title: Analgesic Use and Daytime Sleepiness in Residents With and Without Dementia in Residential Aged Care Facilities.
abstract: BACKGROUND
  Managing pain in residents of residential aged care facilities (RACFs) is challenging, especially for people with dementia. Clinicians must weigh the benefits of analgesic use against the potential for adverse events, particularly daytime sleepiness.
  
  
  OBJECTIVE
  The aim was to investigate the association between analgesic use and daytime sleepiness in residents with and without dementia in RACFs.
  
  
  METHODS
  This was a cross-sectional study of 383 permanent residents from six low-level and high-level RACFs in South Australia. Main measures included analgesic use in the previous 24 h, analgesic load and self-reported daytime sleepiness. Covariates included relevant comorbidities (insomnia, depression, painful conditions), Charlson's Comorbidity Index, sedative load, self-reported and clinician-observed pain and dementia severity. Logistic regression was used to compute odds ratios (ORs) and confidence intervals (CIs) for the association between analgesic use and daytime sleepiness.
  
  
  RESULTS
  Analgesics were used by 288 residents (75.2%) in the previous 24 h. These included paracetamol (n = 264, 68.9%), opioids (n = 110, 28.7%) and oral NSAIDs (n = 14, 3.7%). Overall, 116 (30.3%) residents were categorized as having daytime sleepiness. Of those with dementia, 77 (45.6%) were categorized as having daytime sleepiness. Opioid use in the previous 24 h was not associated with daytime sleepiness in unadjusted or adjusted analyses. Paracetamol use was positively associated with daytime sleepiness (OR 2.31; 95% CI 1.20-4.42).
  
  
  CONCLUSIONS
  Although daytime sleepiness occurred in a large number of residents, especially those with dementia, this sleepiness was not necessarily associated with use of opioids. The risk of opioid-induced sedation may have been managed by strategies including preferential prescribing of paracetamol to residents at risk of sleepiness, opioid discontinuation in residents who experienced sleepiness, and use of low doses of opioids.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia. edwin.tan@monash.edu.
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: Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, The University of Sydney, Sydney, Australia.|NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.affiliation: Resthaven Incorporated, Adelaide, Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Emery
authors.affiliation: Resthaven Incorporated, Adelaide, Australia.
authors.forename: Leonie
authors.initials: L
authors.lastname: Robson
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: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Hughes
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Jones
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moawad
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ilomäki
authors.affiliation: Consumer Dementia Research Network, Alzheimer's Australia, Scullin, Australia.
authors.forename: Tara
authors.initials: T
authors.lastname: Quirke
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia. simon.bell2@monash.edu.|NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia. simon.bell2@monash.edu.|Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. simon.bell2@monash.edu.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use; D000369:Aged, 80 and over; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003704:Dementia / Q000503:physiopathology*; D003863:Depression / Q000453:epidemiology; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D010146:Pain / Q000188:drug therapy
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen