title: Deficits in pain treatment in nursing homes in Germany: a cross-sectional study.
abstract: BACKGROUND
  Current knowledge about the quality and appropriateness of pharmacological pain treatment in nursing home residents (NHR), particularly in NHR with moderate to severe cognitive impairment, is poor.
  
  
  METHODS
  This observational cross-sectional study assessed pain treatment in a random sample of NHR with or without cognitive impairment from nursing homes in Germany. Prescribed drugs, pain intensity and frequency, diagnoses, and surgical procedures and injuries during the last 4 weeks were documented. Quality and appropriateness of pain medication were assessed by analysis of pain medications and the Pain Medication Appropriateness Scale (PMAS) score (S(PMAS) ), with a cut-off value of >67% indicating appropriate pain treatment.
  
  
  RESULTS
  A total of 321 residents (62% women) were studied, including 152 (47%) with severe cognitive impairment. The most frequently prescribed analgesics were dipyrone, fentanyl, tramadol and ibuprofen. The mean S(PMAS) was 48.5 ± 1.5 (range, -33 to +100). Residents with prescribed scheduled analgesics had a significantly better S(PMAS) than patients without such treatment (S(PMAS) 58 ± 1.5 vs. 37 ± 2.5, p < 0.01). NHR without current pain had significantly better S(PMAS) than residents suffering from pain (S(PMAS) 47 ± 1.9 vs. 59 ± 4.2, p = 0.01). With an S(PMAS) of 69 ± 1.5, residents (n = 106) with scheduled pain medication plus PRN analgesics achieved the highest scores in the population. Overall, similar results were found in NHR with and in NHR without cognitive impairment.
  
  
  CONCLUSIONS
  Our study points to a significant deficit in pain treatment in German NHR, including NHR with or without cognitive impairment.
authors.affiliation: Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, D-10117, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kölzsch
authors.forename: I
authors.initials: I
authors.lastname: Wulff
authors.forename: S
authors.initials: S
authors.lastname: Ellert
authors.forename: T
authors.initials: T
authors.lastname: Fischer
authors.forename: K
authors.initials: K
authors.lastname: Kopke
authors.forename: S
authors.initials: S
authors.lastname: Kalinowski
authors.forename: D
authors.initials: D
authors.lastname: Dräger
authors.forename: R
authors.initials: R
authors.lastname: Kreutz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000592:standards; D000700:Analgesics / Q000627:therapeutic use; D003072:Cognition Disorders / Q000150:complications; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000592:standards*; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement; D012720:Severity of Illness Index
chemical_list: D000700:Analgesics