Horgas A L, Tsai P F
Institute of Gerontology and College of Nursing, Wayne State University, Detroit, MI 48202, USA.
Nurs Res. 1998 Jul-Aug;47(4):235-42. doi: 10.1097/00006199-199807000-00009.
Prior research has documented the high prevalence of pain in elderly adults and the difficulties associated with properly assessing and treating pain in elders with cognitive impairment.
To investigate the prescription and administration of analgesic medications to treat pain in cognitively impaired nursing home residents.
The current sample consisted of 339 nursing home residents (295 women and 44 men) with a mean age of 87 years (range 66-104). Forty-six percent of the sample had diagnosed cognitive impairment, and 55% had at least one diagnosed painful condition. Data for this correlational study were drawn from four nursing homes in Western Pennsylvania. The Multidimensional Observation Scale for Elderly Subjects was used to assess behavioral indicators of cognitive impairment, and chart review was used to obtain demographic, medication, and diagnostic data.
The results indicated that cognitively impaired nursing home residents are prescribed and administered significantly less analgesic medication, both in number and in dosage of pain drugs than their more cognitively intact peers. In multiple regression analyses holding the presence of painful conditions constant, more disoriented and withdrawn residents were prescribed significantly less analgesia by physicians; more disoriented, withdrawn, and functionally impaired residents were administered significantly less analgesia by nursing staff.
The findings highlight the difficulties of assessing pain in cognitively impaired elders and the lack of knowledge among health care providers about effective pain management.
先前的研究已证明老年人疼痛的高患病率，以及在正确评估和治疗认知障碍老年人疼痛方面存在的困难。
调查用于治疗认知障碍养老院居民疼痛的镇痛药的处方和使用情况。
当前样本包括339名养老院居民（295名女性和44名男性），平均年龄87岁（范围66 - 104岁）。样本中46%被诊断为认知障碍，55%至少有一种被诊断出的疼痛状况。这项相关性研究的数据来自宾夕法尼亚西部的四家养老院。使用老年受试者多维观察量表评估认知障碍的行为指标，并通过病历审查获取人口统计学、用药和诊断数据。
结果表明，与认知功能更健全的同龄人相比，认知障碍的养老院居民所开具和使用的镇痛药在数量和剂量上都显著更少。在控制疼痛状况存在的多元回归分析中，医生给定向障碍和孤僻的居民开具的镇痛药显著更少；护理人员给定向障碍、孤僻且功能受损的居民使用的镇痛药显著更少。
研究结果凸显了评估认知障碍老年人疼痛的困难，以及医疗保健提供者在有效疼痛管理方面的知识欠缺。
