养老院中患有晚期痴呆症的居民的阿片类药物处方使用情况。

Opioid Prescription Use in Nursing Home Residents with Advanced Dementia.

机构信息

Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.

Novicare, Elderly Care, Best, the Netherlands.

出版信息

Pain Med. 2019 Jan 1;20(1):50-57. doi: 10.1093/pm/pnx268.

DOI:10.1093/pm/pnx268

PMID:29136228

Abstract

BACKGROUND

Although proper pain treatment may require opioids, discussion continues about possible undertreatment or overtreatment in persons with advanced dementia.

OBJECTIVE

To investigate the prevalence of pain, frequency of opioid prescription use, and factors associated with strong opioid prescription use in nursing homes.

DESIGN

Cross-sectional study.

SETTING AND SUBJECTS

Eighteen Norwegian nursing homes; 327 persons with advanced dementia and behavioral disturbances participated.

METHODS

Potential factors associated with strong opioid prescription use were assessed: demographics (age, gender), medical conditions (comorbidity, number of medications), pain (Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale ≥ 3, pain-related diagnoses, analgesic prescription use), functioning (activities of daily living, Mini-Mental State Examination) and behavior (Neuropsychiatric Inventory-Nursing Home version, Cohen-Mansfield Agitation Inventory). Factors with P < 0.10, age, and gender were included in multivariate regression analysis.

RESULTS

The prevalence of moderate to severe pain was 62.1%. Of all participants, 19.3% (N = 63) were prescribed opioids, and of these, 79.4% (N = 50) were still in pain; 66.7% of the opioid prescriptions were less than or equal to the lowest dosage of fentanyl patches (12 mcg/h) or buprenorphine (5 or 10 mcg/h). Pain (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.12-1.42), total number of pain-related diagnoses (OR = 1.47, 95% CI = 1.14-1.90), and depression and anxiety (OR = 1.05, 95% CI = 1.01-1.11) were positively associated with an opioid prescription. Stroke was negatively associated (OR = 0.43, 95% CI = 0.19-0.99).

CONCLUSIONS

Strong opioid prescription use was mainly associated with pain. However, in this population, despite the relatively prevalent use of strong prescription opioids, pain was still prevalent. This emphasizes the challenge of proper pain treatment and need for regular evaluation of pain and pain management.

摘要

背景

尽管适当的疼痛治疗可能需要使用阿片类药物，但对于患有晚期痴呆症的患者，是否存在治疗不足或过度治疗的问题仍存在争议。

目的

调查养老院中患有晚期痴呆症且伴有行为障碍的患者的疼痛发生率、阿片类药物处方使用频率，以及与开具强阿片类药物处方相关的因素。

设计

横断面研究。

地点和研究对象

挪威的 18 家养老院；327 名患有晚期痴呆症且伴有行为障碍的患者参与了本研究。

方法

评估了与开具强阿片类药物处方相关的潜在因素：人口统计学特征（年龄、性别）、医疗状况（合并症、用药数量）、疼痛（改良的移动-观察-行为-强度-痴呆-2 疼痛量表评分≥3 分、疼痛相关诊断、镇痛药处方使用）、功能（日常生活活动、简易精神状态检查）和行为（神经精神科问卷-养老院版、科恩-曼斯菲尔德激越量表）。对 P＜0.10 的因素、年龄和性别进行了多变量回归分析。

结果

中重度疼痛的发生率为 62.1%。所有参与者中有 19.3%（N=63）开具了阿片类药物处方，其中 79.4%（N=50）仍有疼痛；66.7%的阿片类药物处方的用量小于或等于最低剂量的芬太尼贴片（12μg/h）或丁丙诺啡（5 或 10μg/h）。疼痛（优势比[OR] = 1.26，95%置信区间[CI] = 1.12-1.42）、与疼痛相关的总诊断数量（OR=1.47，95%CI=1.14-1.90）和抑郁和焦虑（OR=1.05，95%CI=1.01-1.11）与开具阿片类药物处方呈正相关。而中风呈负相关（OR=0.43，95%CI=0.19-0.99）。