Tait Raymond C, Chibnall John T
Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri 63104, USA.
Pain Med. 2002 Sep;3(3):231-9. doi: 10.1046/j.1526-4637.2002.02031.x.
To examine the relationship between patient pain levels and clinical status and treatment in older adults.
A correlational study involving patient and nurse ratings of pain and retrospective review of clinical records.
A subacute care inpatient facility.
Seventy-five older adults (mean age: 75.9 years) who met entry criteria for pain, age, and mental status.
Patients and nurses made independent ratings of pain over a 7-day period. Clinical data included measures of mental status, depression, behavioral signs of discomfort, functional independence, and analgesic medication use.
Nurse ratings of patient pain were uncorrelated with patient ratings and underestimated pain relative to patient reports. Nurse ratings correlated with levels of behavioral discomfort and with doses of opioid medication. Patient ratings were associated with functional limitations, depression, and behavioral signs of discomfort, but were minimally related to administration of opioids or other pain medication. Patient mental status did not appreciably moderate these relationships.
These findings support a growing literature indicating deficiencies in pain assessment of older patients and suggest inappropriate administration of analgesic medications for these patients. More systematic assessment of pain, including the use of instruments with established psychometric properties for older patients, may improve pain control and enhance functional rehabilitation in this group.
探讨老年患者疼痛程度与临床状况及治疗之间的关系。
一项相关性研究，涉及患者和护士对疼痛的评分以及对临床记录的回顾性分析。
一家亚急性护理住院机构。
75名符合疼痛、年龄和精神状态纳入标准的老年人（平均年龄：75.9岁）。
患者和护士在7天内对疼痛进行独立评分。临床数据包括精神状态、抑郁、不适行为体征、功能独立性和镇痛药物使用情况的测量。
护士对患者疼痛的评分与患者自身评分不相关，且相对于患者报告低估了疼痛程度。护士评分与行为不适程度和阿片类药物剂量相关。患者评分与功能受限、抑郁和不适行为体征相关，但与阿片类药物或其他止痛药物的使用关系不大。患者的精神状态并未明显调节这些关系。
这些发现支持了越来越多的文献表明老年患者疼痛评估存在缺陷，并提示对这些患者的止痛药物使用不当。对疼痛进行更系统的评估，包括使用具有既定心理测量特性的工具对老年患者进行评估，可能会改善该群体的疼痛控制并促进功能康复。
