title: Pharmacological management of pain in Australian Aged Care Facilities.
abstract: BACKGROUND
  up to 80% of residents in aged care facilities (ACFs) experience pain, and previous studies have found that older patients with pain are often undertreated. Few studies have been conducted in Australia evaluating the use of analgesic therapy in ACF residents.
  
  
  OBJECTIVE
  to explore the use of analgesics among ACF residents, including independent predictors of analgesic use, evaluate analgesic use against pain management guidelines and identify potential medication management issues.
  
  
  METHODS
  a retrospective analysis of 7,309 medicines reviews conducted on Australian ACF residents was undertaken. Medication use was compared with published guidelines relating to the management of pain in elderly patients or ACF residents. Multiple variable logistic regression was used to identify independent predictors of analgesic use.
  
  
  RESULTS
  nearly 91% of residents were prescribed analgesics. Of those, 2,057 residents were taking regular opioids (28.1%). Only 50% of those taking regular opioids received regular paracetamol at doses of 3-4 g/day. The concurrent use of sedatives was high, with 48.4% of those taking regular opioids also taking an anxiolytic/hypnotic.
  
  
  CONCLUSIONS
  there is a need to optimise the prescribing and administration of regular paracetamol as a first line and continuing therapy for pain management in ACF residents, to potentially improve pain management and reduce opioid requirements. Furthermore, with the risk of falls and fractures increased by concurrent use of opioids and sedatives, the widespread use of these drugs in a population already at high risk was concerning, indicating a need for better education of health professionals in this area.
authors.affiliation: Unit for Medication Outcomes Research and Education, University of Tasmania, Private Bag 26 University of Tasmania, Hobart, Tasmania 7001, Australia.
authors.forename: Felicity C
authors.initials: FC
authors.lastname: Veal
authors.affiliation: Unit for Medication Outcomes Research and Education, University of Tasmania, Private Bag 26 University of Tasmania, Hobart, Tasmania 7001, Australia.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Bereznicki
authors.affiliation: Unit for Medication Outcomes Research and Education, University of Tasmania, Private Bag 26 University of Tasmania, Hobart, Tasmania 7001, Australia.
authors.forename: Angus J
authors.initials: AJ
authors.lastname: Thompson
authors.affiliation: Unit for Medication Outcomes Research and Education, University of Tasmania, Private Bag 26 University of Tasmania, Hobart, Tasmania 7001, Australia.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Peterson
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000700:Analgesics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001315:Australia; D016009:Chi-Square Distribution; D015897:Comorbidity; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000592:standards; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D000082:Acetaminophen
keywords: elderly; older people; opioids; pain