Deficits in pain medication in older adults with chronic pain receiving home care: A cross-sectional study in Germany

Abstract

Objective To analyze the pattern and appropriateness of pain medications in older adults receiving home care. Methods We 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 (S PMAS) was applied to evaluate inappropriateness (i.e. a score �67) of pain medication. Results Overall 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 S PMAS 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.

High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems

“…The current analysis is a planned pre-specified subanalysis of the ACHE study (“Development of a Model for PAin Management in Older Adults ReCeiving Home CarE”) in Germany. Briefly, ACHE was an observational cross-sectional analysis of a population-based cohort of older adults which focused on pain management in home care and has been described previously in detail ( Schneider et al, 2020 ). Ethical approval was obtained by the local ethical committee of the Charité, Universitätsmedizin Berlin (EA1/368/14).…”

Paracetamol: A Review of Guideline Recommendations

“…However, OA-related pain and disability are often underdiagnosed and undertreated, especially in the elderly; for example, 72% of hip fracture patients receive no prehospital treatment for pain [ 47 ]. Patients and their caregivers often regard pain as a common natural occurrence of aging or because elderly patients are thought to feel less pain, be cognitively impaired, or be reluctant to report pain for stoicism [ 47 , 48 , 49 ]. A negative attitude toward treating pain in the elderly is favored by a lack of studies on the efficacy and safety of pharmacological treatments of OA pain in the elderly [ 50 , 51 , 52 , 53 , 54 , 55 , 56 ].…”

Palliative Care in Advanced Dementia

“…People with primary dementia diagnosisreceive pain treatment less often than those with secondary diagnosis (29). In home care settings people with dementia were not even treated adequately with analgesics if they suffered already from pain previously (76). Moreover people with dementia experience pain even if treated against it (73).…”