Pain reports and pain medication treatment in nursing home residents with and without dementia.

Abstract

AIM:

The purpose of this pilot study was to determine if a diagnosis of dementia influenced pain self-reports and pain medication use in a group of verbally communicative nursing home (NH) residents.

METHODS:

The study design was a between groups, cross-sectional chart audit and a seven-question structured pain interview comparing outcomes in residents with and without a diagnosis of dementia. The study was carried out at a large metropolitan NH in the southern USA. The participants consisted of 52 long-stay NH residents capable of self-consent with at least one order for pain medication (opioid or non-narcotic) either pro re nata, scheduled or both. Approximately 40% (n = 20) had a diagnosis of dementia.

RESULTS:

Although each group had similar pain-related diagnoses, residents without a dementia diagnosis were significantly more likely to have a medication order for an opioid (OR 4.37,95% CI 1.29-14.73, P = 0.018). Based on self-reported pain interview responses, no statistically significant differences were identified between the groups for chronic pain symptoms. However, among residents who reported current pain, those with a dementia diagnosis reported greater pain intensity (based on a 0-10 numeric rating scale) than did those without dementia (median 8.0 vs 6.0, respectively; P = 0.010).

CONCLUSIONS:

Verbally communicative NH residents with mild and moderate cognitive impairment can report their pain symptoms and pain intensity. Nurses in long-term care might assume that residents with dementia cannot reliably self-report their pain; however, suffering from untreated severe pain could exacerbate cognitive impairment, worsen functional impairment and severely impair sleep. A brief, focused pain interview might be one method for increasing the detection of moderate to severe pain in verbally communicative NH residents with dementia.

• Authors: Todd B Monroe, Sumathi K Misra, Ralf C Habermann, Mary S Dietrich, Ronald L Cowan, Sandra F Simmons
• Journal: Geriatrics & gerontology international (Geriatr Gerontol Int) Vol. 14 Issue 3 Pg. 541-8 (Jul 2014) ISSN: 1447-0594 [Electronic] Japan
• PMID: 24020433 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 Japan Geriatrics Society.

Chemical References

• Analgesics

Topics

• Aged
• Aged, 80 and over
• Analgesics (therapeutic use)
• Case-Control Studies
• Cross-Sectional Studies
• Dementia (complications, psychology)
• Drug Utilization
• Female
• Humans
• Male
• Nursing Homes
• Outcome Assessment, Health Care
• Pain (diagnosis, drug therapy, psychology)
• Pain Measurement
• Pilot Projects
• Self Report