Deficits in pain treatment in nursing homes in Germany: a cross-sectional study.

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Journal Article
European Journal of Pain, 2012, 16 (3), pp. 439 - 446
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BACKGROUND: Current knowledge about the quality and appropriateness of pharmacological pain treatment in nursing home residents (NHR), particularly in NHR with moderate to severe cognitive impairment, is poor. METHODS: This observational cross-sectional study assessed pain treatment in a random sample of NHR with or without cognitive impairment from nursing homes in Germany. Prescribed drugs, pain intensity and frequency, diagnoses, and surgical procedures and injuries during the last 4 weeks were documented. Quality and appropriateness of pain medication were assessed by analysis of pain medications and the Pain Medication Appropriateness Scale (PMAS) score (S(PMAS) ), with a cut-off value of >67% indicating appropriate pain treatment. RESULTS: A total of 321 residents (62% women) were studied, including 152 (47%) with severe cognitive impairment. The most frequently prescribed analgesics were dipyrone, fentanyl, tramadol and ibuprofen. The mean S(PMAS) was 48.5 ± 1.5 (range, -33 to +100). Residents with prescribed scheduled analgesics had a significantly better S(PMAS) than patients without such treatment (S(PMAS) 58 ± 1.5 vs. 37 ± 2.5, p < 0.01). NHR without current pain had significantly better S(PMAS) than residents suffering from pain (S(PMAS) 47 ± 1.9 vs. 59 ± 4.2, p = 0.01). With an S(PMAS) of 69 ± 1.5, residents (n = 106) with scheduled pain medication plus PRN analgesics achieved the highest scores in the population. Overall, similar results were found in NHR with and in NHR without cognitive impairment. CONCLUSION: Our study points to a significant deficit in pain treatment in German NHR, including NHR with or without cognitive impairment.
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