451
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Wranker LS, Rennemark M, Berglund J. Pain among older adults from a gender perspective: findings from the Swedish National Study on Aging and Care (SNAC-Blekinge). Scand J Public Health 2015; 44:258-63. [PMID: 26647094 DOI: 10.1177/1403494815618842] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Pain is common in the elderly population and its prevalence varies according to the studied disease, clinical setting, sex and age. This study examines pain in an aging population from a gender perspective. METHODS The Swedish National study on Aging and Care (SNAC) is conducted at four research centres. Participants were recruited from the baseline sample (n=1402) at one of the research centres, SNAC-Blekinge. Individuals aged 60 years and older were included and non-participation was documented. Research personnel conducted the medical examination on two occasions. RESULTS The prevalence of pain was 769/1402 (54.8%), distributed as 496/817 (64.5%) women and 273/585 (35.5%) men,p<0.01. Women reported more pain located in the vertebral column,p<0.01. The most common pain location was the legs and feet. About 84% reported pain intensity as 4 or higher on the visual analogue scale (VAS). Pain intensity declines with age among men,p<0.01. The most frequent treatment was painkillers. A total of 128/263 (48.7%) of the men received no pain treatment compared with 177/478 (37.0%) of the women,p<0.01. In a multivariate logistic regression model, women yielded the highest OR [OR 1.94 (C.I. 1.51-2.49)] for pain. CONCLUSIONS Pain is common among older adults and there are significant differences between the sexes. Almost 55% of participants reported pain, predominantly women. In the majority of cases the intensity was rated as moderate or severe (VAS >4) and women rated higher than men p<002. Almost half of the men (48.7%) did not receive any treatment compared to 37% of the women, p<001.
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Affiliation(s)
- Lena Sandin Wranker
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden Department of Health Sciences, Division of Geriatric Medicine, Lund University, Sweden
| | | | - Johan Berglund
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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452
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Pilgrim AL, Robinson SM, Sayer AA, Roberts HC. An overview of appetite decline in older people. Nurs Older People 2015; 27:29-35. [PMID: 26018489 DOI: 10.7748/nop.27.5.29.e697] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Poor appetite is a common problem in older people living at home and in care homes, as well as hospital inpatients. It can contribute to weight loss and nutritional deficiencies, and associated poor healthcare outcomes, including increased mortality. Understanding the causes of reduced appetite and knowing how to measure it will enable nurses and other clinical staff working in a range of community and hospital settings to identify patients with impaired appetite. A range of strategies can be used to promote better appetite and increase food intake.
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Affiliation(s)
- Anna L Pilgrim
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust; MRC Lifecourse Epidemiology Unit, University of Southampton
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453
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Zhou S, Després O, Pebayle T, Dufour A. Age-Related Decline in Cognitive Pain Modulation Induced by Distraction: Evidence From Event-Related Potentials. THE JOURNAL OF PAIN 2015; 16:862-72. [DOI: 10.1016/j.jpain.2015.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/28/2015] [Accepted: 05/28/2015] [Indexed: 01/16/2023]
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454
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Siordia C. INTERSECTING SELF-REPORTED MOBILITY AND GAIT SPEED TO CREATEA MULTI-DIMENSIONAL MEASURE OF AMBULATION: THE "AMBULATION SPEED-ENDURANCE" (ASE) TYPOLOGY. J Frailty Aging 2015; 4:56-63. [PMID: 26258113 DOI: 10.14283/jfa.2015.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessing mobility through readily available and affordable protocols may help advance public health by providing early detection and implementing intervention therapies aimed at mitigating the progression from physiological vitality to disability at older ages. Until now, little attention has been given to how self-reported mobility (SRM) and gait speed can be combined in a categorization scheme. OBJECTIVES The specific aim of this report is to introduce the Ambulation Speed-Endurance (ASE) Typology to the literature-a classification system that intersects SRM and gait speed to create a multi-dimensional measure of ambulation. DESIGN Cross-sectional. SETTING Community-dwelling older adults in the United States. PARTICIPANTS Evidence is provided from the National Health and Aging Trends Study (NHATS) that community-dwelling older adults (n=5,403) may be found in each of the ASE Typologies. The discussion is complimented by investigating the cross-sectional predictors of a "Discrepancy Score" (measure of gap between speed and endurance) amongst those with gait speeds < 0.99 m/sec (n=4,521). RESULTS Multivariable linear regression results indicate level of severity in speed-endurance discrepancy is higher amongst: non-Latino-Blacks (β=0.48); Latinos (β=0.42); older ages; and lower educated. Models also show that severity in speed-endurance discrepancy is lower amongst: females (β=-0.38); those with higher body mass index; with more chronic health conditions; and poorer self-rated health. CONCLUSION Research should continue to investigate how to optimize SRM.
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Affiliation(s)
- C Siordia
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh ; Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
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455
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Hunt LJ, Covinsky KE, Yaffe K, Stephens CE, Miao Y, Boscardin WJ, Smith AK. Pain in Community-Dwelling Older Adults with Dementia: Results from the National Health and Aging Trends Study. J Am Geriatr Soc 2015. [PMID: 26200445 DOI: 10.1111/jgs.13536] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report prevalence, correlates, and medication management of pain in community-dwelling older adults with dementia. DESIGN Cross-sectional. SETTING In-person interviews with self- or proxy respondents living in private residences or non-nursing home residential care settings. PARTICIPANTS Nationally representative sample of community-dwelling Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study 2011 wave. MEASUREMENTS Dementia status was determined using a modified previously validated algorithm. Participants were asked whether they had had bothersome and activity-limiting pain over the past month. A multivariable Poisson regression model was used to determine the relationship between bothersome pain and sociodemographic and clinical characteristics. RESULTS Of the 7,609 participants with complete data on cognitive function, 802 had dementia (67.2% aged ≥80, 65.0% female, 67.9% white, 49.7% proxy response, 32.0% lived alone, 18.8% lived in residential care); 670 (63.5%) participants with dementia experienced bothersome pain, and 347 (43.3%) had pain that limited activities. These rates were significantly higher than in a propensity score-matched cohort without dementia (54.5% bothersome pain, P < .001, 27.2% pain that limited activity, P < .001). Proxies reported slightly higher rates of pain than self-respondents, but differences were statistically significant only for activity-limiting pain (46.6% proxy vs 40.1% self, P = .03). Correlates of bothersome pain included arthritis, heart and lung disease, less than high school education, activity of daily living disability, depressive and anxiety symptoms, and low energy. Of those reporting pain, 30.3% stated that they rarely or never took any medications for pain. CONCLUSION Community-living older adults with dementia are at high risk of having pain. Creative interventions and programs are needed to manage pain adequately in this vulnerable population.
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Affiliation(s)
- Lauren J Hunt
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, California
| | - Kenneth E Covinsky
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,Division of Geriatrics, University of California at San Francisco, San Francisco, California
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,Division of Geriatrics, University of California at San Francisco, San Francisco, California.,Department of Psychiatry, University of California at San Francisco, San Francisco, California.,Department of Neurology, University of California at San Francisco, San Francisco, California
| | - Caroline E Stephens
- Department of Community Health Systems, University of California at San Francisco, San Francisco, California
| | - Yinghui Miao
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - W John Boscardin
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Alex K Smith
- Division of Geriatrics, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
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456
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Abstract
This review summarizes existing evidence relevant to the epidemiology of chronic pain in older adults, age-related differences relevant to pain, pain assessment, and important considerations regarding pain management in later life. Features unique to pain assessment in older adults include the likelihood of multiple diagnoses contributing to chronic pain, the ability of older adults to self-report, including those with mild to moderate cognitive impairment, and recognition that some older adults with cognitive impairment may demonstrate various behaviors to communicate pain. Management is best accomplished through a multimodal approach, including pharmacologic and nonpharmacologic treatments, physical rehabilitation, and psychological therapies. Interventional pain therapies may be appropriate in select older adults, which may reduce the need for pharmacologic treatments.
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Affiliation(s)
- Mark C Bicket
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center, 55 Fruit Street Gray-Bigelow 444, Boston, MA 02114, USA.
| | - Jianren Mao
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center, 55 Fruit Street Gray-Bigelow 444, Boston, MA 02114, USA
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457
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Herr K, Marie BS, Gordon DB, Paice JA, Watt-Watson J, Stevens BJ, Bakerjian D, Young HM. An interprofessional consensus of core competencies for prelicensure education in pain management: curriculum application for nursing. J Nurs Educ 2015; 54:317-27. [PMID: 26057425 PMCID: PMC4462171 DOI: 10.3928/01484834-20150515-02] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/18/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ineffective assessment and management of pain is a significant problem. A gap in prelicensure health science program pain content has been identified for the improvement of pain care in the United States. METHOD Through consensus processes, an expert panel of nurses, who participated in the interdisciplinary development of core competencies in pain management for prelicensure health professional education, developed recommendations to address the gap in nursing curricula. RESULTS Challenges and incentives for implementation of pain competencies in nursing education are discussed, and specific recommendations for how to incorporate the competencies into entry-level nursing curricula are provided. CONCLUSION Embedding pain management core competencies into prelicensure nursing education is crucial to ensure that nurses have the essential knowledge and skills to effectively manage pain and to serve as a foundation on which clinical practice skills can be later honed. [J Nurs Educ. 2015;54(6):317-327.].
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458
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Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults. Physiotherapy 2015; 102:152-8. [PMID: 26091560 DOI: 10.1016/j.physio.2015.03.3721] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether musculoskeletal pain (pain severity and number of chronic pain sites; single or multisite) is associated with balance confidence over and above previously established risk factors. DESIGN Cross-sectional study. SETTING Ten community sites (five day centres, two sheltered housing schemes and three community 'clubs') in the UK. PARTICIPANTS Two hundred and eighty-nine community-dwelling older adults [response rate 72%, mean age 78 (standard deviation 8) years, 67% female] completed the study assessment. Eligibility criteria were as follows: living in the community; aged ≥60 years; able to walk ≥10m; able to communicate in English; and no cognitive (e.g. dementia), neurological or mental health conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Balance confidence as measured by the 16-item Activities Balance Confidence (ABC) scale (lower scores indicate less confidence). RESULTS One hundred and fifty participants had at least one site of chronic musculoskeletal pain (52%), and the remaining 139 (48%) participants did not report chronic musculoskeletal pain. Older people with chronic musculoskeletal pain had significantly lower scores on the ABC scale compared with those without chronic musculoskeletal pain (mean 48.3 vs 71.3, P<0.001). After adjustment for established risk factors, two separate hierarchical regression models demonstrated that both pain severity (β=-0.106, P=0.029) and number of chronic musculoskeletal pain sites (β=-0.98, P=0.023) were significantly associated with lower balance confidence. CONCLUSION Both pain severity and number of chronic pain sites (particularly multisite pain) are associated with lower balance confidence in community-dwelling older adults. Further research is needed to target pain symptoms and balance confidence in relation to fall risk in older adults with chronic musculoskeletal pain.
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459
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Gell NM, Wallace RB, LaCroix AZ, Mroz TM, Patel KV. Mobility device use in older adults and incidence of falls and worry about falling: findings from the 2011-2012 national health and aging trends study. J Am Geriatr Soc 2015; 63:853-9. [PMID: 25953070 DOI: 10.1111/jgs.13393] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the prevalence of mobility device use in community-dwelling older adults in the United States and to investigate the incidence of falls and worry about falling according to type and number of mobility devices used. DESIGN Analysis of cross-sectional and longitudinal data from the 2011-12 National Health and Aging Trends Study. SETTING In-person interviews in the homes of study participants. PARTICIPANTS Nationally representative sample of Medicare beneficiaries (n=7,609). MEASUREMENTS Participants were asked about mobility device use (e.g., canes, walkers, wheelchairs and scooters) in the last month, 1-year fall history and worry about falling. RESULTS Twenty-four percent of adults aged 65 and older reported mobility device use in 2011, and 9.3% reported using multiple devices within the last month. Mobility device use increased with advancing age and was associated with nonwhite race and ethnicity, female sex, lower education level, greater multimorbidity, and obesity (all P<.001). Adjusting for demographic and health characteristics and physical function, the incidence of falls and recurrent falls was not associated with the use of multiple devices or any particular type of mobility device. Activity-limiting worry about falling was significantly higher in cane-only users than in nonusers. CONCLUSION The percentage of older adults reporting mobility device use is higher than results from previous national surveys, and multiple device use is common in those who use any device. Mobility device use is not associated with greater incidence of falls. Cane-only users may compensate for worry about falling by limiting activity.
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Affiliation(s)
- Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Robert B Wallace
- College of Public Health Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Andrea Z LaCroix
- Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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460
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Cazacu I, Mogosan C, Loghin F. Safety issues of current analgesics: an update. ACTA ACUST UNITED AC 2015; 88:128-36. [PMID: 26528060 PMCID: PMC4576793 DOI: 10.15386/cjmed-413] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/17/2015] [Indexed: 12/18/2022]
Abstract
Pain represents a complex experience which can be approached by various medicines. Non-opioid and opioid analgesics are the most common drugs used to manage different types of pain. The increased attention nowadays to pain management entailed concomitantly more frequent adverse drug reactions (ADRs) related to analgesic use. Drug-drug interactions can be sometimes responsible for the adverse effects. However, a significant proportion of analgesic ADRs are preventable, which would avoid patient suffering. In order to draw the attention to analgesics risks and to minimize the negative consequences related to their use, the present review comprises a synthesis of the most important safety issues described in the scientific literature. It highlights the potential risks of the most frequently used analgesic medicines: non-opioid (paracetamol, metamizole, non-steroidal anti-inflammatory drugs) and opioid analgesics. Even if there is a wide experience in their use, they continue to capture attention with safety concerns and with potential risks recently revealed. Acknowledging potential safety problems represents the first step for health professionals in assuring a safe and efficient analgesic treatment with minimum risks to patients. Taking into consideration all medical and environmental factors and carefully monitoring the patients are also essential in preventing and early detecting analgesic ADRs.
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Affiliation(s)
- Irina Cazacu
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Mogosan
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Felicia Loghin
- Department of Toxicology, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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461
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Special Needs Population: Care of the Geriatric Patient Population in the Perioperative Setting. AORN J 2015; 101:443-56; quiz 457-9. [DOI: 10.1016/j.aorn.2014.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/01/2014] [Indexed: 12/20/2022]
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462
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van Kooten J, Delwel S, Binnekade TT, Smalbrugge M, van der Wouden JC, Perez RSGM, Rhebergen D, Zuurmond WWA, Stek ML, Lobbezoo F, Hertogh CMPM, Scherder EJA. Pain in dementia: prevalence and associated factors: protocol of a multidisciplinary study. BMC Geriatr 2015; 15:29. [PMID: 25879681 PMCID: PMC4436741 DOI: 10.1186/s12877-015-0025-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/02/2015] [Indexed: 01/28/2023] Open
Abstract
Background Pain is a common problem in people with dementia, however the exact prevalence of pain in dementia subtypes, e.g. Alzheimer’s Disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia (FTD) and dementia with Lewy Bodies (DLB), is unknown, as is the relation between pain and the different subtypes of dementia. In this study, the prevalence of pain in people with dementia will be investigated per dementia subtype and the relationship between the various subtypes of dementia and the presence of specific types of pain (i.e. musculoskeletal pain, neuropathic pain and orofacial pain) will be examined. Secondly, associations between various types of pain, cognitive functioning, neuropsychiatric symptoms and quality of life in people with dementia will be examined. A third purpose is to study the value of the assessment of autonomic responses in assessing pain in people with dementia. Finally, the effect of feedback to the attending physician on the presence of pain, based on examination by investigators with backgrounds in neuropsychology, geriatric dentistry and elderly care medicine, will be evaluated. Methods/Design A cross-sectional, partially longitudinal observational study in 400 participants with dementia, aged 60 years and older. Participants will be recruited from an outpatient memory clinic and dementia special care units. All participants will be examined by an elderly care medicine trainee, a dentist with experience in geriatric dentistry, and a neuropsychologist. The primary outcome is presence of pain. Secondary outcomes will include oral health, autonomic responses to pain stimulus, vital sensibility and gnostic sensibility, musculoskeletal examination, cognitive functioning, neuropsychiatric symptoms, and quality of life. Discussion This study will help to enhance our knowledge regarding the prevalence of different types of pain in different dementia subtypes i.e. AD, VaD, FTD and DLB. This study also aims to contribute to a better understanding of oral health status in people with dementia, the use of autonomic responses in the assessment of pain in people with dementia and the relationships between pain and cognitive symptoms, neuropsychiatric symptoms and quality of life in people with various dementia subtypes and in different stages of the disease.
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Affiliation(s)
- Janine van Kooten
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suzanne Delwel
- Department of Clinical Neuropsychology VU University, Amsterdam, The Netherlands. .,Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
| | - Tarik T Binnekade
- Department of Clinical Neuropsychology VU University, Amsterdam, The Netherlands.
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Roberto S G M Perez
- Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Didi Rhebergen
- GGZ InGeest /Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Wouter W A Zuurmond
- Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Max L Stek
- GGZ InGeest /Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
| | - Cees M P M Hertogh
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Erik J A Scherder
- Department of Clinical Neuropsychology VU University, Amsterdam, The Netherlands.
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463
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Rundell SD, Sherman KJ, Heagerty PJ, Mock CN, Jarvik JG. The clinical course of pain and function in older adults with a new primary care visit for back pain. J Am Geriatr Soc 2015; 63:524-30. [PMID: 25754841 DOI: 10.1111/jgs.13241] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the clinical course of older adults presenting for a new primary care visit for back pain, no healthcare visit for back pain within the prior 6 months, by describing pain intensity, disability, pain interference, and resolution of back pain over 12 months. DESIGN Prospective inception cohort study. SETTING Primary care settings of three integrated healthcare systems in the United States that participated in the Back pain Outcomes using Longitudinal Data (BOLD) registry. PARTICIPANTS Five thousand two hundred eleven (99.5%) of the 5,239 adults aged 65 and older who had reached their 12-month follow-up date. MEASUREMENTS Baseline demographic characteristics, EQ-5D score, duration of back pain, expectation for recovery, depression, and anxiety. Participant-reported outcomes of back-related disability (Roland Morris Disability Questionnaire), numerical pain rating scale, pain interference, and resolution of back pain were collected at baseline and 3, 6, and 12 months. RESULTS Most improvement occurred within the first 3 months. The number and proportion with 30% improvement in back pain increased from 1,950 (42.3%) at 3 months to 1,994 (44.8%) by 12 months, and 1,331 (28.8%) and 1,576 (35.4%) had 30% improvement in disability at 3 and 12 months. Only 23.0% reported that their back pain had resolved at 12 months. Improvements in disability and interference with activity over 12 months differed according to age, duration of back pain, symptoms of depression and anxiety, and expectation for recovery. CONCLUSION The majority of older adults in primary care practice settings presenting with a new visit for back pain have persistent symptoms, disability, and interference over 12 months of follow-up. Future research is needed to identify risk factors for persistent symptoms and effective interventions.
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Affiliation(s)
- Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Department of Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington
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464
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Affiliation(s)
- M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, NY, USA
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465
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Rottenberg Y, Jacobs JM, Stessman J. Prevalence of pain with advancing age brief report. J Am Med Dir Assoc 2015; 16:264.e1-5. [PMID: 25659621 DOI: 10.1016/j.jamda.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The epidemiology of chronic pain with advancing age remains poorly established. Although most studies have examined somatic (musculoskeletal and joint) pain, visceral pain (such as headache and abdominal pain) has warranted less attention. We present longitudinal data from age 70 to 90 years concerning chronic musculoskeletal/joint pain, abdominal pain, and headache. METHODS Data was collected by the Jerusalem Longitudinal Study, which is a prospective study of a representative sample from the 1920-1921 birth-cohort living in West Jerusalem. Participants underwent comprehensive assessment at home in 1990, 1998, 2005, and 2010, at ages 70 (n = 460), 78 (n = 763), 85 (n = 1149), and 90 years (n = 394), respectively, and were directly questioned concerning the presence and location of pain. RESULTS The overall prevalence of pain of any kind at ages 70, 78, 85, and 90 years was 73% (n = 336/460), 81.1% (n = 619/763), 56.3% (n = 647/1149), and 31.2% (n = 123/394), respectively. Pain at younger ages only was associated with female gender, lower educational status, functional dependence, physical inactivity, increased body mass index, loneliness, depression, and poor self-rated health. At ages 70, 78, 85, and 90 years, chronic neck/back pain was present among 41.5%, 58.9%, 30.1%, and 14.6% of participants, respectively; chronic joint pain was present among 43.0%, 60.6%, 45.2%, and 25.2%, respectively. In contrast abdominal pain was less common and disappeared among the oldest old: 14.7%, 13.9%, 1.7%, and 1.5%, respectively, with a similar pattern for headache: 43.3%, 33.5%, 2.1%, and 1.3%. While pain was reported at ≥2 sites by 42.3% and 54.6% at ages 70 and 78 years, respectively, by ages 85 and 90 years, pain was most frequently reported at only 1 site. CONCLUSIONS Visceral pain (headache and abdominal pain) completely disappeared among the oldest old, in contrast to a far smaller decline in somatic (musculoskeletal and joint) pain.
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Affiliation(s)
- Yakir Rottenberg
- Institute for Aging Research, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Oncology, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Jeremy M Jacobs
- Institute for Aging Research, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Jochanan Stessman
- Institute for Aging Research, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and the Hebrew University-Hadassah Medical School, Jerusalem, Israel
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466
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de Rekeneire N, Volpato S. Physical Function and Disability in Older Adults with Diabetes. Clin Geriatr Med 2015; 31:51-65, viii. [DOI: 10.1016/j.cger.2014.08.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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467
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Wee CC, Davis RB, Chiodi S, Huskey KW, Hamel MB. Sex, race, and the adverse effects of social stigma vs. other quality of life factors among primary care patients with moderate to severe obesity. J Gen Intern Med 2015; 30:229-35. [PMID: 25341644 PMCID: PMC4314477 DOI: 10.1007/s11606-014-3041-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/12/2014] [Accepted: 08/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with obesity face widespread social bias, but the importance of this social stigma to patients relative to other quality of life (QOL) factors is unclear. OBJECTIVE Our aim was to examine the importance of obesity-related social stigma relative to other QOL factors on reducing patients' overall well-being. DESIGN We used a cross-sectional telephone interview. SETTING The study was conducted at four diverse primary care practices in Greater Boston. PARTICIPANTS Three hundred and thirty-seven primary care patients aged 18-65 years and with a body mass index (BMI) of 35 kg/m(2) or higher participated in the study. MAIN MEASURES Patients' health utility (preference-based QOL measure) was determined via responses to a series of standard gamble scenarios assessing willingness to risk death to lose various amounts of weight or to achieve perfect health. We used the Impact of Weight on Quality of Life-lite instrument to assess QOL domains specific to obesity (physical function, self-esteem, sexual life, public distress or social stigma, and work), and we examined variation in utility explained by these domains. KEY RESULTS Depending on patients' race/ethnicity, mean health utilities ranged from 0.92 to 0.99 among men and from 0.89 to 0.93 among women. After adjustment for race, BMI, and education, none of the QOL domains explained much of the variation in utility among men, except for work function among Hispanic men. In contrast, social stigma was the leading QOL contributor to utility for Caucasian women (explaining 6 % of the marginal variation beyond demographics and BMI). In contrast, sexual function was the most important contributor among African American women (3 % marginal variation), and work life was most important among Hispanic women (> 20 % in variation). Lower scores in one domain did not always translate into lower well-being. Moreover, QOL summary scores often explained less of the variation than some individual domains. CONCLUSION Obesity-related social stigma had disproportionate adverse effects on Caucasian women patients' well-being, whereas weight-related impairment in work function was particularly important among Hispanic patients and impaired sexual function was important to diminished well-being among African American women although its impact appeared modest.
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Affiliation(s)
- Christina C Wee
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA,
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468
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Jerome GJ, Ko SU, Kauffman D, Studenski SA, Ferrucci L, Simonsick EM. Gait characteristics associated with walking speed decline in older adults: results from the Baltimore Longitudinal Study of Aging. Arch Gerontol Geriatr 2015; 60:239-43. [PMID: 25614178 DOI: 10.1016/j.archger.2015.01.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the mechanisms that contribute to walking speed decline can provide needed insight for developing targeted interventions to reduce the rate and likelihood of decline. OBJECTIVE Examine the association between gait characteristics and walking speed decline in older adults. METHODS Participants in the Baltimore Longitudinal Study of Aging aged 60 to 89 were evaluated in the gait laboratory which used a three dimensional motion capture system and force platforms to assess cadence, stride length, stride width, percent of gait cycle in double stance, anterior-posterior mechanical work expenditure (MWE), and medial-lateral MWE. Usual walking speed was assessed over 6 m at baseline and follow-up. Gait characteristics associated with meaningful decline (decline≥0.05 m/s/y) in walking speed were evaluated by logistic regression adjusted for age, sex, race, height, weight, initial walking speed and follow-up time. RESULTS Among 362 participants, the average age was 72.4 (SD=8.1) years, 51% were female, 27% were black and 23% were identified has having meaningful decline in usual walking speed with an average follow-up time of 3.2 (1.1) years. In the fully adjusted model, faster cadence [ORadj=0.65, 95% CI (0.43,0.97)] and longer strides [ORadj=0.87, 95% CI (0.83,0.91)] were associated with lower odds of decline. However age [ORadj=1.04, 95% CI (0.99,1.10)] was not associated with decline when controlling for gait characteristics and other demographics. CONCLUSION A sizable proportion of healthy older adults experienced walking speed decline over an average of 3 years. Longer stride and faster cadence were protective against meaningful decline in usual walking speed.
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Affiliation(s)
- Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA.
| | - Seung-uk Ko
- Department of Mechanical Engineering, Chonnam National University, Yeosu, South Korea
| | - Danielle Kauffman
- Longitudinal Studies Section, National Institute on Aging (NIA/NIH), Baltimore, MD, USA
| | - Stephanie A Studenski
- Longitudinal Studies Section, National Institute on Aging (NIA/NIH), Baltimore, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, National Institute on Aging (NIA/NIH), Baltimore, MD, USA
| | - Eleanor M Simonsick
- Longitudinal Studies Section, National Institute on Aging (NIA/NIH), Baltimore, MD, USA
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469
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Stubbs B, Schofield P, Patchay S. Mobility Limitations and Fall-Related Factors Contribute to the Reduced Health-Related Quality of Life in Older Adults With Chronic Musculoskeletal Pain. Pain Pract 2014; 16:80-9. [DOI: 10.1111/papr.12264] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/22/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Brendon Stubbs
- School of Health and Social Care; University of Greenwich; London U.K
| | - Pat Schofield
- School of Health and Social Care; University of Greenwich; London U.K
| | - Sandhi Patchay
- School of Psychology; University of Greenwich; London U.K
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470
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Savvas SM, Gibson SJ. Treating pain in patients with impaired cognition. Pain Manag 2014; 4:335-8. [PMID: 25350073 DOI: 10.2217/pmt.14.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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471
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Pain interference is associated with psychological concerns related to falls in community-dwelling older adults: multisite observational study. Phys Ther 2014; 94:1410-20. [PMID: 24925074 DOI: 10.2522/ptj.20140093] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain interference and psychological concerns related to falls (PCRF) are pervasive phenomena among community-dwelling older adults, yet their association remains elusive. OBJECTIVE The purpose of this study was to establish whether pain interference is associated with PCRF in community-dwelling older adults. DESIGN This was a multisite cross-sectional study. METHOD Two hundred ninety-five community-dwelling older adults (mean age=77.5 years, SD=8.1; 66.4% female) participated in the study. All participants completed the Brief Pain Inventory (BPI) interference subscale, Short Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC), modified version of the Survey of Activities and Fear of Falling in Elderly Scale (mSAFFE), and Consequences of Falling Scale (CoF). Hierarchical multiple regression analysis were conducted. In the first step of the study, sociodemographic and known risk factors for psychological concerns related to falls were inserted into the model, followed by the BPI interference subscale score in the second step. RESULTS One hundred sixty-nine participants (57.3%) reported some pain interference. The BPI interference subscale was highly correlated with all PCRF (r>.5, P<.0001). After the adjustment for established risk factors, the BPI interference subscale significantly increased the variance in the Short FES-I (R2 change=13.2%), ABC (R2 change=4.7%), mSAFFE (R2 change=5.0%), and CoF (R2 change=10.0%). Pain interference was a significant and independent predictor in the final model for the Short FES-1 (β=0.455, P<.001), ABC (β=-0.265, P<.001), mSAFFE (β=0.276, P<.001), and CoF (β=0.390, P<.001). LIMITATIONS The study was cross-sectional. CONCLUSIONS Pain interference is an important contributing factor in each of the psychological concerns related to falls. Pain interference had the strongest impact on reducing falls efficacy and increasing older adults' concerns about the consequences of falling.
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472
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Patel KV, Phelan EA, Leveille SG, Lamb SE, Missikpode C, Wallace RB, Guralnik JM, Turk DC. High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study. J Am Geriatr Soc 2014; 62:1844-52. [PMID: 25283473 PMCID: PMC4206582 DOI: 10.1111/jgs.13072] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the prevalence of clinically relevant falls-related outcomes according to pain status in older adults in the United States. DESIGN Cross-sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged 65 and older (response rate 71.0%). SETTING In-person assessments were conducted in the home or residential care facility of the sampled study participant. PARTICIPANTS Individuals aged 65 and older (n = 7,601, representing 35.3 million Medicare beneficiaries). MEASUREMENTS Participants were asked whether they had been "bothered by pain" and the location of pain, as well as questions about balance and coordination, fear of falling, and falls. RESULTS Fifty-three percent of the participants reported bothersome pain. The prevalence of recurrent falls in the past year (≥ 2 falls) was 19.5% in participants with pain and 7.4% in those without (age- and sex-adjusted prevalence ratio (PR) = 2.63, 95% confidence interval (CI) = 2.28-3.05). The prevalence of fear of falling that limits activity was 18.0% in those with pain and 4.4% in those without (adjusted PR = 3.98, 95% CI = 3.24-4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance and coordination that limited activity was 6.6% in participants with no pain, 11.6% in those with one site of pain, 17.7% in those with two sites, 25.0% in those with three sites, and 41.4% in those with four or more sites (P < .001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance. CONCLUSION Falls-related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.
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Affiliation(s)
- Kushang V. Patel
- Center for Pain Research on Impact, Measurement and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Elizabeth A. Phelan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle
| | - Suzanne G. Leveille
- College of Nursing and Health Sciences, University of Massachusetts, Boston
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Sarah E. Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK
- Kadoorie Critical Care Research Centre, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Jack M. Guralnik
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
| | - Dennis C. Turk
- Center for Pain Research on Impact, Measurement and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
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473
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Kolanowski A, Mogle J, Fick DM, Hill N, Mulhall P, Nadler J, Colancecco E, Behrens L. Pain, delirium, and physical function in skilled nursing home patients with dementia. J Am Med Dir Assoc 2014; 16:37-40. [PMID: 25239018 DOI: 10.1016/j.jamda.2014.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Skilled nursing facilities (SNFs) are major sites of postacute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are suboptimal because of poor-quality treatment, including the failure to provide needed care. Pain is frequently unrecognized and untreated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined. DESIGN Secondary analysis of data from an on-going randomized clinical trial. SETTING Eight SNFs located in central and northeast Pennsylvania. PARTICIPANTS A total of 103 SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were women (66%) and white (98%). MEASUREMENTS Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge. RESULTS On days when participants experienced greater than their average level of pain, they also experienced more delirium symptoms (P < .001) and lower physical function (P < .001). Participants with higher levels of average daily pain were more likely to die (odds ratio [OR] 6.306, 95% confidence interval [CI] 1.914-20.771, P = .003) or be placed in a nursing home (OR 4.77, 95% CI 1.7-13.2, P = .003) compared with returning to the community at 3-month follow-up. CONCLUSION Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs.
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Affiliation(s)
| | - Jacqueline Mogle
- Center for Healthy Aging, College of Health & Human Development, Penn State, University Park, PA
| | - Donna M Fick
- College of Nursing, Penn State, University Park, PA
| | - Nikki Hill
- College of Nursing, Penn State, University Park, PA
| | | | - Jamie Nadler
- College of Nursing, Penn State, University Park, PA
| | | | - Liza Behrens
- College of Nursing, Penn State, University Park, PA
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474
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Stubbs B, Eggermont L, Patchay S, Schofield P. Older adults with chronic musculoskeletal pain are at increased risk of recurrent falls and the brief pain inventory could help identify those most at risk. Geriatr Gerontol Int 2014; 15:881-8. [DOI: 10.1111/ggi.12357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Brendon Stubbs
- School of Health and Social Care; University of Greenwich; London UK
| | - Laura Eggermont
- Department of Clinical Neuropsychology; VU University Amsterdam; Amsterdam the Netherlands
| | - Sandhi Patchay
- School of Psychology and Counselling; University of Greenwich; London UK
| | - Pat Schofield
- School of Health and Social Care; University of Greenwich; London UK
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475
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Abstract
IMPORTANCE Persistent pain is highly prevalent, costly, and frequently disabling in later life. OBJECTIVE To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. EVIDENCE ACQUISITION Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. FINDINGS Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended-emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. CONCLUSIONS AND RELEVANCE Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.
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Affiliation(s)
- Una E Makris
- Department of Internal Medicine, Division of Rheumatic Diseases, UT Southwestern Medical Center, Dallas, Texas2Department of Medicine, Division of Rheumatology, Veterans Administration Medical Center, Dallas, Texas
| | - Robert C Abrams
- Department of Psychiatry, Weill Cornell Medical College, New York, New York4Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Barry Gurland
- Stroud Center, Columbia University, New York, New York
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
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476
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Kissin I. Scientometric assessment of drugs for chronic pain, 1979-2013: rapid growth of publications, paucity of successful drugs. J Pain Res 2014; 7:505-14. [PMID: 25187736 PMCID: PMC4149448 DOI: 10.2147/jpr.s67479] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to find signs of progress in the pharmacotherapy of chronic pain over the past 35 years using scientometric analysis. The following scientometric indices were used: 1) popularity index, representing the share of articles on a specific drug(s) relative to all articles in the field of chronic pain; 2) index of change, representing the degree of growth in publications on a topic from one period to the next; 3) index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed; and 4) index of ultimate success, representing a publication outcome when a new drug takes the place of a common drug previously used for the same purpose. Publications on 55 drugs used in the treatment of chronic pain were assessed during seven 5-year periods, from 1979 to 2013. The rate of rise in the number of publications on chronic pain was exponential, with an increase of nearly ninefold from 2,346 articles over the 5-year period 1979–1983 to 21,095 articles in 2009–2013. However, despite this huge increase in publications, our scientometric analysis did not reveal signs of really successful drugs in this field. For the 2009–2013 period, the popularity index had a meaningful magnitude (from 0.5–2.8) for only 13 of 55 drugs. Five of them were opioids, including morphine, which had the highest index value of all drugs (2.8). None of the drugs had a high index of expectations in 2009–2013. The index of ultimate success was positive only with triptans in the relatively limited area of acute treatment of migraine. As a result, despite rapid growth in the number of publications, our scientometric analysis did not reveal signs of substantial progress in the field of pharmacotherapy for chronic pain.
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Affiliation(s)
- Igor Kissin
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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477
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Treating chronic non-cancer pain in older people--more questions than answers? Maturitas 2014; 79:34-40. [PMID: 25048719 DOI: 10.1016/j.maturitas.2014.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
There is little evidence specifically relating to drug treatments for pain in older people, but much can be extrapolated from what we already know. The evidence about drug treatments for chronic non-cancer pain is changing, driven by major improvements in understanding of clinical trial analysis and by the adoption of patient-centered outcomes of proven economic benefit. There is clear evidence of lack of useful effect, or insufficient evidence of effect for a number of commonly used drugs, including paracetamol, topical rubefacients, low concentration topical capsaicin, and for strong opioids in chronic non-cancer pain. In musculoskeletal pain there is evidence of efficacy for NSAIDs, tramadol, and tapentadol, and in neuropathic pain for duloxetine, pregabalin, and gabapentin, with weak evidence for amitriptyline. The new perspective is of drugs that work well in a minority of patients, but hardly at all in the remainder. The goal of treatment is large reductions in pain, by 50% or more. This outcome, and only this outcome, is associated with large benefits in terms of improved sleep, reduced depression, and large gains in function and quality of life. It is not possible to predict which patient will benefit from which drug, but early success or failure appears to be predictive of long-term success or failure. The emphasis is on stopping treatments that do not work and switching to other drugs in the same or different class, so that any potential future risk of treatment is balanced by very large and immediate benefit.
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478
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Aging, Fatigue, and Fatigability: Implications for Occupational and Physical Therapists. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0093-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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479
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Jarvik JG, Comstock BA, Heagerty PJ, Turner JA, Sullivan SD, Shi X, Nerenz DR, Nedeljkovic SS, Kessler L, James K, Friedly JL, Bresnahan BW, Bauer Z, Avins AL, Deyo RA. Back pain in seniors: the Back pain Outcomes using Longitudinal Data (BOLD) cohort baseline data. BMC Musculoskelet Disord 2014; 15:134. [PMID: 24755158 PMCID: PMC4021204 DOI: 10.1186/1471-2474-15-134] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Back pain represents a substantial burden globally, ranking first in a recent assessment among causes of years lived with disability. Though back pain is widely studied among working age adults, there are gaps with respect to basic descriptive epidemiology among seniors, especially in the United States. Our goal was to describe how pain, function and health-related quality of life vary by demographic and geographic factors among seniors presenting to primary care providers with new episodes of care for back pain. METHODS We examined baseline data from the Back pain Outcomes using Longitudinal Data (BOLD) registry, the largest inception cohort to date of seniors presenting to a primary care provider for back pain. The sample included 5,239 patients ≥ 65 years old with a new primary care visit for back pain at three integrated health systems (Northern California Kaiser-Permanente, Henry Ford Health System [Detroit], and Harvard Vanguard Medical Associates [Boston]). We examined differences in patient characteristics across healthcare sites and associations of patient sociodemographic and clinical characteristics with baseline patient-reported measures of pain, function, and health-related quality of life. RESULTS Patients differed across sites in demographic and other characteristics. The Detroit site had more African-American patients (50%) compared with the other sites (7-8%). The Boston site had more college graduates (68%) compared with Detroit (20%). Female sex, lower educational status, African-American race, and older age were associated with worse functional disability as measured by the Roland-Morris Disability Questionnaire. Except for age, these factors were also associated with worse pain. CONCLUSIONS Baseline pain and functional impairment varied substantially with a number of factors in the BOLD cohort. Healthcare site was an important factor. After controlling for healthcare site, lower education, female sex, African-American race, and older age were associated with worse physical disability and all of these factors except age were associated with worse pain. TRIAL REGISTRATION Clinical Trials.gov NCT01776242; Registration date: June 13, 2012.
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Affiliation(s)
- Jeffrey G Jarvik
- Department of Radiology, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Bryan A Comstock
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Patrick J Heagerty
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Judith A Turner
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sean D Sullivan
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Xu Shi
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - David R Nerenz
- Neuroscience Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Srdjan S Nedeljkovic
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Larry Kessler
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Kathryn James
- Department of Radiology, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
| | - Janna L Friedly
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brian W Bresnahan
- Department of Radiology, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
| | - Zoya Bauer
- Department of Radiology, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
| | - Andrew L Avins
- Division of Research, Northern California Kaiser-Permanente, Oakland, CA, USA
| | - Richard A Deyo
- Departments of Family Medicine, Internal Medicine, and Public Health and Preventive Medicine, and the Center for Research in Occupational and Environmental Toxicology Oregon Health and Science University, Portland, OR, USA
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