Pain assessment and management in persons with dementia

Horgas, Ann L.; Elliott, Amanda

doi:10.1016/j.cnur.2004.02.013

Cited by 79 publications

(66 citation statements)

References 50 publications

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“…Simon and Ludman (2006) recently found that benzodiazepines were prescribed to older adults in primary care for sleep and anxiety problems without clear indication for use and were continued long term without improvements in symptoms. Many non-pharmacological approaches for pain, sleep, and behavior problems are nurse led (Horgas & Elliott, 2004;Kolanowski, Litaker, & Buettner, 2005;McDowell, Mion, Lydon, & Inouye, 1998;Richards, Beck, O'Sullivan, & Shue, 2005).…”

Section: Nursing Implicationsmentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

256

198

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The purpose of this study was to examine the prevalence of potentially inappropriate medication use (PIMs) among community-dwelling older adults and the association between PIMs and health care outcomes. Participants were 17,971 individuals age 65 years and older. PIM use was defined by the Beers criteria. Drug-related problems (DRPs) were defined using ICD-9 codes. Forty percent of the 17,971 individuals filled at least 1 PIM prescription, and 13% filled 2 or more PIM prescriptions. Overall DRP prevalence among those with at least 1 PIM prescription was 14.3% compared to 4.7% in the non-PIM group (p < .001). In conclusion, preventing PIM use may be important for decreasing medication-related problems, which are increasingly being recognized as requiring an integrated interdisciplinary approach. Keywordsmedications; healthcare costs; geriatrics; adverse drug events Drug-related problems (DRPs) are prevalent in the older adult population and pose a major patient safety concern. DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al., 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs. The purpose of this study was to examine both the prevalence of potentially inappropriate medication (PIMs) use among community-dwelling older adults and the association between PIMs and health care outcomes.One method promoted to identify high-risk medications is the use of an explicit list of PIMs. PIMs were first devised and publicized by Beers et al. for nursing home residents and subsequently expanded to include older adults in all settings (Beers, 1997). PIMs are medications identified through expert panel review as having risks that outweigh benefits (Beers et al., 1991). Since the early 1990s, the prevalence of PIMs has been examined in a (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999Curtis et al., 2004), acute care (Onder et al., 2005), and community settings (Zhan et al., 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.The clinical validity of using a list of medications based on expert panel review and explicit criteria has been questioned as being overly simplistic and not including all the common drugs causing problems in older adults (Crownover & Unwin, 2005;Shorr, 2004). Moreover, despite the numerous reports of the prevalence of PIMs, only a few investigators (Fu, Liu, & Christensen, 2004;Thapa, Gideon, Cost, Milam, & Ray, 1998) have examined whether PIMs are associated with adverse clinical outcomes. Therefore, we investigated the outcomes associated with PIM use in a population of community-dwelling older adults.The Beers criteria have been revised recently; hence, the current prevalence of PIMs in...

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Section: Nursing Implicationsmentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

256

198

View full text Add to dashboard Cite

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“…Painful conditions are common in elderly people (Horgas and Elliott, 2004) and the experience of pain is related to several factors, such as etiology and comorbidity. More recently, attention has been directed towards cognitive factors.…”

Section: Introductionmentioning

confidence: 99%

Exploring the relationship between cognition and self-reported pain in residents of homes for the elderly

Oosterman

Vries²,

Dijkerman

et al. 2008

IPG

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Background: Pain poses a major problem in older adults, specifically for those living in homes for the elderly. Previous research indicates that the presence of pain may be associated with changes in cognitive functions. It is unclear, however, how the reported experience of pain relates to cognitive functioning in elderly people with chronic pain. The present study was intended to examine the relationship between clinical pain experience and neuropsychological status in residents of homes for the elderly.

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“…The final SQIs are presented in Table 2. [38][39][40][41][42][43][44][45][46][47][48] It maps the indicator, the SQI-related evidence, SQI numerator and denominator, and trigger values for each indicator.…”

Section: Resultsmentioning

confidence: 99%

Structural Quality Indicators to Support Quality of Care for Older People With Cognitive Impairment in Emergency Departments

Schnitker

Martin‐Khan

Burkett

et al. 2015

Academic Emergency Medicine

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Objectives: The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).Methods: A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria.Results: At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment.Conclusions: This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.ACADEMIC EMERGENCY MEDICINE 2015;22:273-284

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Pain assessment and management in persons with dementia

Cited by 79 publications

References 50 publications

Health outcomes associated with potentially inappropriate medication use in older adults

Health outcomes associated with potentially inappropriate medication use in older adults

Exploring the relationship between cognition and self-reported pain in residents of homes for the elderly

Structural Quality Indicators to Support Quality of Care for Older People With Cognitive Impairment in Emergency Departments

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