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Drugs & Aging
Published in: Drugs & Aging 4/2011

01-04-2011 | Original Research Article

Pain Treatment in Elderly Persons With and Without Dementia

A Population-Based Study of Institutionalized and Home-Dwelling Elderly

Authors: Ylva Haasum, MSc, Johan Fastbom, Laura Fratiglioni, Ingemar Kåreholt, Kristina Johnell

Published in: Drugs & Aging | Issue 4/2011

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Abstract

Background: Several previous studies have reported an undertreatment of pain in elderly persons with dementia. It has also been suggested that persons with dementia may be at risk for inappropriate treatment of pain with psychotropics.
Objectives: The objective of this study was to investigate if persons with dementia are as likely as persons without dementia to receive pharmacological pain treatment, after taking into account residential setting and pain-related disorders. We also aimed to investigate whether use of psychotropics is related to pain in persons with and without dementia.
Methods: We used baseline data from the SNAC-K (Swedish National Study of Aging and Care — Kungsholmen). We analysed use of analgesics and psychotropics, prevalence of pain-related diagnoses, self-reported pain, dementia status and residential setting in 2610 participants aged >65 years.
Results: Of the persons with dementia, 46% used at least one analgesic drug compared with 25% of those without dementia. Although persons with dementia reported pain less frequently than persons without dementia, the prevalence of pain-related diagnoses was similar. After adjustment for individual factors and residential setting (own home/institution), persons with dementia had a higher probability of use of paracetamol (acetaminophen) and psychotropics, whereas there were no significant differences in use of any analgesic, opioids and NSAIDs. Furthermore, having a pain-related diagnosis was associated with use of psychotropics in persons with dementia.
Conclusions: Persons with dementia had a higher probability of use of paracetamol and were about as likely as persons without dementia to use any analgesic, opioids and NSAIDs, after adjustment for confounders. This may reflect a recent increased awareness of pain and pain management in persons with dementia, compared with previous studies that have reported an underuse of analgesics in persons with dementia. However, further research is needed to analyse if persons with dementia are appropriately treated for pain with regard to type of analgesic drug, pain intensity, indication, dosage and regimen.
Literature
1.
Gibson SJ. IASP global year against pain in older persons: highlighting the current status and future perspectives in geriatric pain. Expert Rev Neurother 2007 Jun; 7(6): 627–35PubMedCrossRef
2.
Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic assessment of geriatric drug use via epidemiology. JAMA 1998 Jun 17; 279(23): 1877–82PubMedCrossRef
3.
Lovheim H, Sandman PO, Kallin K, et al. Poor staff awareness of analgesic treatment jeopardises adequate pain control in the care of older people. Age Ageing 2006 May; 35(3): 257–61PubMedCrossRef
4.
Won AB, Lapane KL, Vallow S, et al. Persistent non-malignant pain and analgesic prescribing patterns in elderly nursing home residents. J Am Geriatr Soc 2004 Jun; 52(6): 867–74PubMedCrossRef
5.
Pahor M, Guralnik JM, Wan JY, et al. Lower body osteoarticular pain and dose of analgesic medications in older disabled women: the Women’s Health and Aging Study. Am J Public Health 1999 Jun; 89(6): 930–4PubMedCrossRef
6.
Johnell K, Fastbom J, Rosen M, et al. Inappropriate drug use in the elderly: a nationwide register-based study. Ann Pharmacother 2007 Jul; 41(7): 1243–8PubMedCrossRef
7.
Olsson J, Bergman A, Carlsten A, et al. Quality of drug prescribing in elderly people in nursing homes and special care units for dementia: a cross-sectional computerized pharmacy register analysis. Clin Drug Investig 2010; 30(5): 289–300PubMedCrossRef
8.
Frankfort SV, Tulner LR, van Campen JP, et al. Evaluation of pharmacotherapy in geriatric patients after performing complete geriatric assessment at a diagnostic day clinic. Clin Drug Investig 2006; 26(3): 169–74PubMedCrossRef
9.
Schmidt I, Fastbom J. Quality of drug use in Swedish nursing homes: a follow up study. Clin Drug Investig 2000; 20(6): 433–46CrossRef
10.
Sengupta M, Bercovitz A, Harris-Kojetin LD. Prevalence and management of pain, by race and dementia among nursing home residents: United States, 2004. NCHS Data Brief 2010 Mar; 30: 1–8PubMed
11.
Auret K, Schug SA. Underutilisation of opioids in elderly patients with chronic pain: approaches to correcting the problem. Drugs Aging 2005; 22(8): 641–54PubMedCrossRef
12.
Smalbrugge M, Jongenelis LK, Pot AM, et al. Pain among nursing home patients in the Netherlands: prevalence, course, clinical correlates, recognition and analgesic treatment — an observational cohort study. BMC Geriatr 2007; 7: 3PubMedCrossRef
13.
Davis MP, Srivastava M. Demographics, assessment and management of pain in the elderly. Drugs Aging 2003; 20(1): 23–57PubMedCrossRef
14.
Hellstrom Y, Persson G, Hallberg IR. Quality of life and symptoms among older people living at home. J Adv Nurs 2004 Dec; 48(6): 584–93PubMedCrossRef
15.
Leveille SG, Bean J, Bandeen-Roche K, et al. Musculoskeletal pain and risk for falls in older disabled women living in the community. J Am Geriatr Soc 2002 Apr; 50(4): 671–8PubMedCrossRef
16.
Scherder EJ, Bouma A. Is decreased use of analgesics in Alzheimer disease due to a change in the affective component of pain? Alzheimer Dis Assoc Disord 1997 Sep; 11(3): 171–4PubMedCrossRef
17.
Husebo BS, Strand LI, Moe-Nilssen R, et al. Who suffers most?. Dementia and pain in nursing home patients: a cross-sectional study. J Am Med Dir Assoc 2008 Jul; 9(6): 427–33PubMedCrossRef
18.
Nygaard HA, Jarland M. Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment? Int J Geriatr Psychiatry 2005 Aug; 20(8): 730–7PubMedCrossRef
19.
Reynolds KS, Hanson LC, DeVellis RF, et al. Disparities in pain management between cognitively intact and cogni-tively impaired nursing home residents. J Pain Symptom Manage 2008 Apr; 35(4): 388–96PubMedCrossRef
20.
Morrison RS, Siu AL. A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 2000 Apr; 19(4): 240–8PubMedCrossRef
21.
Lövheim H, Karlsson S, Gustafson Y. The use of central nervous system drugs and analgesics among very old people with and without dementia. Pharmacoepidemiol Drug Saf 2008 Sep; 17(9): 912–8PubMedCrossRef
22.
Horgas AL, Elliott AF, Marsiske M. Pain assessment in persons with dementia: relationship between self-report and behavioral observation. J Am Geriatr Soc 2009 Jan; 57(1): 126–32PubMedCrossRef
23.
Scherder EJ. Low use of analgesics in Alzheimer’s disease: possible mechanisms. Psychiatry 2000 Spring; 63(1): 1–12PubMed
24.
Kovach CR, Weissman DE, Griffie J, et al. Assessment and treatment of discomfort for people with late-stage dementia. J Pain Symptom Manage 1999 Dec; 18(6): 412–9PubMedCrossRef
25.
Cohen-Mansfield J, Billig N, Lipson S, et al. Medical correlates of agitation in nursing home residents. Gerontology 1990; 36(3): 150–8PubMedCrossRef
26.
Shega JW, Hougham GW, Stocking CB, et al. Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 2004 Dec; 28(6): 585–92PubMedCrossRef
27.
Balfour JE, O’Rourke N. Older adults with Alzheimer disease, comorbid arthritis and prescription of psychotropic medications. Pain Res Manag 2003 Winter; 8(4): 198–204PubMed
28.
Oborne CA, Hooper R, Li KC, et al. An indicator of appropriate neuroleptic prescribing in nursing homes. Age Ageing 2002 Nov; 31(6): 435–9PubMedCrossRef
29.
Wimo A, Johansson L, Jonsson L. The societal costs and prevalence of dementia in Sweden 2005 [in Swedish]. Stockholm: The Swedish National Board of Health and Welfare, 2007. Report no.: 2007-123-32
30.
Kragh A. Two out of three persons living in nursing homes for the elderly are treated with at least ten different drugs: a survey of drug prescriptions in the northeastern part of Skane (in Swedish). Lakartidningen 2004 Mar 11; 101(11): 994–6, 999PubMed
31.
Lagergren M, Fratiglioni L, Hallberg IR, et al. A longitudinal study integrating population, care and social services data: the Swedish National study on Aging and Care (SNAC). Aging Clin Exp Res 2004 Apr; 16(2): 158–68PubMed
32.
Johansson L, Thorslund M. Care of the elderly in Sweden: formal and informal support. In: Lesemann F, Martin C, editors. Home-based care, the elderly, the family and the welfare state: an international comparison. Ottawa (ON): University of Ottawa Press, 1993: 151–84
33.
34.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994
35.
Fratiglioni L, Viitanen M, Backman L, et al. Occurrence of dementia in advanced age: the study design of the Kungsholmen Project. Neuroepidemiology 1992; 11Suppl. 1: 29–36PubMedCrossRef
36.
Cornelius C, Fastbom J, Winblad B, et al. Aspirin, NSAIDs, risk of dementia, and influence of the apolipoprotein E epsilon 4 allele in an elderly population. Neuroepidemiology 2004 May-Jun; 23(3): 135–43PubMedCrossRef
37.
Klarin I, Fastbom J, Wimo A. The use of angiotensin-converting enzyme inhibitors and other drugs with cardiovascular effects by non-demented and demented elderly with a clinical diagnosis of heart failure: a population-based study of the very old. Eur J Clin Pharmacol 2006 Jul; 62(7): 555–62PubMedCrossRef
38.
Pedhazur EJ. Multiple regression in behavioral research: explanation and prediction. New York: Holt, Rinehart, & Winston, 1982
39.
Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975 Nov; 12(3): 189–98PubMedCrossRef
40.
Wills P, Claesson CB, Fratiglioni L, et al. Drug use by demented and non-demented elderly people. Age Ageing 1997 Sep; 26(5): 383–91PubMedCrossRef
41.
Giron MS, Wang HX, Bernsten C, et al. The appropriateness of drug use in an older nondemented and demented population. J Am Geriatr Soc 2001 Mar; 49(3): 277–83PubMedCrossRef
42.
Giron MS, Forsell Y, Bernsten C, et al. Psychotropic drug use in elderly people with and without dementia. Int J Geriatr Psychiatry 2001 Sep; 16(9): 900–6PubMedCrossRef
43.
Mann E, Kopke S, Haastert B, et al. Psychotropic medication use among nursing home residents in Austria: a cross-sectional study. BMC Geriatr 2009; 9: 18PubMedCrossRef
44.
Horgas AL, Tsai PF. Analgesic drug prescription and use in cognitively impaired nursing home residents. Nurs Res 1998 Jul-Aug; 47(4): 235–42PubMedCrossRef
45.
Torvik K, Kaasa S, Kirkevold O, et al. Pain in patients living in Norwegian nursing homes. Palliat Med 2009 Jan; 23(1): 8–16PubMedCrossRef
46.
Gallelli L, Colosimo M, Pirritano D, et al. Retrospective evaluation of adverse drug reactions induced by non-steroidal anti-inflammatory drugs. Clin Drug Investig 2007; 27(2): 115–22PubMedCrossRef
47.
Harirforoosh S, Jamali F. Renal adverse effects of non-steroidal anti-inflammatory drugs. Expert Opin Drug Saf 2009 Nov; 8(6): 669–81PubMedCrossRef
48.
Fosbol EL, Gislason GH, Jacobsen S, et al. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study. Clin Pharmacol Ther 2009 Feb; 85(2): 190–7PubMedCrossRef
49.
Sawyer P, Lillis JP, Bodner EV, et al. Substantial daily pain among nursing home residents. J Am Med Dir Assoc 2007 Mar; 8(3): 158–65PubMedCrossRef
50.
Wheeler MS. Pain assessment and management in the patient with mild to moderate cognitive impairment. Home Healthc Nurse 2006 Jun; 24(6): 354–9; quiz 60-1PubMedCrossRef
51.
Holmquist IB, Svensson B, Hoglund P. Psychotropic drugs in nursing- and old-age homes: relationships between needs of care and mental health status. Eur J Clin Pharmacol 2003 Nov; 59(8-9): 669–76PubMedCrossRef
52.
Fastbom J, Claesson CB, Cornelius C, et al. The use of medicines with anticholinergic effects in older people: a population study in an urban area ofSweden. J Am Geriatr Soc 1995 Oct; 43(10): 1135–40PubMed
53.
Kallin K, Jensen J, Olsson LL, et al. Why the elderly fall in residential care facilities, and suggested remedies. J Fam Pract 2004 Jan; 53(1): 41–52PubMed
54.
Grimby C, Fastbom J, Forsell Y, et al. Musculoskeletal pain and analgesic therapy in a very old population. Arch Gerontol Geriatr 1999 Jul-Aug; 29(1): 29–43PubMedCrossRef
Metadata
Title
Pain Treatment in Elderly Persons With and Without Dementia
A Population-Based Study of Institutionalized and Home-Dwelling Elderly
Authors
Ylva Haasum, MSc
Johan Fastbom
Laura Fratiglioni
Ingemar Kåreholt
Kristina Johnell
Publication date
01-04-2011
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 4/2011
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/11587040-000000000-00000

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