Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol

Abstract

IntroductionPeople living with dementia may experience and express pain in different ways to people without dementia. People with dementia are typically prescribed fewer analgesics than people without dementia indicating a potential difference in how pain is identified and treated in these populations. The objectives of this study are to (1) investigate the prevalence of analgesic load, pain and daytime sedation in people with and without dementia in Australian residential aged care facilities (RACFs), and (2) investigate the clinical and diagnostic associations between analgesic load, pain and daytime sedation in people with and without dementia in Australian RACFs.Methods/analysisThis will be a cross-sectional study of 300 permanent residents of up to 10 low-level and high-level RACFs in South Australia with and without dementia. Trained study nurses will administer validated and dementia-specific assessments of self-reported and clinician-observed pain, sedation and other clinical and humanistic outcomes. Medicine-use data will be extracted directly from each resident's medication administration chart. Binary and multinominal logistic regression will be used to compute unadjusted and adjusted ORs and 95% CIs for factors associated with pain, analgesic load and daytime sedation. These factors will include dementia severity, behavioural and psychological symptoms, quality of life, resident satisfaction, attitudes towards medicines, activities of daily living and nutritional status.Ethics and disseminationInstitutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences and in peer-reviewed journal articles. The findings of this study will allow for a better understanding of the prevalence and factors associated with analgesic use, pain and other outcomes in residential care. The findings of this study will be used to inform the development and implementation of strategies to improve the quality of life of people with dementia.

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

“…Finish study involving 67 215 community-dwelling persons diagnosed with AD and 67 215 matched comparison persons without AD found that fewer people with AD used NSAIDs compared with people without AD (13.2% vs. 17.3%, respectively), which is in line with our findings 35. Underrecognition of pain and fear of adverse drug events due to NSAIDs might account for a lower prevalence of analgesic use in people with dementia 36. The main strength of this study was the whole-population coverage of people dispensed medicines for dementia and an inclusion of a matched comparison cohort of people not dispensed medicines for dementia.…”

“…35 Underrecognition of pain and fear of adverse drug events due to NSAIDs might account for a lower prevalence of analgesic use in people with dementia. 36 The main strength of this study was the whole-population coverage of people dispensed medicines for dementia and an inclusion of a matched comparison cohort of people not dispensed medicines for dementia. However, there are some limitations in this study.…”

Frailty Levels in Residential Aged Care Facilities Measured Using the Frailty Index and FRAIL‐NH Scale

“…The Neuropsychiatric Inventory—Nursing Home (NPI‐NH) version was used to assess residents' neuropsychiatric symptoms using the frequency and severity questions of the behavioral domains of the scale and professional caregiver burden using the disruptiveness question for each behavioral domain of the scale. Details of scales used have been published previously . A total score was calculated for each scale, and those scoring in the lowest (satisfaction, quality‐of‐life) or highest (neuropsychiatric symptom, disruptiveness) quartiles were identified as reporting a deficit in this scale.…”

The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

“…RACFs were classified according to level of support: ranging from aided daily tasks and personal care in low-level RACFs to 24-h nursing in high-level RACFs. The full study protocol has been described previously [18]. …”

“…A standard data extraction form, comprising a series of validated and widely used data collection scales, enabled collection of other clinical data. Both resident self-report and observational scales completed by staff informants were utilized [18]. Where possible, residents chose the most appropriate response through verbal or written communication.…”