Quality of life in nursing home residents with pain: pain interference, depression and multiple pain-related diseases as important determinants

Brandauer, Anna; Berger, Sandra L.; Freywald, Nicole; Gnass, Irmela; Osterbrink, Jürgen; Seidenspinner, Dietmar; Kutschar, Patrick

doi:10.1007/s11136-019-02290-x

Cited by 8 publications

(9 citation statements)

References 22 publications

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“…Optimizing analgesic use in residential aged care services is complex and involves assessing each resident’s treatment benefits and risks. Unmanaged or undermanaged pain is associated with reduced quality of life, while overuse of analgesics poses a risk to resident wellbeing [ 1 , 2 ]. Complex multimorbidity, polypharmacy and renal impairment correspond to increased susceptibility to analgesic-related adverse drug events (ADEs) [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

et al. 2023

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Background Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). Objective The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. Methods Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study ( N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. Results Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. Conclusions Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01025-5.

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Section: Introductionmentioning

confidence: 99%

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

et al. 2023

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“…19 A score of 1 to 2 describes mild pain, 3 to 5 moderate pain, and $6 describes severe pain. 36 For statistical analysis, pain intensity (MOBID-2) were categorized into moderate (3)(4)(5) or severe pain (6-10).…”

Section: Data Collection Instrumentsmentioning

confidence: 99%

“…A high proportion of older individuals with dementia, who represent most residents in nursing homes, 15 have pain, most often chronic, that impairs mobility, diminishes quality of life, 5 and may cause behavioral or neuropsychiatric symptoms. 29 The fact that nursing home residents with dementia often are unable to inform caregivers about intensity and type of pain leads to inadequate pain treatment for this vulnerable group.…”

Section: Introductionmentioning

confidence: 99%

Chronic pain conditions and use of analgesics among nursing home patients with dementia

Myrenget

Borchgrevink

Rustøen

et al. 2022

Pain

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Pain management for patients with dementia is challenging because many experience pain while being unable to communicate their pain. The aim of this study was to describe pain, pain management, and to perform a thorough clinical examination of chronic pain conditions among patients with dementia. Residents (n 5 498) from 12 nursing homes were assessed for dementia (Clinical Dementia Rating scale [CDR]) and for pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) assessment form. Of all examined nursing home patients with dementia, 68% had moderate or severe chronic pain. The final study population (n 5 262) with a CDR score of $1 and a MOBID-2 score of $3 were examined by pain expert physicians for chronic pain and categorized according to the International Classification of Disease (ICD-10/-11) classification systems. More than half (54.6%) had chronic pain conditions without underlying disease classified as chronic primary pain by ICD-11. Chronic widespread pain was the most prevalent (14.5%) followed by nonspecific pain from the back (13.4%), whereas the most prevalent chronic secondary pain conditions were chronic pain caused by osteoarthritis (15.4%) and stroke (8.0%). One-fourth received opioids, which was significantly associated with severe pain (P , 0.001) compared with moderate pain, although no significant association was found between opioid use and the type of pain condition. Although knowledge of the severity and specific types of pain conditions is recommended to direct the choice of treatment, these areas are not sufficiently explored in the nursing home populations with dementia and may hinder a better treatment of pain in this population.

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“…Given that pain can generally be prevented or treated, these rates are unacceptably high [ 18 , 19 ]. Pain severely impacts residents’ health-related quality of life (HRQoL) [ 24 ]. It impairs residents’ mobility and independence [ 25 , 26 ] and contributes to hopelessness, insomnia, loneliness, depression, poor social relationships, and unnecessary health care costs [ 24 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…Pain severely impacts residents’ health-related quality of life (HRQoL) [ 24 ]. It impairs residents’ mobility and independence [ 25 , 26 ] and contributes to hopelessness, insomnia, loneliness, depression, poor social relationships, and unnecessary health care costs [ 24 , 27 , 28 ]. However, even when applying best practices in pain management [ 29 – 31 ], eliminating pain is not always possible, especially when residents have multiple comorbidities [ 12 , 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing health-related quality of life among long-term care residents experiencing pain: a systematic review protocol

Shrestha,

Cummings,

Knopp-Sihota

et al. 2024

Syst Rev

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Background Pain is highly burdensome, affecting over 30% of long-term care (LTC) residents. Pain significantly reduces residents’ health-related quality of life (HRQoL), limits their ability to perform activities of daily living (ADLs), restricts their social activities, and can lead to hopelessness, depression, and unnecessary healthcare costs. Although pain can generally be prevented or treated, eliminating pain may not always be possible, especially when residents have multiple chronic conditions. Therefore, improving the HRQoL of LTC residents with pain is a priority goal. Understanding factors influencing HRQoL of LTC residents with pain is imperative to designing and evaluating targeted interventions that complement pain management to improve residents’ HRQoL. However, these factors are poorly understood, and we lack syntheses of available research on this topic. This systematic review protocol outlines the methods to identify, synthesize, and evaluate the available evidence on these factors. Methods This mixed methods review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will systematically search Medline, EMBASE, PsycINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ProQuest Dissertation and Thesis Global from database inception. We will include primary studies and systematically conducted reviews without restrictions to language, publication date, and study design. We will also include gray literature (dissertation and reports) and search relevant reviews and reference lists of all included studies. Two reviewers will independently screen articles, conduct quality appraisal, and extract data. We will synthesize results thematically and conduct meta-analyses if statistical pooling is possible. Residents and family/friend caregivers will assist with interpreting the findings. Discussion This proposed systematic review will address an important knowledge gap related to the available evidence on factors influencing HRQoL of LTC residents with pain. Findings will be crucial for researchers, LTC administrators, and policy makers in uncovering research needs and in planning, developing, and evaluating strategies in addition to and complementary with pain management to help improve HRQoL among LTC residents with pain. Systematic review registration PROSPERO CRD42023405425

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Quality of life in nursing home residents with pain: pain interference, depression and multiple pain-related diseases as important determinants

Cited by 8 publications

References 22 publications

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

Chronic pain conditions and use of analgesics among nursing home patients with dementia

Factors influencing health-related quality of life among long-term care residents experiencing pain: a systematic review protocol

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