title: Drug-based pain management for people with dementia after hip or pelvic fractures: a systematic review.
abstract: Studies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings. Treatment could be surgical or conservative. We also analysed study designs, methods and variables, as well as which assessments were applied to measure pain management and mental status.
  
  
  
  The development of this systematic review protocol was guided by the PRISMA-P requirements, which were taken into consideration during the review procedures. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect were searched. Studies published up to January 2016 were included. The data extraction, content and quantitative descriptive analysis were carried out systematically, followed by a critical appraisal.
  
  
  
  Eight of the 13 included studies focusing on patient data showed that people with dementia received less drug-based pain management than people without cognitive impairment. Four studies based on surveys of healthcare professionals stated that cognitive impairment is a major barrier for effective pain management. There was heterogeneity regarding the assessment of the mental status and the pain assessment of the patients. The assessment of the drugs administered in all of the studies working with patient data was achieved through chart reviews.
  
  
  
  People with dementia do not seem to receive the same amount of opioid analgesics after hip fracture as people without cognitive impairment. There is need to enhance pain assessment and management for these patients. Future research should pay more attention to the use of the appropriate items for assessing cognitive impairment and pain in people with dementia.
  
  
  
  This systematic review was registered at Prospero ( CRD42016037309 ); on 11 April 2016, and the systematic review protocol was published (Syst Rev. 5(1):1, 2016).
authors.affiliation: Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany. kai.moschinski@googlemail.com.
authors.forename: Kai
authors.initials: K
authors.lastname: Moschinski
authors.affiliation: Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Kuske
authors.affiliation: Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Andrich
authors.affiliation: Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.|Department of Nursing, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Stephan
authors.affiliation: Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Irmela
authors.initials: I
authors.lastname: Gnass
authors.affiliation: Faculty of Nursing Science, Vallendar College of Philosophy and Theology (PTHV Catholic University), Palottistraße 3, 56179, Vallendar, Germany.
authors.forename: Erika
authors.initials: E
authors.lastname: Sirsch
authors.affiliation: Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
mesh_terms: D000698:Analgesia / Q000379:methods*; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology; D003704:Dementia / Q000150:complications* / Q000523:psychology; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D010146:Pain / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D010147:Pain Measurement; D010348:Patient Care Team; D010384:Pelvic Bones / Q000473:pathology*
keywords: Alzheimer; Analgesics; Cognitive disorders; Cognitive impairment; Dementia; Drugs; Hip fractures; Pain management; Pelvic fractures