Deficits in pain treatment in nursing homes in Germany: A cross-sectional study

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Abstract

Background:

Current knowledge about the quality and appropriateness of pharmacological pain treatment in nursing home residents (NHR), particularly in NHR with moderate to severe cognitive impairment, is poor.

Methods:

This observational cross-sectional study assessed pain treatment in a random sample of NHR with or without cognitive impairment from nursing homes in Germany. Prescribed drugs, pain intensity and frequency, diagnoses, and surgical procedures and injuries during the last 4 weeks were documented. Quality and appropriateness of pain medication were assessed by analysis of pain medications and the Pain Medication Appropriateness Scale (PMAS) score (SPMAS), with a cut-off value of >67% indicating appropriate pain treatment.

Results:

A total of 321 residents (62% women) were studied, including 152 (47%) with severe cognitive impairment. The most frequently prescribed analgesics were dipyrone, fentanyl, tramadol and ibuprofen. The mean SPMAS was 48.5 ± 1.5 (range, −33 to +100). Residents with prescribed scheduled analgesics had a significantly better SPMAS than patients without such treatment (SPMAS 58 ± 1.5 vs. 37 ± 2.5, p < 0.01). NHR without current pain had significantly better SPMAS than residents suffering from pain (SPMAS 47 ± 1.9 vs. 59 ± 4.2, p = 0.01). With an SPMAS of 69 ± 1.5, residents (n = 106) with scheduled pain medication plus PRN analgesics achieved the highest scores in the population. Overall, similar results were found in NHR with and in NHR without cognitive impairment.

Conclusion:

Our study points to a significant deficit in pain treatment in German NHR, including NHR with or without cognitive impairment.

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