms in NH patients. The COSMOS intervention improved musculoskeletal pain in people with dementia, but not psychosis symptoms, and there is need for further studies on treatment of psychosis symptoms in NH patients.

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Section: Discussionsupporting

confidence: 90%

Managing Pain and Psychosis Symptoms in Nursing Home Patients: Results from a Cluster-Randomized Controlled Trial (COSMOS)

Habiger

Achterberg

Flo

et al. 2021

Journal of the American Medical Directors Association

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“…The individual subscale scores will be re‐calculated into a percentage score, as is usual for studies using the QUALIDEM (van Dam et al, , 2019 , 2020 ; Dichter et al, 2015 ; Gräske et al, 2014 ; Oudman & Veurink, 2014 ). We will obtain an overall score by calculating the mean of the summed percentage scores.…”

Section: The Studymentioning

confidence: 99%

“…The primary outcome would be repeatedly obtained from the same participants within each cluster (nursing home), as in previous similar studies (Aegerter et al, 2020 ). Based on previous QUALIDEM results, we assumed a baseline mean of 71.3 and a standard deviation of 16.7 (van Dam et al, 2019 ). The number of nursing homes was set to 20 with three cluster groups.…”

Section: The Studymentioning

confidence: 99%

Improving caring quality for people with dementia in nursing homes using IPOS‐Dem: A stepped‐wedge cluster randomized controlled trial protocol

Spichiger

Koppitz

Wolf-Linder

et al. 2021

Journal of Advanced Nursing

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“…Both the domain scores and the overall mean score can range from 0 (worst QoL possible) to 100 (best QoL possible). These transformations have been applied successfully multiple times in previous studies [12,[31][32][33].…”

Section: Quality Of Life and Discomfortmentioning

confidence: 99%

“…behavioural problems (agitation, aggression, psychosis) [6][7][8][9] and depression [9,10]. On the other hand, in view of the large increase in opioids and paracetamol prescription in the past years [11][12][13][14], clinicians should be aware of side effects and overtreatment with pain medication in this population.…”

Section: Introductionmentioning

confidence: 99%

Does paracetamol improve quality of life, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia living in long-term care facilities? A randomised double-blind placebo-controlled crossover (Q-PID) trial

Dam

Achterberg

Husebø

et al. 2020

BMC Med

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Background The objectives of this study are to determine the effects of regularly scheduled administration of paracetamol (acetaminophen) on quality of life (QoL), discomfort, pain and neuropsychiatric symptoms of persons with dementia living in long-term care facilities (LTCFs). Methods A multicentre randomised double-blind placebo-controlled crossover trial for 13 weeks (January 2018 to June 2019) in 17 LTCFs across the west of the Netherlands. Inclusion criteria were age ≥ 65 years, (advanced) dementia and a moderate to low QoL, independent of the presence of pain (QUALIDEM ≤ 70). Exclusion criteria were the use of regular pain treatment, allergies to the study medication, severe liver disease, use of > 4 units of alcohol/day, weight < 50 kg and/or concomitant use of flucloxacillin. Participants received study medication (paracetamol/placebo) in two periods of 6 weeks each (1 week in between as a wash-out period). Randomisation decided in which order participants received paracetamol and placebo. Primary outcomes included QoL (QUALIDEM) and discomfort (DS-DAT), secondary outcomes included pain (MOBID-2) and neuropsychiatric symptoms (NPI-NH). Results Ninety-five LTCF residents (mean age 83.9 years [SD 7.6], 57.9% females) were included. Repeated linear mixed models showed no difference in mean differences of QUALIDEM (paracetamol +1.3 [95% CI -1.0–3.5], placebo +1.5 [95% CI -0.7–3.8]), DS-DAT (paracetamol -0.1 [95% CI -1.4–1.2], placebo 0.6 [95 CI -0.7–1.8]), MOBID-2 (paracetamol 0.0 [95% CI -0.5–0.5], placebo -0.2 [95% CI -0.7–0.3]) and NPI-NH (paracetamol +1.5 [95% CI -2.3–5.4], placebo -2.1 [95% CI -6.0–1.7]) in favour of either paracetamol or placebo. Conclusions Compared to placebo, paracetamol showed no positive effect on QoL, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia with low QoL. It is important to find out more specifically which individual persons with advanced dementia could benefit from pain treatment with paracetamol, and for clinicians to acknowledge that a good assessment, monitoring and multidomain approach is vital for improving QoL in this vulnerable group. Trial registration Netherlands Trial Register NTR6766. Trial registration date: 20 October 2017

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Quality of Life and Pain Medication Use in Persons With Advanced Dementia Living in Long-Term Care Facilities

Cited by 18 publications

References 43 publications

Managing Pain and Psychosis Symptoms in Nursing Home Patients: Results from a Cluster-Randomized Controlled Trial (COSMOS)

Managing Pain and Psychosis Symptoms in Nursing Home Patients: Results from a Cluster-Randomized Controlled Trial (COSMOS)

Improving caring quality for people with dementia in nursing homes using IPOS‐Dem: A stepped‐wedge cluster randomized controlled trial protocol

Does paracetamol improve quality of life, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia living in long-term care facilities? A randomised double-blind placebo-controlled crossover (Q-PID) trial

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