Opioid Prescription Use in Nursing Home Residents with Advanced Dementia
Opioid Prescription Use in Nursing Home Residents with Advanced Dementia
复制标题
DOI：
10.1093/pm/pnx268
复制
发表时间：
2019-01-01
期刊：
影响因子：
3.1
通讯作者：
Achterberg, Wilco P.
中科院分区：
文献类型：
--
作者：
Griffioen, Charlotte;Husebo, Bettina S.;Achterberg, Wilco P.
背景。尽管适当的疼痛治疗可能需要阿片类药物，但关于晚期痴呆症患者可能治疗不足或过度治疗的讨论仍在继续。调查疼痛的患病率、阿片类药物处方的使用频率以及疗养院中与强效阿片类药物处方使用相关的因素。横断面研究。十八家挪威疗养院； 327 名患有晚期痴呆症和行为障碍的患者参与了研究。评估了与强力阿片类药物处方使用相关的潜在因素：人口统计学（年龄、性别）、医疗状况（合并症、药物数量）、疼痛（活动-观察-行为-强度-痴呆-2 疼痛量表3、疼痛相关诊断、镇痛处方使用）、功能（日常生活活动、简易精神状态检查）和行为（神经精神病学调查表疗养院版本，科恩-曼斯菲尔德激越调查表）。将P<0.10、年龄、性别等因素纳入多因素回归分析。中度至重度疼痛的患病率为62.1%。在所有参与者中，19.3% (N=63) 服用了阿片类药物，其中 79.4% (N=50) 仍处于疼痛之中； 66.7%的阿片类药物处方小于或等于芬太尼贴剂（12微克/小时）或丁丙诺啡（5或10微克/小时）的最低剂量。疼痛（比值比 [OR] = 1.26，95% 置信区间 [CI] = 1.121.42）、疼痛相关诊断总数（OR=1.47，95% CI=1.141.90）以及抑郁和焦虑（OR=1.05，95% CI=1.011.11）与阿片类药物处方呈正相关。中风呈负相关（OR=0.43，95% CI=0.190.99）。强阿片类药物处方的使用主要与疼痛相关。然而，在这一人群中，尽管强效处方阿片类药物的使用相对普遍，但疼痛仍然普遍存在。这强调了正确疼痛治疗的挑战以及定期评估疼痛和疼痛管理的需要。
Background. Although proper pain treatment may require opioids, discussion continues about possible undertreatment or overtreatment in persons with advanced dementia.To investigate the prevalence of pain, frequency of opioid prescription use, and factors associated with strong opioid prescription use in nursing homes.Cross-sectional study.Eighteen Norwegian nursing homes; 327 persons with advanced dementia and behavioral disturbances participated.Potential factors associated with strong opioid prescription use were assessed: demographics (age, gender), medical conditions (comorbidity, number of medications), pain (Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale3, pain-related diagnoses, analgesic prescription use), functioning (activities of daily living, Mini-Mental State Examination) and behavior (Neuropsychiatric InventoryNursing Home version, Cohen-Mansfield Agitation Inventory). Factors with P < 0.10, age, and gender were included in multivariate regression analysis.The prevalence of moderate to severe pain was 62.1%. Of all participants, 19.3% (N=63) were prescribed opioids, and of these, 79.4% (N=50) were still in pain; 66.7% of the opioid prescriptions were less than or equal to the lowest dosage of fentanyl patches (12mcg/h) or buprenorphine (5 or 10mcg/h). Pain (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.121.42), total number of pain-related diagnoses (OR=1.47, 95% CI=1.141.90), and depression and anxiety (OR=1.05, 95% CI=1.011.11) were positively associated with an opioid prescription. Stroke was negatively associated (OR=0.43, 95% CI=0.190.99).Strong opioid prescription use was mainly associated with pain. However, in this population, despite the relatively prevalent use of strong prescription opioids, pain was still prevalent. This emphasizes the challenge of proper pain treatment and need for regular evaluation of pain and pain management.