患有痴呆症诊断的养老院患者接受疼痛治疗不足的风险是否更高？

Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment?

作者信息

Nygaard Harald A, Jarland Marit

机构信息

Section for Geriatric Medicine, Department of Public Health and Primary Health Care, University of Bergen, Norway.

出版信息

Int J Geriatr Psychiatry. 2005 Aug;20(8):730-7. doi: 10.1002/gps.1350.

DOI:10.1002/gps.1350

PMID:16035124

Abstract

BACKGROUND

Mentally impaired and demented nursing home patients are at increased risk of undertreatment for pain. We wanted to examine pain assessment and complaints and pain treatment of nursing home patients according to mental state, and with special regard to treatment of patients with dementia diagnosis and cognitively impaired patients who did not have a dementia diagnosis.

METHODS

Cross sectional study from three nursing homes in Bergen, Norway including 125 persons (median age 84 years), living permanently in a nursing home. Diagnoses and prescribed and administered analgesic drugs were recorded. An experienced nurse interviewed nurses in charge and patients regarding presence of pain during the last week. Patients who were able to answer whether they had experienced pain during the last week were categorised as communicative. Cognitive function was assessed by means of the Abbreviated Mental Test.

RESULTS

Seventeen percent of the patients were cognitively intact, 30% cognitively impaired and 54% had a dementia diagnosis. Forty-seven percent of communicative patients complained of pain, nurses reported pain in 67% patients. Twenty-nine percent of the patients had received scheduled analgesics during the last week, cognitively intact patients 38%, cognitively impaired 30%, demented 25% (p = 0.53). Twenty percent were given analgesics PRN: cognitively intact patients 33%, cognitively impaired 27%, demented 12% (p = 0.05). Logistic regression analyses revealed that patients with dementia diagnosis were less likely to receive PRN medication [Adjusted odds ratio (AOR) 0.22 95% confidence interval (CI) 0.06-0.76] compared to mentally impaired patients. Regarding scheduled medication there was no difference between the groups. Nurses' opinion of pain was a significant factor for receiving analgesic drugs, scheduled AOR 3.95 95% CI 1.48-10.5, PRN 3.80-95% CI 1.28-11.3).

CONCLUSIONS

A label of dementia may bias the interpretation of pain cues of demented patients, while complaints from cognitively impaired patients may be taken for granted. This may contribute to lower use of PRN medication in demented patients compared to cognitively impaired patients.

摘要

背景

智障和痴呆的疗养院患者接受疼痛治疗不足的风险增加。我们想根据精神状态检查疗养院患者的疼痛评估、疼痛主诉及疼痛治疗情况，尤其关注痴呆诊断患者以及无痴呆诊断的认知障碍患者的治疗情况。

方法

对挪威卑尔根的三家疗养院进行横断面研究，纳入125名长期居住在疗养院的人员（中位年龄84岁）。记录诊断结果以及所开具和使用的镇痛药。一名经验丰富的护士就过去一周内是否存在疼痛问题采访了负责护士和患者。能够回答过去一周内是否经历过疼痛的患者被归类为有沟通能力。通过简易精神状态检查表评估认知功能。

结果

17%的患者认知功能正常，30%认知受损，54%有痴呆诊断。47%有沟通能力的患者主诉疼痛，护士报告67%的患者有疼痛。29%的患者在过去一周内接受了定期镇痛药治疗，认知功能正常的患者为38%，认知受损患者为30%，痴呆患者为25%（p = 0.53）。20%的患者接受了按需镇痛药治疗：认知功能正常的患者为33%，认知受损患者为27%，痴呆患者为12%（p = 0.05）。逻辑回归分析显示，与认知受损患者相比，有痴呆诊断的患者接受按需用药的可能性较小[调整后的优势比（AOR）为0.22，95%置信区间（CI）为0.06 - 0.76]。关于定期用药，各组之间没有差异。护士对疼痛的看法是接受镇痛药的一个重要因素，定期用药的AOR为3.95，95% CI为1.48 - 10.5，按需用药的AOR为3.80，95% CI为1.28 - 11.3）。