Family members’ perceptions of pain and distress related to analgesics and psychotropic drugs, and quality of care of elderly nursing home residents

Abstract

The aims of the present study were: (1) to describe family members' perceptions of nursing homes residents' pain and distress in relation to analgesics and psychotropic drugs; and (2) to compare whether background variables, dementia, help/support, prescribing of analgesics and psychotropic drugs, and quality of care vary between subgroups of residents. Two hundred and thirty-two family members of elderly people in 10 Swedish nursing homes participated in the study. The participants responded to a questionnaire including background variables, pain and distress variables, and the Quality from the Patient's Perspective (QPP) questionnaire. Data on drug prescribing was obtained from the medical records. The head nurse on each ward noted whether or not the resident had a documented or known diagnosis of dementia. The results showed that a high frequency of elderly nursing home residents were estimated as having physical pain and worry. A large number of the residents were prescribed psychotropic drugs. In addition, some of the residents with moderate or severe physical pain were not prescribed any analgesics. The residents were divided into three subgroups based on scores of physical discomfort, physical pain and worry. Subgroup comparisons differed with regard to sex, help/support, drugs and quality of care. Staff have a responsibility to assess the residents' pain and distress since this will form a basis for better pain and distress management. Other suggestions for improving quality of care are the provision of better information to the family members and the residents, meaningful occupation, less task-oriented care, and care that involves residents.

Pain in care home residents with dementia: an exploration of frequency, prescribing and relatives' perspectives

“…Relatives of the residents sampled reported that pain was managed appropriately by the care home; other studies have reported contrasting findings (Hall-Lord et al, 2002). Although many relatives felt that residents were treated with respect by the care home staff, fewer felt that the staff fully understood the resident's situation.…”

“…Demographic associations (relative gender, educational level (up to secondary level vs higher or further education received), if the resident had lived with the relative before care home admission, the relative's relationship to resident (child vs sibling/niece/nephew), frequency of visits to resident (once a week or less vs 2-3 times a week or more) and relative knowledge of resident's current medication) were investigated with response. These explorations were based upon associations previously reported (Weiner et al, 1999;Cohen-Mansfield, 2002;Hall-Lord et al, 2002). Univariate analysis was used initially to explore associations between presence of pain and the following variables: resident gender, history of psychiatric illness, use of prescribed analgesics, analgesics used in the past for pain, the staging of dementia (mild/moderate/severe), use of hypnotic/anxiolytic medication, use of antidepressant medication and use of antipsychotic medication.…”

“…had to state their level of agreement or disagreement using a 5-point Likert scale. The statements were based upon relatives' perceptions of care provided by the care home staff, treatment of pain and medication use, and addressed issues that had emerged from the literature (Weiner et al, 1999;Cohen-Mansfield, 2002;Hall-Lord et al, 2002).…”

Perception of quality of care: comparison of the views of patients’ with lung cancer and their family members

“…2010). Hall‐Lord et al (2003) grouped family members’ ratings and nursing home residents ratings of QoC by severity of self‐assessed physical and emotional distress, finding that family members who rated symptoms as most severe were also most dissatisfied with QoC. These relationships between mental health and perception of QoC further emphasise the importance of sensitive and high quality care of particularly vulnerable patients and their family members.…”

Pain in patients with dementia: A review of pain assessment and treatment challenges

“…1 Persistent pain results in a progressive decline of functional and mental capacity, 2 social interaction 3 and quality of life, 4-6 appetite 7,8 and sleep disturbances, 9,10 and increased behavioural disturbances including agitation, depression and anxiety. [11][12][13] Pain causes immense stress for the patient, their formal and informal care givers 14,15 and increases health care costs. 16,17 In the last decades, clinicians and scientists concentrated on the prevalence, 18 assessment 19,20 and treatment of pain in older people with mental impairment and the consequences of undetected and untreated pain.…”