Abstract
ObjectiveTo analyze the pattern and appropriateness of pain medications in older adults receiving home care.MethodsWe performed a prospective cross-sectional study in patients ≥65 years old having chronic pain and receiving home care in Berlin, Germany. Data on prescribed pain medications were collected using self-reported information, nursing documents, and medication plans during interviews at home. Pain intensity was determined with the numeric rating scale (NRS) and the Pain Assessment In Advanced dementia (PAINAD) scale. The Pain Medication Appropriateness Scale score (SPMAS) was applied to evaluate inappropriateness (i.e. a score ≤67) of pain medication.ResultsOverall 322 patients with a mean age of 82.1 ± 7.4 years (71.4% females) were evaluated. The average pain intensity scores during the last 24 hours were 5.3 ± 2.1 and 2.3 ± 2.3 on NRS and PAINAD scale (range 0–10, respectively). Sixty (18.6%) patients did not receive any pain medication. Among the treated patients, dipyrone was the most frequently prescribed analgesic (71.4%), while 50.8% and 19.1% received systemic treatment with opioids and non-steroidal anti-inflammatory drugs, respectively. The observed median SPMAS was 47.6 (range 0–100) with 58 (18.0%) of patients achieving appropriate values. Half of the patients were treated with scheduled, while 29.9% were only treated with on-demand medications. Cognitive status had no effect on appropriateness of pain treatment.ConclusionsWe observed substantial deficits in dosing patterns and appropriateness of pain medication in older adults with pain receiving home care. This applied to both patients with and without severe cognitive impairment.
Highlights
The global population has experienced a demographic change over the last century towards an aging population [1]
We observed substantial deficits in dosing patterns and appropriateness of pain medication in older adults with pain receiving home care. This applied to both patients with and without severe cognitive impairment
Older adults receiving home care were mainly recruited through ambulatory nursing services (Fig 1) and were included if they met the following criteria: 1) aged 65 years or older; 2) suffering from chronic pain ( 3 months); 3) live at their own homes and 4) in need of care according to the legal regulations in Germany
Summary
The global population has experienced a demographic change over the last century towards an aging population [1]. In Germany, an estimated 3.4 million individuals are in need of care and the majority of them (81%) are more than 65 years old, while 35% are at least 85 years old [2]. For this elderly population, pain represents a significant problem due to the high prevalence of musculoskeletal disorders, cancer, neuropathy and other medical conditions for which pain is a major symptom [3]. A previous study indicated that there is an age-dependent discrepancy between the prevalence of chronic pain and pain interference or suffering from chronic pain [6]. The problem is further complicated in those with cognitive impairment who are mostly incapable of communicating their own symptoms, which hinders appropriate management of pain in this population [8]
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