认知障碍养老院居民的疼痛患病率和疼痛管理。2014 年至 2018 年期间德国五个多中心横断面调查的结果。

Pain Prevalence and Pain Management in Nursing Home Residents With Cognitive Impairment. Results From Five Multicenter Cross-Sectional Surveys in Germany Between 2014 and 2018.

机构信息

Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany.

出版信息

Pain Manag Nurs. 2024 Oct;25(5):487-493. doi: 10.1016/j.pmn.2024.05.005. Epub 2024 Jun 8.

DOI:10.1016/j.pmn.2024.05.005

PMID:38853041

Abstract

BACKGROUND

Pain management depends on continuous pain assessment and a pain concept. In particular, pain assessment and treatment are major challenges for nursing home residents (NHR) with cognitive impairment (CI). Many caregivers often lack the knowledge to recognize and appropriately treat pain in this vulnerable group. Little is known about the proportion of NHR who are fundamentally dependent on external assessment for pain due to CI.

OBJECTIVE

The aim of the study was to determine pain prevalence and management among NHR with and without CI. A second objective was to determine the proportion of NHR who are dependent on external assessment for pain.

METHODS

Information on pain was collected from 3,437 NHR in multicenter cross-sectional surveys in 51 German nursing homes between 2014 and 2018. The presence of current pain in one-to-one interviews was determined as well as dependencies on third-party information, number of daily pain recordings, and administration of medication for pain. The analysis included a contingency table and log regression analyses.

RESULTS

Pain prevalence was 24.9% among NHR with severe CI and 40.4% among NHR without CI. Overall, 19.8% of all NHRs relied on a third-party assessment of pain. Significantly, NHR with severe CI were less likely to be classified as having pain (OR 0.51), to be assessed for pain several times a day (OR 0.53) or to receive pain medication (OR 0.55) compared with NHR without CI. No influence on pain management was shown for the type of pain assessment.

CONCLUSIONS

The study provides evidence of significant deficits in pain management among NHR with moderate and severe CI in nursing homes in Germany. NHR with moderate and severe CI are significantly less likely to be observed for pain or classified as pain sufferers and receive significantly less pain medication than NHR without CI. Intensive training of staff on pain management of NHR with severe CI is recommended.

摘要

背景

疼痛管理依赖于持续的疼痛评估和疼痛概念。特别是，对于认知障碍（CI）的养老院居民（NHR），疼痛评估和治疗是主要挑战。许多护理人员通常缺乏识别和适当治疗这一弱势群体疼痛的知识。由于 CI，NHR 中有多少人基本上依赖外部评估来确定疼痛，这方面的了解甚少。

目的

本研究旨在确定有和没有 CI 的 NHR 的疼痛患病率和管理情况。第二个目的是确定依赖外部评估来确定疼痛的 NHR 的比例。

方法

2014 年至 2018 年，在德国 51 家养老院的多中心横断面调查中，从 3437 名 NHR 中收集了有关疼痛的信息。在一对一访谈中确定了当前疼痛的存在情况，以及对第三方信息的依赖程度、每日疼痛记录的次数以及疼痛药物的管理情况。分析包括列联表和对数回归分析。

结果

严重 CI 的 NHR 中疼痛患病率为 24.9%，无 CI 的 NHR 中疼痛患病率为 40.4%。总体而言，19.8%的 NHR 依赖第三方评估疼痛。有显著意义的是，与无 CI 的 NHR 相比，严重 CI 的 NHR 被归类为有疼痛的可能性较小（OR 0.51），每天评估疼痛的次数较少（OR 0.53），或接受疼痛药物治疗的可能性较小（OR 0.55）。疼痛评估的类型对疼痛管理没有影响。