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Poor staff awareness of analgesic treatment jeopardises adequate pain control in the care of older people
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
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2006 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 35, no 3, 257-261 p.Article in journal (Refereed) Published
Abstract [en]

Background: undertreatment of pain is a common problem in geriatric care. The aim of this study was to compare the caring staff 's answers concerning the resident's pain treatment with actual pharmacological pain treatment in a cross-sectional survey of the geriatric care population in the county of Vasterbotten, Sweden. Methods: a cross-sectional study in all geriatric care units in the county of Vasterbotten, Sweden, including 3,724 inhabitants aged 65 years and over. The mean age was 83.3 and the number of cognitively impaired 2,047 (55.0%). Medication data were obtained from prescription records. The member of staff who knew the resident best judged their pain based on observations the preceding week. Results: the reported pain prevalence in the sample was 56.7%. Of those residents reported to suffer from pain, 27.9% received no analgesics as regular medication. In 72.7% of those cases with reported pain and no pharmacological treatment, the staff member who knew the resident best still thought that the resident was receiving treatment for her/his pain. Conclusion: a large proportion of the old people in geriatric care settings suffer from pain, and undertreatment of pain appears to be a significant problem. Even when the resident was not receiving pharmacological treatment for their pain, the assessor, who was expected to know the resident best, still believed in a majority of cases that the resident was receiving treatment. This highlights the need for better communication between the various professional categories involved in geriatric care.

Place, publisher, year, edition, pages
2006. Vol. 35, no 3, 257-261 p.
Keyword [en]
pain, analgesics, geriatrics, residential facilities, interdisciplinary communication, elderly
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-6782DOI: 10.1093/ageing/afj067ISI: 000237318900010PubMedID: 16547117OAI: oai:DiVA.org:umu-6782DiVA: diva2:146452
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Psychotropic and analgesic drug use among old people: with special focus on people living in institutional geriatric care
Open this publication in new window or tab >>Psychotropic and analgesic drug use among old people: with special focus on people living in institutional geriatric care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years.

Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders.

This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006.

The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation.

Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder.

Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common.

In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering, 2008. 109 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1157
Keyword
dementia, depression, pain, nursing Home, old, analgesics, antidepressants, anti-psychotics, behavioral and psychological symptoms of dementia, inappropriate drugs
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-1608 (URN)978-91-7264-504-2 (ISBN)
Public defence
2008-04-25, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (English)
Opponent
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Available from: 2008-04-08 Created: 2008-04-08 Last updated: 2014-01-16Bibliographically approved

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Lövheim, HugoSandman, Per-OlofKallin, KristinaKarlsson, StigGustafson, Yngve
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