Pain treatment for nursing home residents differs according to cognitive state - a cross-sectional study.
Communication skills are known to decrease with advancing cognitive impairment. Analgesic treatment in long-term care may be deficient due to the residents' impaired ability to communicate their pain and needs. Undertreated pain frequently leads to rising BPSD in residents with cognitive impairment, resulting in a treatment with antipsychotics. Aim of this study was the analysis of differences in assessment and pharmacological treatment of pain in nursing home residents relative to their cognitive state and ability to articulate pain.



Data stems from the baseline of a non-experimental pre-post-study in 12 Austrian nursing homes. Residents' pain prevalence in relation to pain assessment and cognitive decline was assessed, data on medical diagnoses and prescriptions were retrieved from the nursing homes' documentation (n = 425). Residents were first divided into two groups: Residents with MMSE ≥ 18 were selected into group CUS (cognitively unimpaired/slightly impaired), residents with MMSE ≤ 17 were selected into group CI (cognitively moderately to severely impaired). CI residents were then sub-grouped according to their ability to communicate pain via the Verbal Rating Scale (VRS) (i.e. group CI-V, group CI-NV). Pain behavior of CI residents was assessed with a modified German version of PAINAD. Group differences were tested with ANOVA and H-test, 95 % confidence intervals were calculated and associations were tested with log-binomial regression.



Pain prevalence in CI residents irrespective of their ability to communicate pain was 80 % and exceeded the CUS group prevalence significantly by 14 %. CI residents had significantly less analgesic prescriptions. Furthermore, CI residents have a significantly higher risk of getting no analgesics when in pain than CUS residents (CI-V: RR =2.6, CI-NV: RR =3.4). Use of antipsychotics was high in all groups (49 - 65 %) with more prescriptions in the cognitively impaired group.



Results point toward an underuse of pain medication in cognitively impaired residents, especially those unable to communicate pain verbally. The implementation of standardized pain assessments adapted to the cognitive abilities of residents may foster the recognition of pain, warrant optimized pain management, reduce inadequate medication and consequently raise the chance of equally effective pain treatment regardless of cognitive state.
Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria. Ulrike.bauer@pmu.ac.at.
Ulrike
U
Bauer
Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria.
Stefan
S
Pitzer
Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria.
Maria Magdalena
MM
Schreier
Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, A-5020, Salzburg, Austria.
Jürgen
J
Osterbrink
Department of Geriatric Medicine, Christian Doppler Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, A-5020, Salzburg, Austria.
Reinhard
R
Alzner
Department of Geriatric Medicine, Christian Doppler Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, A-5020, Salzburg, Austria.
Bernhard
B
Iglseder
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001317:Austria; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D020380:Needs Assessment; D009735:Nursing Homes / Q000458:organization & administration*; D010146:Pain / Q000175:diagnosis / Q000523:psychology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods
D000700:Analgesics; D014150:Antipsychotic Agents
Analgesic treatment; Assessment; Cognitive impairment; Nursing home residents; Pain