Pain in cognitively impaired nursing home patients
Pain in cognitively impaired nursing home patients
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DOI：
10.1016/0885-3924(95)00121-2
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发表时间：
1995-11-01
影响因子：
4.7
通讯作者：
Rivera, L
中科院分区：
文献类型：
--
作者：
Ferrell, BA;Ferrell, BR;Rivera, L
疼痛是一个未充分研究的问题，在体弱的老年患者，特别是那些有认知障碍，谵妄，或痴呆。本研究的重点是描述患者在治疗过程中所经历的疼痛。熟练的疗养院，认知障碍的患病率很高。从10个社区技术疗养院随机抽取325名受试者。受试者接受了苔藓截面的内部视图和图表审查的患病率疼痛投诉，病因和疼痛管理策略。疼痛评估使用麦吉尔疼痛问卷和四个一维尺度以前使用的年轻人。33%的受试者因昏迷（21%）、不讲英语（3.7%）、暂时离开（住院）（4.3%）或拒绝参加（3.7%）而被排除。在最终分析的217例受试者中，平均年龄为84.9岁，85%为女性，大多数受试者在所有日常生活活动中均具有依赖性。受试者表现出严重的认知障碍（平均Folstein简易精神状态检查评分为12.1 +/- 7.9），通常在记忆、定向和视觉空间技能方面存在缺陷。62%的人报告了疼痛投诉，主要与肌肉骨骼和神经病变有关。记录中没有一致记录疼痛，疼痛管理策略似乎范围有限，在控制疼痛方面仅部分成功。在这项调查中研究的四个一维疼痛强度结痂没有一个比麦吉尔疼痛问卷的当前疼痛强度量表（65%完成率）更高的完成率。然而，83%有疼痛的受试者可以完成至少一个量表。我们的结论是，老年疗养院居民的认知障碍提出了一个实质性的障碍，疼痛评估和管理。尽管如此，大多数轻度至中度认知障碍患者可以使用至少一种可用的床边评估量表进行评估。
Pain is an understudied problem in frail elderly patients, especially those with cognitive impairment, delirium, or dementia. The focus of this study was to describe the pain experienced by patients in. skilled nursing homes, which have a high prevalence of cognitive impairment. A random sample of 325 subjects was selected from ten community skilled nursing homes. Subjects underwent a moss-sectional inter-view and chart review for the prevalence of pain complaints, etiology, and pain management strategies. Pain was assessed using the McGill Pain Questionnaire and four unidimensional scales previously utilized in younger adults. Thirty-three percent (33%) of subjects were excluded because they were either comatose (21%), non-English speaking (3.7%), temporarily away (sick in hospital) (4.3%), or refused to participate (3.7%). Of 217 subjects in the final analysis, the mean age was 84.9 years, 85% were women, and most were dependent in all activities of daily living. Subjects demonstrated substantial cognitive impairment (mean Folstein Mini-Mental State exam score was 12.1 +/- 7.9), typically having deficits in memory, orientation, and visual spatial skills. Sixty-two percent reported pain complaints, mostly related to musculoskeletal and neuropathic causes. Pain was not consistently documented in records, and pain management strategies appeared to be limited in scope and only partially successful in controlling pain. None of the four unidimensional pain-intensity scab studied in this investigation had a higher completion rate than the Present Pain Intensity Scale of the McGill Pain Questionnaire (65% completion rate). However, 83% of subjects who had pain could complete at least one of the scales. We conclude that cognitive impairment among elderly nursing home residents presents a substantial barrier to pain assessment and management. Nonetheless, most patients with mild to moderate cognitive impairment can be assessed using at least one of the available bedside assessment scales.