Bernabei R, Gambassi G, Lapane K, Landi F, Gatsonis C, Dunlop R, Lipsitz L, Steel K, Mor V
Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy.
JAMA. 1998 Jun 17;279(23):1877-82. doi: 10.1001/jama.279.23.1877.
Cancer pain can be relieved with pharmacological agents as indicated by the World Health Organization (WHO). All too frequently pain management is reported to be poor.
To evaluate the adequacy of pain management in elderly and minority cancer patients admitted to nursing homes.
Retrospective, cross-sectional study.
A total of 1492 Medicare-certified and/or Medicaid-certified nursing homes in 5 states participating in the Health Care Financing Administration's demonstration project, which evaluated the implementation of the Resident Assessment Instrument and its Minimum Data Set.
A group of 13 625 cancer patients aged 65 years and older discharged from the hospital to any of the facilities from 1992 to 1995. Data were from the multilinked Systematic Assessment of Geriatric Drug Use via Epidemiology (SAGE) database.
Prevalence and predictors of daily pain and of analgesic treatment. Pain assessment was based on patients' report and was completed by a multidisciplinary team of nursing home personnel that observed, over a 7-day period, whether each resident complained or showed evidence of pain daily.
A total of 4003 patients (24%, 29%, and 38% of those aged > or =85 years, 75 to 84 years, and 65 to 74 years, respectively) reported daily pain. Age, gender, race, marital status, physical function, depression, and cognitive status were all independently associated with the presence of pain. Of patients with daily pain, 16% received a WHO level 1 drug, 32% a WHO level 2 drug, and only 26% received morphine. Patients aged 85 years and older were less likely to receive morphine or other strong opiates [corrected] than those aged 65 to 74 years (13% vs 38%, respectively). More than a quarter of patients (26%) in daily pain did not receive any analgesic agent. Patients older than 85 years in daily pain were also more likely to receive no analgesia (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.13-1.73). Other independent predictors of failing to receive any analgesic agent were minority race (OR, 1.63; 95% CI, 1.18-2.26 for African Americans), low cognitive performance (OR, 1.23; 95% CI, 1.05-1.44), and the number of other medications received (OR, 0.65; 95% CI, 0.5-0.84 for 11 or more medications).
Daily pain is prevalent among nursing home residents with cancer and is often untreated, particularly among older and minority patients.
世界卫生组织（WHO）指出，癌症疼痛可用药物缓解。但经常有报道称疼痛管理效果不佳。
评估入住疗养院的老年和少数族裔癌症患者的疼痛管理是否充分。
回顾性横断面研究。
参与医疗保健财务管理局示范项目的5个州的1492家经医疗保险认证和/或医疗补助认证的疗养院，该项目评估了居民评估工具及其最小数据集的实施情况。
1992年至1995年期间从医院出院后入住上述任何一家疗养院的13625名65岁及以上的癌症患者。数据来自多链接的老年药物使用流行病学系统评估（SAGE）数据库。
每日疼痛及镇痛治疗的患病率和预测因素。疼痛评估基于患者报告，并由疗养院多学科团队完成，该团队在7天时间内观察每位居民是否每天抱怨疼痛或有疼痛迹象。
共有4003名患者（年龄≥85岁、75至84岁、65至74岁的患者分别占24%、29%和38%）报告每天疼痛。年龄、性别、种族、婚姻状况、身体功能、抑郁和认知状态均与疼痛的存在独立相关。在每天疼痛的患者中，16%接受WHO一级药物治疗，32%接受WHO二级药物治疗，只有26%接受吗啡治疗。85岁及以上的患者比65至74岁的患者更不可能接受吗啡或其他强效阿片类药物治疗（分别为13%和38%）。超过四分之一（26%）每天疼痛的患者未接受任何镇痛剂治疗。每天疼痛的85岁以上患者也更有可能未接受任何镇痛治疗（优势比[OR]为1.40；95%置信区间[CI]为1.13 - 1.73）。未接受任何镇痛剂治疗的其他独立预测因素包括少数族裔（非裔美国人的OR为1.63；95%CI为1.18 - 2.26）、认知能力低下（OR为1.23；95%CI为1.05 - 1.44）以及所接受的其他药物数量（接受11种或更多药物的OR为0.65；95%CI为0.5 - 0.84）。
癌症疗养院居民中每日疼痛很普遍，且常常未得到治疗，尤其是老年患者和少数族裔患者。
