The prevalence and management of current daily pain among older home care clients.
The aim of this cross-sectional study was to examine the prevalence and correlates of pharmacotherapy for current daily pain in older home care clients, focusing on analgesic type and potential contraindications to treatment. The sample included 2779 clients aged 65+years receiving services from Community Care Access Centres in Ontario during 1999-2001. Clients were assessed with the Resident Assessment Instrument-Home Care (RAI-HC). Prescription and over-the-counter (OTC) medications listed on the RAI-HC were used to categorize analgesic treatment into two groups (relative to no analgesic use): use of non-opioids (acetaminophen or non-steroidal anti-inflammatory drugs only); and, use of opioids alone or in combination with non-opioids. Associations between client characteristics and analgesic treatment among those in current daily pain were examined using multivariable multinomial logistic regression. Approximately 48% (n=1,329) of clients had daily pain and one-fifth (21.6%) of this group received no analgesic. In multivariable analyses, clients aged 75+years and those with congestive heart failure, diabetes, other disease-related contraindications, cognitive impairment and/or requiring an interpreter were significantly less likely to receive an opioid alone or in combination with a non-opioid. Clients with congestive heart failure and without a diagnosis of arthritis were significantly less likely to receive a non-opioid alone. A diagnosis of arthritis or cancer and use of nine or more medications were significantly associated with opioid use. The findings provide evidence of both rational prescribing practices and potential treatment bias in the pharmacotherapeutic management of daily pain in older home care clients.
Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, Canada T2N 4N1 Department of Medicine, University of Calgary, Calgary, AB, Canada Department of Psychiatry, University of Calgary, Calgary, AB, Canada Institute of Health Economics, Edmonton, AB, Canada Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, Ont., Canada Department of Health Studies & Gerontology, University of Waterloo, Waterloo, Ont., Canada Homewood Research Institute, Guelph, Ont., Canada.
Colleen J
CJ
Maxwell
Dawn M
DM
Dalby
Morgan
M
Slater
Scott B
SB
Patten
David B
DB
Hogan
Michael
M
Eliasziw
John P
JP
Hirdes
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome
D000700:Analgesics