title: [Pain therapy in German long-term care facilities in a European comparison. Results of the SHELTER study].
abstract: BACKGROUND
  A considerable number of nursing home residents suffering from pain are insufficiently treated. International comparisons of pain management in German (GER) and other European (EU) nursing homes are still lacking.
  
  
  OBJECTIVE
  This study compared the treatment of pain in GER and EU nursing homes in order to improve allocation of therapeutic resources.
  
  
  METHODS
  A cross-sectional study was carried out with 4156 residents assessed using the interRAI instrument for long-term care facilities, including pharmacological and non-pharmacological pain management modalities. Only those residents reporting pain were included in the analyses (n = 1900 from EU and 245 from GER). Descriptive analyses and analyses of correlations between different parameters and pain were performed.
  
  
  RESULTS
  More than three quarters of the residents with at least moderate pain received pharmacological treatment (GER: 77.4 % and EU: 79.3 %). Combination therapy (pharmacological and non-pharmacological) was more frequent in Germany (approximately  13 %). Even in cases of moderate to severe pain one third of GER compared to one quarter of the EU residents received either no analgesic treatment or only on a when needed basis (PRN). Differences were also seen in drugs used (GER metamizole). The amount of PRN was higher in Germany (approximately 13 %, alone or in combination). Only 5 % received the recommended level of non-pharmacological treatment. Pain severity and decubitus were identified as important triggers for pharmacological treatment. Non-pharmacological treatment was used less often than analgesics (EU: 39.2 %, GER: 46.8 %). There were no differences regarding administration frequency and intensity of non-pharmacological treatments in residents with or without pain; however, non-pharmacological treatment was used less often in residents with successful pharmacological treatment.
  
  
  CONCLUSIONS
  The data demonstrate significant deficits in the recognition and treatment of pain in residents living in German or other European nursing home facilities. Further scope for improvement is seen in better recognition of relevant pain, in the adequate use of PRN and long-term medication and especially in the use of activating non-pharmacological treatment.
authors.affiliation: Geriatrie/Zentrum für Altersmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Akademisches Lehrkrankenhaus der Universität Bonn, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland, albert.lukas@malteser.org.
authors.forename: A
authors.initials: A
authors.lastname: Lukas
authors.forename: B
authors.initials: B
authors.lastname: Mayer
authors.forename: G
authors.initials: G
authors.lastname: Onder
authors.forename: R
authors.initials: R
authors.lastname: Bernabei
authors.forename: M D
authors.initials: MD
authors.lastname: Denkinger
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005060:Europe; D005858:Germany; D019538:Health Care Surveys; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D003668:Pressure Ulcer / Q000150:complications / Q000188:drug therapy
chemical_list: D000700:Analgesics