A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture
A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture
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DOI：
10.1016/s0885-3924(00)00113-5
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发表时间：
2000-04-01
影响因子：
4.7
通讯作者：
Siu, AL
中科院分区：
文献类型：
--
作者：
Morrison, RS;Siu, AL
晚期痴呆患者可能存在未被发现或治疗不足的疼痛的重大风险。为了检查髋部骨折后疼痛的治疗，在一家学术教学医院进行了一项前瞻性队列研究。每天评估59名认知功能完好的老年髋部骨折患者和38名髋部骨折和晚期痴呆患者。认知功能完好的患者在0（无）至4（非常严重）的数字量表上对他们的疼痛进行评分。镇痛剂处方和管理进行了记录，并与髋部骨折患者晚期痴呆症。晚期痴呆患者接受的硫酸吗啡当量是认知功能正常患者的三分之一。44%的认知功能完好的个体在术前报告了严重到非常严重的疼痛，42%的患者在术后报告了类似的疼痛。一半的认知功能完整的患者经历了中度至非常严重的疼痛，他们的疼痛程度的镇痛处方不足。83%的认知功能完好的患者和76%的痴呆患者没有收到止痛剂的长期订单。这些数据表明，大多数老年髋部骨折患者的疼痛治疗不足。事实上，晚期痴呆患者接受阿片类镇痛的三分之一的量相比，认知功能完好的受试者-其中40%的人报告严重疼痛术后-表明，大多数痴呆患者在术后严重疼痛。这项研究和其他研究表明，有必要进行定向干预，以改善疼痛检测和改变医生处方的做法，在认知受损。疼痛症状管理杂志2000;19：240-248。(C)美国癌症疼痛缓解委员会，2000年。
Advanced dementia patients may be at substantial risk for undetected or undertreated pain. To examine the treatment of pain following hip fracture, a prospective cohort study was conducted in an academic teaching hospital. Fifty-nine cognitively intact elderly patients with hip fracture and 38 patients with hip fracture and advanced dementia were assessed daily. The cognitively intact patients rated their pain on a numeric scale ranging from 0 (none) to 4 (very severe). Analgesics prescribed and administered were recorded and compared to hip fracture patients with advanced dementia. The advanced dementia patients received one-third the amount of morphine sulfate equivalents as the cognitively intact patients. Forty-four percent of cognitively intact individuals reported severe to very severe pain preoperatively and 42% reported similar pain postoperatively. Half the cognitively intact patients who experienced moderate to very severe pain were prescribed inadequate analgesia for their level of pain. Eighty-three percent of cognitively intact patients and 76% of dementia patients did not receive a standing order for an analgesic agent. These data reveal that a majority of elderly hip fracture patients experienced undertreated pain. The fact that advanced dementia patients received one-third the amount of opioid analgesia as compared to cognitively intact subjects-40% of whom reported severe pain postoperatively-suggests that the majority of dementia patients were in severe pain postoperatively. This study and others suggest that directed interventions to improve pain detection and alter physician prescribing practices in the cognitively impaired are needed. J Pain Symptom Manage 2000;19:240-248. (C) U.S. Cancer Pain Relief Committee, 2000.