Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Institute of Medical Sociology and Rehabilitation Sciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
PLoS One. 2020 Feb 21;15(2):e0229229. doi: 10.1371/journal.pone.0229229. eCollection 2020.
To analyze the pattern and appropriateness of pain medications in older adults receiving home care.
We performed a prospective cross-sectional study in patients ≥65 years old having chronic pain and receiving home care in Berlin, Germany. Data on prescribed pain medications were collected using self-reported information, nursing documents, and medication plans during interviews at home. Pain intensity was determined with the numeric rating scale (NRS) and the Pain Assessment In Advanced dementia (PAINAD) scale. The Pain Medication Appropriateness Scale score (SPMAS) was applied to evaluate inappropriateness (i.e. a score ≤67) of pain medication.
Overall 322 patients with a mean age of 82.1 ± 7.4 years (71.4% females) were evaluated. The average pain intensity scores during the last 24 hours were 5.3 ± 2.1 and 2.3 ± 2.3 on NRS and PAINAD scale (range 0-10, respectively). Sixty (18.6%) patients did not receive any pain medication. Among the treated patients, dipyrone was the most frequently prescribed analgesic (71.4%), while 50.8% and 19.1% received systemic treatment with opioids and non-steroidal anti-inflammatory drugs, respectively. The observed median SPMAS was 47.6 (range 0-100) with 58 (18.0%) of patients achieving appropriate values. Half of the patients were treated with scheduled, while 29.9% were only treated with on-demand medications. Cognitive status had no effect on appropriateness of pain treatment.
We observed substantial deficits in dosing patterns and appropriateness of pain medication in older adults with pain receiving home care. This applied to both patients with and without severe cognitive impairment.
分析接受家庭护理的老年患者疼痛药物使用模式和适宜性。
我们在德国柏林进行了一项针对≥65 岁、患有慢性疼痛且接受家庭护理的患者的前瞻性横断面研究。通过在家中访谈时的自我报告信息、护理文件和用药计划收集规定的疼痛药物数据。使用数字评分量表（NRS）和晚期痴呆疼痛评估量表（PAINAD）来确定疼痛强度。应用疼痛药物适宜性量表评分（SPMAS）来评估疼痛药物的不适宜性（即评分≤67）。
共评估了 322 名平均年龄为 82.1±7.4 岁（71.4%为女性）的患者。过去 24 小时的平均疼痛强度评分分别为 NRS 评分 5.3±2.1 和 PAINAD 评分 2.3±2.3（范围分别为 0-10）。60（18.6%）名患者未接受任何疼痛药物治疗。在接受治疗的患者中，双氯芬酸是最常开的镇痛药（71.4%），分别有 50.8%和 19.1%的患者接受了阿片类药物和非甾体抗炎药的系统治疗。观察到的中位 SPMAS 为 47.6（范围 0-100），其中 58（18.0%）名患者的评分达到了适宜。半数患者接受定期治疗，而 29.9%的患者仅按需接受药物治疗。认知状态对疼痛治疗的适宜性没有影响。
我们观察到接受家庭护理的疼痛老年患者在药物剂量模式和适宜性方面存在明显不足。这适用于有和没有严重认知障碍的患者。
