Drug-based pain management for people with dementia after hip or pelvic fractures: a systematic review

Abstract

BackgroundStudies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture.The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings. Treatment could be surgical or conservative. We also analysed study designs, methods and variables, as well as which assessments were applied to measure pain management and mental status.Method/designThe development of this systematic review protocol was guided by the PRISMA-P requirements, which were taken into consideration during the review procedures. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect were searched. Studies published up to January 2016 were included. The data extraction, content and quantitative descriptive analysis were carried out systematically, followed by a critical appraisal.ResultsEight of the 13 included studies focusing on patient data showed that people with dementia received less drug-based pain management than people without cognitive impairment. Four studies based on surveys of healthcare professionals stated that cognitive impairment is a major barrier for effective pain management. There was heterogeneity regarding the assessment of the mental status and the pain assessment of the patients. The assessment of the drugs administered in all of the studies working with patient data was achieved through chart reviews.ConclusionPeople with dementia do not seem to receive the same amount of opioid analgesics after hip fracture as people without cognitive impairment. There is need to enhance pain assessment and management for these patients. Future research should pay more attention to the use of the appropriate items for assessing cognitive impairment and pain in people with dementia.Trial registrationThis systematic review was registered at Prospero (CRD42016037309); on 11 April 2016, and the systematic review protocol was published (Syst Rev. 5(1):1, 2016).

Association between malnutrition risk and pain in older hospital patients

“…Our study revealed that patients with severe/very severe or unbearable pain are at higher risk of developing malnutrition risk than those without pain. As a result, an adequate assessment of pain can be considered as the first step towards providing help and improving the pain management practice ( 15 , 32 , which can help reduce consequences of pain like malnutrition. The accurate assessment of pain is a great challenge, because pain cannot be easily measured using a single biological marker ( 35) .…”

“…Numerous pain assessment scales are available, but pain assessment is not performed routinely ( 10 , 36 , 37 . This has been described as a substantial barrier to the accurate treatment of older people with pain ( 32 , 33 . Furthermore, older patients may attempt to avoid to taking too many pain killers, because they may be afraid of adverse effects or addiction.…”

Pain in older adults with dementia

“…However, while there are numerous assessment scales available, pain assessment is not performed routinely [12,23]. The low use of pain assessment scales has previously been described as a substantial barrier against the accurate treatment of older people with pain and dementia [21,22]. Care professionals acknowledged lack of knowledge has also been identified as a fundamental barrier to optimal pain management [9,11].…”

Comparison between femoral block and PENG block in femoral neck fractures: A cohort study

“…This could be related to the population here described, as one of the exclusion criteria was severe dementia, which implies an impossibility to autonomously and reliably evaluate pain. A meta-analysis by Moschinski et al [ 22 ] reports that postoperative morphine consumption could be significantly different in demented patients compared to non-demented. Finally, one of the other potential reasons for the absence of a statistically significant difference on the primary endpoint concerns the way the blocks were performed.…”