UNderstanding pain in aged care: the UNPAC study – exploring the nature and treatment of chronic pain in the Australian aged care setting

Abstract

Objective To analyse management of chronic pain in the Australian aged care setting. Methods In the course of performing medication reviews, details of medications prescribed (including dosage) were collated and stored in a secure database along with information about medical morbidities, demographic data and the results of clinical investigations. Details of analgesic and adjuvant medication used in pain management was subjected to de‐identified analysis. Results There were 22 319 reviews analysed. Prescribing of opiate analgesics was widespread, with products containing oxycodone used in 24% of cases. Many residents were concurrently prescribed two or more analgesics. Adjuvant agents were prescribed in 3073 cases, with the most commonly used individual agent being pregabalin (n = 1411). Use of medications for management of adverse effects associated with opioids was common. Conclusion Use of analgesics and related medications is widespread in the aged care sector. These agents are associated with significant adverse effects, and older people may not tolerate doses that deliver satisfactory pain control.

A systematic review of opioid prevalence in Australian residential aged care facilities

“…One study combined a baseline cross‐sectional and 12‐month longitudinal audit 40 . Three studies investigated period prevalence using a cohort design over 12 months, 41 24 months 42 and 41 months 43 . The majority of the included studies (18/23) were published in 2015 or later 8,22–27,29–32,34,35,38–41,43 .…”

“…Data were sourced from South Australia, 8,24–27 New South Wales, 33,37,42 Victoria, 31,40 Queensland, 22 Tasmania 39 and Western Australia 30 . Of 23 studies, 16 reported overall opioid prevalence (Table 1) 8,22–25,27,28,30,31,33,34,37–41 and 14 reported prevalence of specific opioids (‘ specific opioid classes’ , Table ) 8,24,26–30,32,36,39–43 . Definitions of opioid prevalence are provided in Table 1 and Table .…”

“…Of 23 studies reporting opioid prevalence, nine studies reported elements of opioid appropriateness 24,27–30,33,41,43 . Six studies reported analgesic co‐prescription 27–30,33,43 .…”

“…In a second study by Veal et al, 29 13% of residents charted opioids were charted doses exceeding 100 mg MEQ/day. Other studies reported analgesic load, 8,27 defined daily doses (DDD) 43 and specific opioid doses 30 . Of 23 studies, nine reported inabilities to assess or validate clinical indications, diagnoses or doses as a limitation 8,26,27,30,31,34,36,40,41 …”

“…8,22,24,25,27,30,34,37,40 Nine studies did not provide adequate information on how opioid prevalence was measured; therefore, reliability of methods could not be ascertained. 22,[32][33][34]36,38,[41][42][43] 4 | DISCUSSION This is the first systematic review to synthesise data on opioid prevalence in Australian RACFs. Twenty-three studies reported opioid prevalence, of which 16 reported overall regular or PRN prescribing, dispensing or administration data and 14 reported the prevalence of specific opioids.…”