Reynolds Kimberly S, Hanson Laura C, DeVellis Robert F, Henderson Martha, Steinhauser Karen E
School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA.
J Pain Symptom Manage. 2008 Apr;35(4):388-96. doi: 10.1016/j.jpainsymman.2008.01.001. Epub 2008 Feb 15.
This study tests the association between residents' cognitive impairment and nursing homes' pain management practices. We used chart abstraction to collect data on 551 adults in six North Carolina nursing homes. From the standard data collected in the Minimum Data Set, 24% of residents experienced pain in the preceding week. Reports of pain decreased as cognitive abilities declined: nurses completing the Minimum Data Set reported pain prevalence of 34%, 31%, 24%, and 10%, respectively, for residents with no, mild, moderate, and severe cognitive impairment (P<0.001), demonstrating a "dose-response"-type result. Eighty percent of cognitively intact residents received pain medications, compared to 56% of residents with severe impairment (P<0.001). Cognitively impaired residents had fewer orders for scheduled pain medications than did their less cognitively impaired peers. Yet the presence of diagnoses likely to cause pain did not vary based on residents' cognitive status. We conclude that pain is underrecognized in nursing home residents with cognitive impairment and that cognitively impaired residents often have orders for "as needed" analgesics when scheduled medications would be more appropriate.
本研究检验了养老院居民认知障碍与疼痛管理措施之间的关联。我们采用图表摘要法收集了北卡罗来纳州六家养老院中551名成年人的数据。根据最低数据集收集的标准数据，24%的居民在前一周经历过疼痛。随着认知能力下降，疼痛报告减少：填写最低数据集的护士报告称，认知无损害、轻度损害、中度损害和重度损害的居民疼痛患病率分别为34%、31%、24%和10%（P<0.001），呈现出“剂量反应”型结果。认知功能正常的居民中有80%接受了止痛药治疗，而重度认知障碍居民中这一比例为56%（P<0.001）。与认知障碍程度较轻的同龄人相比，认知障碍居民的定时止痛药医嘱较少。然而，可能导致疼痛的诊断的存在情况并不会因居民的认知状态而有所不同。我们得出结论，认知障碍的养老院居民的疼痛未得到充分认识，并且在定时用药更为合适时，认知障碍居民通常会有“按需”使用镇痛药的医嘱。
