Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

Abstract

Background/Aims: Prior studies have shown that patients with dementia are at risk of receiving insufficient treatment for pain after a hip fracture. We therefore hypothesized that elderly hip fracture patients with dementia received less postoperative pain treatment than those without dementia. Method: All patients (age ≥65 years) who had been operated on for a hip fracture in the Copenhagen University Hospital region in 2009 were included. Data about analgesic use for the first 72 h after surgery were acquired from the hospitals' electronic medication system and linked with information about dementia, comorbidity, and prior drug use. Results: A total of 1,507 patients were included, of which 296 (19.6%) suffered from dementia. Both groups were equally likely to receive paracetamol and opioids. Patients with dementia received lower doses of oral morphine equivalents during the first [dementia vs. no dementia: 29.0 (26.4-31.8) vs. 34.7 (33.1-36.4) mg, p = 0.001] and second [27.8 (25.4-30.5) vs. 31.2 (29.9-32.4) mg, p = 0.019] but not on the third postoperative day (p = 0.10). Conclusion: The lower doses of opioids may reflect uncertainty about how to treat pain patients with dementia. Further guidance is needed, as inadequate treatment of pain may have adverse consequences.

Nurses’ experiences of delivering acute orthopaedic care to patients with dementia

“…Capability and willingness to care for patients with dementia is increasingly a general competency requirement for orthopaedic nurses. A Danish study demonstrated that 19% of all patients admitted to an orthopaedic ward either had a dementia diagnosis or were receiving dementia‐related medications (Jensen‐Dahm et al, ). In addition, a large number of hospitalised acute care patients are known to either be undiagnosed or experience drug‐induced delirium (Reynish et al, ).…”

“…Some studies have reported that as many as 42% of patients can be expected to have dementia with only half diagnosed with dementia prior to admission (Sampson, Blanchard, Jones, Tookman, & King, ). A Danish study investigated all hospital admissions for a column fracture of the femur over the course of a year and revealed 19.2% of the admissions either had a diagnosis of Alzheimer disease or received a medication from the NO6 psychoanaleptics (NO psychoanaleptics, ) group of drugs for the management of dementia symptoms (Jensen‐Dahm, Palm, Gasse, Dahl, & Waldemar, ). People with dementia are three times more likely than other citizens to be hospitalised for hip fracture (Baker, Cook, Arrighi, & Bullock, ).…”

“…The acute trajectory of a hospital admission for a person with dementia, following a hip fracture, together with the likely possibility of discomfort related to uncontrolled pain, and/or distress related to the possible development of delirium, leads to a requirement for complex clinical care management by health professionals. Hip fractures are associated with severe pre‐ and postoperative pain (Foss, Kristensen, & Palm, ), and the use of opioid‐based medication for patients with dementia has been shown to be lower during hospitalisation compared with patients without dementia (Jensen‐Dahm et al, ; Morrison & Siu, ). However, insufficient pain relief, or untreated pain, increases the risk for lengthy hospital stays, reduced mobilisation and superimposed delirium (Morrison & Siu, ).…”

Psychometric Evaluation of the Electronic Pain Assessment Tool: An Innovative Instrument for Individuals with Moderate-to-Severe Dementia

“…Failure to do so may result in a denial of appropriate medication or therapeutic intervention, prescription of analgesics at inadequate dosages, or use of inappropriate medication (e.g., antipsychotics) [15-20]. These may lead to poor quality of life and premature death in these individuals [21-25].…”

Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer’s Disease

“…However, more recent studies indicate more frequent use of paracetamol, but less frequent use of nonsteroidal antiinflammatory drugs (NSAIDs) among community dwellers with cognitive disorders compared to other older adults [11,12]. Reports on opioid use have been more inconsistent, but a higher prevalence of opioid use, strong opioid use, and long-term opioid use have also been found among persons with cognitive disorders compared to those without [12][13][14][15][16].…”