title: Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol.
abstract: BACKGROUND
  People living with dementia may experience and express pain in different ways to people without dementia. People with dementia are typically prescribed fewer analgesics than people without dementia indicating a potential difference in how pain is identified and treated in these populations. The objectives of this study are to (1) investigate the prevalence of analgesic load, pain and daytime sedation in people with and without dementia in Australian residential aged care facilities (RACFs), and (2) investigate the clinical and diagnostic associations between analgesic load, pain and daytime sedation in people with and without dementia in Australian RACFs.
  
  
  METHODS
  This will be a cross-sectional study of 300 permanent residents of up to 10 low-level and high-level RACFs in South Australia with and without dementia. Trained study nurses will administer validated and dementia-specific assessments of self-reported and clinician-observed pain, sedation and other clinical and humanistic outcomes. Medicine-use data will be extracted directly from each resident's medication administration chart. Binary and multinominal logistic regression will be used to compute unadjusted and adjusted ORs and 95% CIs for factors associated with pain, analgesic load and daytime sedation. These factors will include dementia severity, behavioural and psychological symptoms, quality of life, resident satisfaction, attitudes towards medicines, activities of daily living and nutritional status.
  
  
  BACKGROUND
  Institutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences and in peer-reviewed journal articles. The findings of this study will allow for a better understanding of the prevalence and factors associated with analgesic use, pain and other outcomes in residential care. The findings of this study will be used to inform the development and implementation of strategies to improve the quality of life of people with dementia.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
authors.forename: Edwin C K
authors.initials: EC
authors.lastname: Tan
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, Australia Aged and Extended Care Services, The Queen Elizabeth Hospital and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Renuka
authors.initials: R
authors.lastname: Visvanathan
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, The University of Sydney, Sydney, Australia Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.affiliation: Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
authors.forename: Agnes I
authors.initials: AI
authors.lastname: Vitry
authors.affiliation: Consumer Dementia Research Network, Alzheimer's Australia, Scullin, Australia.
authors.forename: Tara
authors.initials: T
authors.lastname: Quirke
authors.affiliation: Resthaven Limited, Adelaide, South Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Emery
authors.affiliation: Resthaven Limited, Adelaide, South Australia.
authors.forename: Leonie
authors.initials: L
authors.lastname: Robson
authors.affiliation: Resthaven Limited, Adelaide, South Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Shortt
authors.affiliation: Resthaven Limited, Adelaide, South Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Sheldrick
authors.affiliation: Resthaven Limited, Adelaide, South Australia.
authors.forename: Sunny Soon Won
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Aged and Extended Care Services, The Queen Elizabeth Hospital and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, University of Adelaide, Adelaide, Australia Resthaven Limited, Adelaide, South Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Clothier
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, The University of Sydney, Sydney, Australia Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Reeve
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, The University of Sydney, Sydney, Australia Faculty of Pharmacy, University of Sydney, Sydney, Australia.
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ilomäki
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications* / Q000453:epidemiology; D006707:Homes for the Aged; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D059408:Pain Management / Q000379:methods*; D012107:Research Design
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives
keywords: Epidemiology; Geriatric Medicine; Pain Management