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Characteristics of pharmacological pain treatment in older nursing home residents

Authors Nowak T, Neumann-Podczaska A, Tobis S, Wieczorowska-Tobis K

Received 31 October 2018

Accepted for publication 18 February 2019

Published 25 March 2019 Volume 2019:12 Pages 1083—1089

DOI https://doi.org/10.2147/JPR.S192587

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Michael E Schatman


Tomasz Nowak,1 Agnieszka Neumann-Podczaska,2 Slawomir Tobis,2 Katarzyna Wieczorowska-Tobis1

1Laboratory of Geriatric Medicine, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland

Background: Pain in older subjects with cognitive impairement is frequently undertreated.
Purpose: The aim of the study was to characterize pain treatment among 199 elderly nursing home residents (NHR), aged 65 years and above.
Patients and methods: In all studied subjects, cognitive functions were assessed. Based on the results, participants were divided into two groups: group 1 – cognitively intact subjects in whom the pain was evaluated based on Numerical Rating Scale (NRS), and group 2 – subjects with cognitive impairment, in whom Abbey Pain Scale (APS) was used to assess pain. Thereafter, subjects with inappropriately treated pain (ie, ineffectively treated or untreated) were analyzed in detail as group 1a (NRS >0) and group 2a (Abbey >2).
Results: The prevalence of pain in group 1 and 2 did not differ (65% and 70% respectively). However, inappropriately treated pain occurred more frequently in group 2 (2a=85% vs 1a=64%; p<0.01). This was related to the more frequent occurrence of untreated pain (52% vs 22%; p<0.001), because the presence of ineffectively treated pain was comparable in both groups (34% vs 42%). Qualitative analysis of pharmacotherapy in subjects with inappropriately treated pain demonstrated that acetaminophen in low dosages was the most frequently consumed drug from the first step of the analgesic ladder (16 individuals), from the second step – a combination of tramadol and acetaminophen (8 individuals), and from the third step – buprenorphine was the only drug applied (6 individuals).
Conclusion: Our study showed a high frequency of untreated or ineffectively treated pain in NHR, regardless of the cognitive status of studied subjects. However, these phenomena were particularly frequent in subjects with cognitive impairment. Thus, proper education of the staff is needed to increase their knowledge about both the pain assessment and its treatment.

Keywords: pain, treatment, cognitive impairment, nursing home residents, analgesics

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