Pain Medication and Global Cognitive Functioning in Dementia Patients with Painful Conditions

Plooij, Bart; Spek, Klaas van der; Scherder, E.J.A.

doi:10.2165/11630850-000000000-00000

Cited by 16 publications

(23 citation statements)

References 26 publications

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“…Pain in patients with dementia has been poorly evaluated in relation to the ACB. Moreover, the hospital setting has seldom been considered, as most studies were based in community and nursing home settings …”

Section: Discussionmentioning

confidence: 99%

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Reinold

Palese

Romanese

et al. 2019

Int J Geriat Psychiatry

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Objectives: To evaluate changes in the use of antipsychotics and medications with anticholinergic activity (MACs) during hospitalization in older adults with dementia and factors associated with antipsychotic prescriptions and increased anticholinergic burden (ACB). Methods and design:This retrospective cohort study included all patients aged 65 years or older with a discharge diagnosis of dementia hospitalized at the university hospital of Udine, Italy, from 2012 to 2014. Medications dispensed within 3 months before and after hospitalization were identified in community-pharmacy dispensations while those prescribed at discharge were collected from Hospital Electronic Medical Records (EMR). ACB was assessed using the Anticholinergic Cognitive Burden score.Results: Among 1908 patients included, at discharge, 37.0% used one or more antipsychotic (9.4% before and 12.6% after hospitalization), 68.6% used one or more MAC (49.1% and 45.7%, respectively), and ACB of 38.4% of patients increased at discharge mainly because of a higher use of antipsychotics with anticholinergic activity (33% at discharge vs 12% before hospitalization). Prescription of antipsychotics at discharge was associated with prior treatment with antipsychotics (adjusted odds ratio [aOR] 4.85; 95%CI, 3.37-6.97), psychiatric conditions, (4.39; 3.47-5.54) and discharge from surgical department (2.17; 1.32-3.55). An increased ACB was associated with psychiatric conditions (1.91; 1.52-2.39), discharge from surgical (1.75; 1.09-2.80) or medical department (1.50; 1.04-2.17), and with cardiac insufficiency (1.41; 1.00-1.99).Conclusions: ACB was higher at discharge, and antipsychotics were the main drivers of this increase. Clinicians treating older adults with dementia should be aware of the risks associated with antipsychotics and that some of these medications may increase the risk of anticholinergic effects.

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Section: Discussionmentioning

confidence: 99%

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Reinold

Palese

Romanese

et al. 2019

Int J Geriat Psychiatry

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“…Patients with altered cognition comprise a significant proportion of nursing home residents, and proper assessment of pain with appropriate treatment options in patients with dementia has the potential to reduce negative behaviors. 20 Our study also demonstrated the key role that family members play in decision making and overall success of pain interventions. 21 Family members of residents view themselves as advocates for nursing home residents.…”

Section: Discussionmentioning

confidence: 52%

Implementation of a Nursing Home Quality Improvement Project to Reduce Resident Pain

Abrahamson

DeCrane

Mueller

et al. 2015

Journal of Nursing Care Quality

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This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.

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“…However, people with intellectual disability and dementia may lose the ability to recognise and report their pain experience due to their disability or as the dementia progresses, which makes pain recognition and treatment more challenging. Thereby, they are less likely to have their pain needs met adequately (Cleary & Doody, 2017a;Doody & Bailey, 2017;Kerr et al, 2006;Kerr, Cunningham, & Wilkinson, 2011;Plooij, Spek, & Scherder, 2012). The inadequate recognition of a person's pain experience can result in diagnostic overshadowing; whereby, behavioural changes displayed are attributed to the intellectual disability or dementia rather than considering other causes such as pain (Kerr et al, 2006(Kerr et al, , 2011.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…generally the evidence identifies that carers (formal and informal) do not adequately recognise or consider pain as a possible cause for changes in presentation (Cleary & Doody, 2017a;Plooij et al, 2012).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Research exploring pain in people with dementia has increased over recent years. However, research exploring pain in people with intellectual disability and dementia is limited (de Knegt & Scherder, ) and generally the evidence identifies that carers (formal and informal) do not adequately recognise or consider pain as a possible cause for changes in presentation (Cleary & Doody, ; Plooij et al, ). While pain assessment tools are available and recommended, their use appears limited (British Pain Society, ).…”

Section: Introductionmentioning

confidence: 99%

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Nursing people with intellectual disability and dementia experiencing pain: An integrative review

Dillane¹,

Doody

2019

Journal of Clinical Nursing

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Aims and objectives To explore the current evidence of nurses caring for people with intellectual disability and dementia who experience pain. Background People with intellectual disability are ageing and are experiencing age‐related health conditions including dementia and conditions associated with pain, but at an earlier age. Addressing the needs of people with intellectual disability who develop dementia is a new challenge for nurses. Design An integrative literature review. Methods A systematic search of databases: CINAHL, MEDLINE, PsycINFO, Cochrane, EMBASE, Academic Search Complete, Scopus and Web of Science between 27 October 2017–7 November 2017. Hand searching and review of secondary references were also undertaken. Quality appraisal (Crowe Critical Appraisal Tool), thematic data analysis (Braun and Clarke, Qualitative Research in Psychology, 3, 2006, 77) and reporting using the PRISMA guidelines. Results Seven papers met the inclusion criteria, and three themes emerged from this review: nurses knowledge of ageing, dementia and pain; recognising pain in people with intellectual disability and dementia; and the role of nurse education. People with intellectual disability and dementia have difficulty communicating their pain experience compounded by pre‐existing communication difficulties. Conclusions A pain experience can present similar to behavioural and psychological symptoms of dementia, and diagnostic overshadowing often occurs whereby a pain need is misinterpreted as behavioural and psychological symptoms resulting in inappropriate treatment. Nurses need greater knowledge about the presence of pain and potential causes in people with intellectual disability and dementia, and education can be effective in addressing this knowledge deficit. Relevance to clinical practice Pain assessment tools for people with intellectual disability and dementia need to include behavioural elements, and baseline assessments are required to identify changes in presentation. Nurses need to recognise and respond to pain based on the evidence in order to deliver quality care.

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Pain Medication and Global Cognitive Functioning in Dementia Patients with Painful Conditions

Cited by 16 publications

References 26 publications

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications

Implementation of a Nursing Home Quality Improvement Project to Reduce Resident Pain

Nursing people with intellectual disability and dementia experiencing pain: An integrative review

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