Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
BMC Geriatr. 2023 Nov 18;23(1):756. doi: 10.1186/s12877-023-04337-8.
Pain is often neglected in disabled older population, especially in Taiwan where the population of institutional residents is rapidly growing. Our study aimed to investigate pain prevalence and associated factors among institutional residents to improve pain assessment and management.
This nationwide study recruited 5,746 institutional residents in Taiwan between July 2019 and February 2020. Patient self-report was considered the most valid and reliable indicator of pain. A 5-point verbal rating scale was used to measure pain intensity, with a score ranging from 2 to 5 indicating the presence of pain. Associated factors with pain, including comorbidities, functional dependence, and quality of life, were also assessed.
The mean age of the residents was 77.1 ± 13.4 years, with 63.1% of them aged over 75 years. Overall, 40.3% of the residents reported pain, of whom 51.2% had moderate to severe pain. Pain was more common in residents with comorbidities and significantly impacted emotions and behavior problems, and the mean EQ5D score, which is a measure of health-related quality of life (p < .001). Interestingly, pain was only related to instrumental activities of daily living (IADL) and not activities of daily living (ADL). On the other hand, dementia was significantly negatively associated with pain (p < .001), with an estimated odds of 0.63 times (95% CI: 0.53-0.75) for the presence of pain when compared to residents who did not have dementia.
Unmanaged pain is common among institutional residents and is associated with comorbidities, IADL, emotional/behavioral problems, and health-related quality of life. Older residents may have lower odds of reporting pain due to difficulty communicating their pain, even through the use of a simple 5-point verbal rating scale. Therefore, more attention and effort should be directed towards improving pain evaluation in this vulnerable population .
在残疾老年人中，疼痛常常被忽视，尤其是在人口结构迅速老龄化的台湾。我们的研究旨在调查机构居民中疼痛的流行情况及其相关因素，以改善疼痛评估和管理。
本研究于 2019 年 7 月至 2020 年 2 月在台湾招募了 5746 名机构居民。患者自述被认为是疼痛最有效和可靠的指标。使用 5 点口述评分量表来衡量疼痛强度，评分范围为 2 至 5 分，表示存在疼痛。还评估了与疼痛相关的因素，包括合并症、功能依赖和生活质量。
居民的平均年龄为 77.1±13.4 岁，其中 63.1%的人年龄超过 75 岁。总体而言，40.3%的居民报告有疼痛，其中 51.2%的人有中度至重度疼痛。有合并症的居民中疼痛更为常见，并且显著影响情绪和行为问题，以及健康相关生活质量的平均 EQ5D 评分（p<.001）。有趣的是，疼痛仅与工具性日常生活活动（IADL）相关，而与日常生活活动（ADL）无关。另一方面，痴呆症与疼痛显著负相关（p<.001），与没有痴呆症的居民相比，疼痛的存在估计比值比为 0.63（95%CI：0.53-0.75）。
机构居民中未得到治疗的疼痛很常见，与合并症、IADL、情绪/行为问题和健康相关生活质量有关。由于难以沟通疼痛，较年长的居民报告疼痛的可能性较低，即使使用简单的 5 点口述评分量表也是如此。因此，应该更加关注并努力改善这个弱势群体的疼痛评估。
