Chronic pain conditions and use of analgesics among nursing home patients with dementia

Prevalence of rheumatic and musculoskeletal diseases (RMDs) in nursing home residents: a systematic literature review

PURPOSE

The objective of this systematic literature review was to: (1) estimate the prevalence of (symptoms of) rheumatic and musculoskeletal diseases (RMDs) and (2) explore how (symptoms of) RMDs are identified and documented in studies among nursing home residents.

METHODS

Prevalence data of (symptoms of) RMDs in permanently admitted nursing home residents ≥ 60 years were included. Data extraction, data synthesis and risk of bias assessment were performed by two reviewers independently. Included studies were categorized based on case ascertainment and case definition comprising: (location of) musculoskeletal pain, general terms for RMDs or a specific type of RMD. Results were summarized descriptively.

RESULTS

Out of 6900 records, 53 studies were included. Case ascertainment comprised databases (n = 5), physical examination (n = 1), self-report questionnaires (n = 14), review of medical charts (n = 23) and self-report questionnaires combined with review of medical charts (n = 10). Prevalence ranged between 0.9 and 77.0% for (localized) musculoskeletal pain (n = 19) and between 0.6 and 67.5% for RMDs in general (n = 39). Prevalence rates of specific type of RMDs ranged between 0.7 and 47.5% for gout, between 3.3 and 11.0% for rheumatoid arthritis and between 2.8 and 75.4% for osteo-arthritis (n = 14). Heterogeneity with regard to documentation of (symptoms of) RMDs in medical data of nursing home residents was high.

CONCLUSION

The overall prevalence of (symptoms of) RMDs varied to a great extent. This was mainly due to large heterogeneity in documentation of (symptoms of) RMDs. Establishing agreement on a useful and practical classification may ultimately increase identification of RMDs in the nursing home setting.

The effect of a music-based caregiving intervention on pain intensity in nursing home patients with dementia: a cluster-randomized controlled study

ABSTRACT

Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = -0.15, 95% CI [-0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [-0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [-0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.

Pharmacological treatment of pain in Swedish nursing homes: Prevalence and associations with cognitive impairment and depressive mood

OBJECTIVES

Chronic pain is highly prevalent in nursing home residents and often occurs with depression as well as cognitive impairment, which can severely influence and limit the expression of pain.

METHODS

The present cross-sectional study aimed to estimate the prevalence of pain, depressive mood, and cognitive impairment in association with pharmacological treatment against pain and depressive symptoms among Swedish nursing home residents.

RESULTS

We found an overall pain prevalence of 52.8%, a prevalence of 63.1% for being in a depressive mood, and a prevalence of cognitive impairment of 68.3%. Among individuals assessed to have depressive mood, 60.5% were also assessed to have pain. The prevalence of pharmacological treatment for pain was 77.5 and 54.1% for antidepressants. Prescription of pharmacological treatment against pain was associated with reports of currently having pain, and paracetamol was the most prescribed drug. A higher cognitive function was associated with more filled prescriptions of drugs for neuropathic pain, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), which could indicate an undertreatment of pain in those cognitively impaired.

CONCLUSION

It is important to further explore the relationship between pain, depressive mood, and cognitive impairment in regard to pain management in nursing home residents.