Tang Mette Marie, Wollsen Morten Gill, Aagaard Lise
Section for Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
Centre for Energy Informatics, University of Southern Denmark, Odense, Denmark.
J Res Pharm Pract. 2016 Apr-Jun;5(2):126-31. doi: 10.4103/2279-042X.179578.
To monitor pain intensity, pain symptoms, and medication use in elderly with dementia.
Nursing home residents above 65 years of age, diagnosed with dementia, and showing pain symptoms were included in the study. The patients' mental status was monitored through a mini-mental state examination score and observations of pain symptoms using Part 1 of the Mobilization-Observation-Behaviour-Intensity-Dementia-2 (MOBID-2) pain scale. Community pharmacists reviewed the patients' medication use, and the prescriptions were compared with guidelines for treatment of geriatric patients. Alterations to the patients' medicine use were forwarded to the general practitioners.
Sixty-one nursing home residents diagnosed with dementia were identified, 15 of these fulfilled the inclusion criteria, and 12 agreed to participate in the study. The mean age was 87 years of age (range: 77-96), and 42% of the residents were males. The patients' overall pain intensity was 83% for observations on the numeric pain rating scale (NRS) >0 and 67% for NRS ≥3. Most painful were the situations in which the residents were to mobilize their legs, turn around to both sides of the bed, and when sitting on the bed. The medication reviews identified a total of 95 individual prescriptions, and 33% of these were for nervous system medications, followed by medicines for the treatment of alimentary tract and metabolism disorders (31% of total). Eleven prescriptions for pain medicine were identified; the majority of these were for paracetamol and opioids. Seventeen proposals to patients' medication use were suggested, but the general practitioners accepted only 6% of these.
This study indicates that the MOBID-2 pain scale in combination with medication reviews can be used as a tool for optimization of patients' medication use. However, we recommend the conduction of a larger-scale study in multiple settings, to validate our results and the generalizability of the findings.
监测老年痴呆患者的疼痛强度、疼痛症状及药物使用情况。
研究纳入了65岁以上、诊断为痴呆且有疼痛症状的养老院居民。通过简易精神状态检查评分监测患者的精神状态，并使用运动-观察-行为-强度-痴呆-2（MOBID-2）疼痛量表的第1部分观察疼痛症状。社区药剂师审查患者的药物使用情况，并将处方与老年患者治疗指南进行比较。患者用药的调整建议会反馈给全科医生。
共识别出61名诊断为痴呆的养老院居民，其中15名符合纳入标准，12名同意参与研究。平均年龄为87岁（范围：77 - 96岁），42%的居民为男性。在数字疼痛评分量表（NRS）>0的观察中，患者的总体疼痛强度为83%；NRS≥3时为67%。最疼痛的情况是居民活动腿部、在床上翻身以及坐在床上时。药物审查共识别出95份个人处方，其中33%为神经系统药物，其次是用于治疗消化道和代谢紊乱的药物（占总数的31%）。识别出11份止痛药处方；其中大多数是对乙酰氨基酚和阿片类药物。共提出了17项关于患者用药的建议，但全科医生仅接受了其中的6%。
本研究表明，MOBID-2疼痛量表结合药物审查可作为优化患者用药的工具。然而，我们建议在多个环境中进行更大规模的研究，以验证我们的结果及研究结果的普遍性。
