Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment.
Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment.
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DOI：
10.1111/jgs.16293
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发表时间：
2020-04
影响因子：
6.3
通讯作者：
Collins, Amber N.
中科院分区：
文献类型：
--
作者：
Ersek, Mary;Nash, Princess, V;Hilgeman, Michelle M.;Neradilek, Moni B.;Herr, Keela A.;Block, Phoebe R.;Collins, Amber N.
研究疼痛的频率和严重程度以及疼痛治疗在中重度痴呆长期护理居民中的使用，并探讨与疼痛严重程度增加相关的因素。在1至3天内收集每位参与者的前瞻性个体数据。亚拉巴马、格鲁吉亚、宾夕法尼亚和新泽西的16家长期护理机构。入组了在长期护理机构居住至少7天的中度至重度认知障碍居民（N = 205）。居民中47%为女性，主要为白色（69%），平均年龄为84岁（SD = 10岁）。采用综合疼痛评估方案，通过病历审查、与疗养院工作人员访谈、体格检查以及疼痛观察工具（活动-观察-行为-强度-痴呆疼痛量表和痴呆患者疼痛强度测量）评估疼痛严重程度和特征。还评估了已知的相关因素（激越、抑郁和睡眠）。专家的疼痛评估表明，居民的日常疼痛是轻微的（平均值= 1.6/10），大多数人只经历间歇性疼痛（70%）。然而，45%的居民经历了中度至重度的最严重疼痛。在住院医生中，90%接受了疼痛治疗，其中对乙酰氨基酚（87%）和阿片类药物（32%）常用。只有3%的患者在病历中记录了非药物治疗。与疼痛严重程度显著相关的唯一居民特征是在过去一周内接受阿片类药物。使用全面的疼痛评估方案，我们发现大多数患有中度至重度痴呆症的养老院居民有轻度的日常间歇性疼痛，绝大多数人在前一周接受了至少一次疼痛治疗。虽然这些发现反映了与旧研究相比疼痛管理的改善，但仍有改进的空间，因为45%的样本在前一周的某个时候经历了中度至重度疼痛。
To examine the frequency and severity of pain and use of pain therapies among long-term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity. Prospective individual data were collected over 1 to 3 days for each participant. Sixteen long-term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. Residents with moderate to severe cognitive impairment residing in a long-term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years). A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep). Experts’ pain evaluations indicated that residents’ usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week. Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week.
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影响因子：
7.4
作者：
Cleeland, CS;Nakamura, Y;Serlin, RC
通讯作者：
Serlin, RC
影响因子：
3.1
作者：
Ersek, Mary;Herr, Keela;Nelson, Francis X.
通讯作者：
Nelson, Francis X.
影响因子：
10.6
作者：
ALEXOPOULOS, GS;ABRAMS, RC;SHAMOIAN, CA
通讯作者：
SHAMOIAN, CA
影响因子：
4.7
作者：
Ersek, Mary;Polissar, Nayak;Neradilek, Moni Blazej
通讯作者：
Neradilek, Moni Blazej
影响因子：
4.7
作者：
Dube, Catherine E.;Mack, Deborah S.;Lapane, Kate L.
通讯作者：
Lapane, Kate L.