title: Treatment of pain in European nursing homes: results from the Services and Health for Elderly in Long TERm Care (SHELTER) study.
abstract: OBJECTIVE
  To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe.
  
  
  METHODS
  Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n = 1900). A deeper analysis was performed for the subsample of residents who reported "current pain," defined as pain at least 1 day within the past 3 days (n = 838), and those who reported "current pain of moderate to severe intensity" (n = 590).
  
  
  RESULTS
  Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians' availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians' availability, and severe pain intensity were negatively associated.
  
  
  CONCLUSIONS
  Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement.
authors.affiliation: Agaplesion Bethesda Clinic, Competence Center of Geriatrics and Aging Research, University of Ulm, Ulm, Germany. Electronic address: albert.lukas@bethesda-ulm.de.
authors.forename: Albert
authors.initials: A
authors.lastname: Lukas
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mayer
authors.forename: Daniela
authors.initials: D
authors.lastname: Fialová
authors.forename: Eva
authors.initials: E
authors.lastname: Topinkova
authors.forename: Jacob
authors.initials: J
authors.lastname: Gindin
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.forename: Thorsten
authors.initials: T
authors.lastname: Nikolaus
authors.forename: Michael D
authors.initials: MD
authors.lastname: Denkinger
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D059408:Pain Management; D010147:Pain Measurement; D011787:Quality of Health Care; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000700:Analgesics
keywords: European; Pain; analgesic; long term care facilities; nursing home residents; occupational therapy; pharmacological and nonpharmacological treatment; physical therapy; therapy