Cognitive Impairment and Pain Among Nursing Home Residents With Cancer
Cognitive Impairment and Pain Among Nursing Home Residents With Cancer
复制标题
DOI：
10.1016/j.jpainsymman.2018.02.012
复制
发表时间：
2018-06-01
影响因子：
4.7
通讯作者：
Lapane, Kate L.
中科院分区：
文献类型：
--
作者：
Dube, Catherine E.;Mack, Deborah S.;Lapane, Kate L.
上下文疼痛的发生率及其管理已被证明与更高水平的认知障碍呈负相关。评估癌症疗养院住院患者疼痛记录和治疗是否因认知障碍水平不同而不同。使用横断面研究，我们确定了2011-2012年所有新入院的美国疗养院居民（n = 367，462）。最小数据集3.0入院评估用于评价过去5天内的疼痛/疼痛管理和认知损害（通过精神状态简短访谈或认知表现量表评估，分别为91.6%和8.4%）。校正后的患病率和95%CI由稳健的Poisson回归模型估计。对于工作人员评估疼痛的患者，无/轻度认知障碍的疼痛患病率为55.5%，严重受损的患者为50.5%。疼痛在能够自我报告的患者中很常见（67.9%无/轻度，55.9%中度，41.8%重度认知障碍）。认知功能障碍程度越高，任何疼痛的患病率越低（校正后的患病率比率为重度与无/轻度认知功能障碍;自我评估的疼痛为0.77; 95% CI 0.76-0.78;工作人员评估的疼痛为0.96; 95% CI 0.93-0.99）。药物性疼痛治疗在重度认知功能障碍患者中不太普遍（59.4% vs. 74.9%）。在患有癌症的疗养院居民中，患有严重认知障碍的人的疼痛记录频率较低，这可能导致疼痛治疗的使用频率较低。技术，以改善文件和治疗疼痛的养老院居民认知障碍是必要的。(C)2018年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. The prevalence of pain and its management has been shown to be inversely associated with greater levels of cognitive impairment.Objectives. To evaluate whether the documentation and management of pain varies by level of cognitive impairment among nursing home residents with cancer.Methods. Using a cross-sectional study, we identified all newly admitted U.S. nursing home residents with a cancer diagnosis in 2011-2012 (n = 367,462). Minimum Data Set 3.0 admission assessment was used to evaluate pain/pain management in the past five days and cognitive impairment (assessed via the Brief Interview for Mental Status or the Cognitive Performance Scale for 91.6% and 8.4%, respectively). Adjusted prevalence ratios with 95% CI were estimated from robust Poisson regression models.Results. For those with staff-assessed pain, pain prevalence was 55.5% with no/mild cognitive impairment and 50.5% in those severely impaired. Pain was common in those able to self-report (67.9% no/mild, 55.9% moderate, and 41.8% severe cognitive impairment). Greater cognitive impairment was associated with reduced prevalence of any pain (adjusted prevalence ratio severe vs. no/mild cognitive impairment; self-assessed pain 0.77; 95% CI 0.76-0.78; staff-assessed pain 0.96; 95% CI 0.93-0.99). Pharmacologic pain management was less prevalent in those with severe cognitive impairment (59.4% vs. 74.9% in those with no/mild cognitive impairment).Conclusion. In nursing home residents with cancer, pain was less frequently documented in those with severe cognitive impairment, which may lead to less frequent use of treatments for pain. Techniques to improve documentation and treatment of pain in nursing home residents with cognitive impairment are needed. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.