The Quality of Pain Treatment in Community-Dwelling Persons with Dementia

Background/Aims: Despite pervasive and debilitating pain among elders, it is underassessed and undertreated; and cognitive impairment can add challenges. We assessed the quality of pain care for community-dwelling elderly patients with dementia. Methods: We phone interviewed 203 Veterans Affairs primary care outpatients with dementia and pain and reviewed medical records to score 15 quality indicators of pain assessment and management. Results: Pain assessment was documented for 98%, and a standard pain scale was used for 94%. Modified pain scales were rarely used. Though 70% self-reported pain of ‘quite bad' or worse, charts documented no pain in 64%. When pain was identified, treatment was offered to 80%; but only 59% had a follow-up assessment within 6 months. Nonpharmacological interventions were underused. Conclusion: Community-dwelling elders with dementia are underdiagnosed and undertreated for pain.

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Monitoring Acute Pain in Donkeys with the Equine Utrecht University Scale for Donkeys Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP)

Animals ◽

10.3390/ani10020354 ◽

2020 ◽

Vol 10 (2) ◽

pp. 354 ◽

Cited By ~ 4

Author(s):

Machteld C. van Dierendonck ◽

Faith A. Burden ◽

Karen Rickards ◽

Johannes P.A.M. van Loon

Keyword(s):

Postoperative Pain ◽

Acute Pain ◽

Pain Assessment ◽

Pain Scale ◽

Follow Up Study ◽

Observer Reliability ◽

Pain Scales ◽

Different Types ◽

Good For

Objective pain assessment in donkeys is of vital importance for improving welfare in a species that is considered stoic. This study presents the construction and testing of two pain scales, the Equine Utrecht University Scale for Donkey Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP), in donkeys with acute pain. A cohort follow-up study using 264 adult donkeys (n = 12 acute colic, n = 25 acute orthopaedic pain, n = 18 acute head-related pain, n = 24 postoperative pain, and n = 185 controls) was performed. Both pain scales showed differences between donkeys with different types of pain and their control animals (p < 0.001). The EQUUS-DONKEY-COMPASS and EQUUS-DONKEY-FAP showed high inter-observer reliability (Cronbach’s alpha = 0.97 and 0.94, respectively, both p < 0.001). Sensitivity of the EQUUS-DONKEY-COMPASS was good for colic and orthopaedic pain (83% and 88%, respectively), but poor for head-related and postoperative pain (17% and 21%, respectively). Sensitivity of the EQUUS-DONKEY-FAP was good for colic and head-related pain (75% and 78%, respectively), but moderate for orthopaedic and postoperative pain (40% and 50%, respectively). Specificity was good for all types of pain with both scales (91%–99%). Different types of acute pain in donkeys can be validly assessed by either a composite or a facial expression-based pain scale.

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Pain Assessment: Benefits of Using Pain Scales for Surgical Patients in South Bohemian Hospitals

Healthcare ◽

10.3390/healthcare9020171 ◽

2021 ◽

Vol 9 (2) ◽

pp. 171

Author(s):

Vera Olisarova ◽

Valerie Tothova ◽

Martin Cerveny ◽

Vendula Dvorakova ◽

Petr Sadilek

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Pain Assessment ◽

Exploratory Study ◽

Surgical Patients ◽

The South ◽

Pain Scales ◽

Emotional Component ◽

Attention To Pain

Pain is a medical and nursing problem that is common in surgical departments. Inadequate pain management can lead to patient distress, as well as extending the period in which the patient’s quality of life is reduced. The standardized SF-MPQ-2 questionnaire provides nurses with the opportunity to assess pain within a broader context. The aim of this descriptive and exploratory study was to describe the state of pain assessment in surgical patients in the South Bohemian Region and to highlight the benefits of using a standardized tool for proper pain assessment. The research was carried out using a quantitative survey within the South Bohemian Region (Czech Republic). The participants in the study were nurses working in surgical departments in hospitals in the region as well as hospitalized patients. The results show that nurses pay slightly more attention to pain assessments than doctors. We know that, generally, pain decreases with time after surgery. Nonetheless, returning pain, as well as continuous pain, can occur, both of which have an emotional component. The results of this study are directed at nurses and include a call for more effective pain management through improved assessment.

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RETROSPECTIVE ANALYSIS OF EVENTS OF DEATH AT HOME AMONG PATIENTS UNDER FOLLOW-UP OBSERVATION

Perm Medical Journal ◽

10.17816/pmj35168-74 ◽

2018 ◽

Vol 35 (1) ◽

pp. 68-74

Author(s):

Ya P Sandakov

Keyword(s):

Cardiovascular Diseases ◽

Medical Records ◽

Emergency Calls ◽

Significant Difference ◽

Duration Of Disease ◽

The Moment ◽

Age Of Death ◽

At Home

Aim. To study the peculiarities of asking for medical care by patients from among those dead at home, who had been under follow-up observation. Materials and methods. The data, received from ambulatory medical records of 100 dead at home patients with follow-up, were analyzed using the methods of descriptive and inductive statistics. Results. A mean age of death was 74.9 ± 13.4 years, men - 65.8 ± 14.1 years, women - 79.2 ± 10.9 years. Cardiovascular diseases were the cause of follow-up observation in 78 % of cases and the cause of death in 85 %; in 30 % of patients the disease was detected while carrying out prophylactic medical examination. A mean duration of disease by the moment of death was 13.0 ± 8.0 years, among pensioners 13.7 ± 8.5 years, in able-bodied persons 9.6 ± 4.3 years. A mean duration of follow-up observation was 9.2 ± 5.8 years. An average number of planned visits was 2.8 ± 0.89, but the number of real visits during the last year of follow-up observation was 2.4 ± 1.2. Disability was registered in 77.6 % of patients, concomitant diseases - in all patients. For the last year, exacerbations were recorded in 92 % of patients, emergency calls - in 80 %, hospitalization events - 52 %, including 55.8 % - urgent ones. Conclusions. The absence of significant difference regarding the duration of disease between pensioners and able-bodied patients (т = 0.16, р = 1.43) as well as the absence of correlation between the age and duration of disease (χ2 = 0.19, p = 0.2) indirectly prove the influence of duration of disease on its outcome, but not the age. Attendance, characterizing clinical loyalty to treatment, does not depend on age (χ2 = -0.19, р = 0.18), sex (т = 1.0, р = 0.32), way of detecting disease (f = 0.9, p = 0.4), class of main disease (f = 0.91, p = 0.44), duration of disease (χ2 = -0.13, р = 0.49), exacerbations (χ2 = -0.17, р = 0.24), concomitant diseases (χ2 = 0.006, р = 0.9). The number of emergency calls, hospitalizations, urgent hospitalizations does not depend on duration of follow-up observation, regularity and number of real visits to a doctor (p > 0.05) that indicates unsatisfactory quality of follow-up observation.

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A bi-directional association between weight change and health-related quality of life: evidence from the 11-year follow-up of 9916 community-dwelling adults

Quality of Life Research ◽

10.1007/s11136-020-02423-7 ◽

2020 ◽

Vol 29 (6) ◽

pp. 1697-1706 ◽

Cited By ~ 1

Author(s):

Berhe W. Sahle ◽

Shameran Slewa-Younan ◽

Yohannes Adama Melaku ◽

Li Ling ◽

Andre M. N. Renzaho

Keyword(s):

Quality Of Life ◽

Weight Change ◽

Community Dwelling ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Instruments for pain assessment in patients with advanced dementia: A systematic review of the evidence for Latin America

Palliative & Supportive Care ◽

10.1017/s147895151900107x ◽

2020 ◽

Vol 18 (6) ◽

pp. 741-747

Author(s):

Silvia Mercedes Coca ◽

Roberto Ariel Abeldaño Zuñiga

Keyword(s):

Systematic Review ◽

Latin American ◽

Pain Assessment ◽

Pain Treatment ◽

Lewy Bodies ◽

Reliability And Validity ◽

Pain Scale ◽

Elderly Persons ◽

Advanced Dementia ◽

People With Dementia

AbstractObjectivePain treatment is an essential component of care for elderly patients with advanced dementia. The objective of this study was to identify and analyze the different scales used for pain assessment in elderly persons diagnosed with dementia, in the literature available at the Latin American level.MethodA systematic review was performed on the existing scales for pain assessment in elderly people diagnosed with Alzheimer's disease, vascular dementia, and dementia with Lewy bodies.Results226 articles were retrieved from the PUBMED, BIREME, and Scielo databases, of which a total of 10 articles entered the systematic review. The instruments identified in these publications were PAINAD, Abbey, McGill, and PACSLAC, while the Colored Pain Scale, Faces Pain Scale, and VAS scales were used as the silver standard. In Spanish, the Abbey scale, and in Portuguese, the PACSLAC scale showed the best reliability and validity coefficients.Significance of resultsIt is concluded that there are only two appropriate scales for the assessment of pain in people with dementia in the region of interest of this study. It is recommended to generate more evidence for a more accurate assessment of pain in people with dementia.

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A descriptive study of pain treatment and its follow-up in primary care of elderly patients after orthopaedic care

Journal of Pharmaceutical Health Care and Sciences ◽

10.1186/s40780-020-00166-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Gabriella Caleres ◽

Patrik Midlöv ◽

Åsa Bondesson ◽

Sara Modig

Keyword(s):

Primary Care ◽

Elderly Patients ◽

Pain Treatment ◽

Nursing Home Residents ◽

Descriptive Study ◽

Pain Medication ◽

Community Dwelling ◽

Orthopaedic Care ◽

Care Of Elderly

Abstract Background Pain treatment post orthopaedic care in the elderly is complicated and requires careful follow-up. Current guidelines state all patients prescribed opioids should have a plan for gradual reduction, with the treatment progressively reduced and ended if any pain remains after more than three months. How this works in primary care remains to be explored. The aim was to describe pain treatment and its follow-up in primary care of elderly patients after orthopaedic care. Methods In this descriptive study, medical case histories were collected for patients ≥ 75 years, which were enrolled at two rural primary care units in southern Sweden, and were discharged from orthopaedic care. Pain medication follow-up plans were noted, as well as current pain medication at discharge as well as two, six and twelve weeks later. Results We included a total of 49 community-dwelling patients with medication aid from nurses in municipality care and nursing home residents, ≥ 75 years, discharged from orthopaedic care. The proportion of patients prescribed paracetamol increased from 28/49 (57%) prior to admission, to 38/44 (82%) after 12 weeks. The proportion of patients prescribed opioids increased from 5/49 (10%) to 18/44 (41%). Primary care pain medication follow-up plans were noted for 16/49 patients (33%). Conclusions Many patients still used pain medication 12 weeks after discharge, and follow-up plans were quite uncommon, which may reflect upon lacking follow-up of these patients in primary care.

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Knowledge of doctors and nurses on pain in patients undergoing craniotomy

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692012000600007 ◽

2012 ◽

Vol 20 (6) ◽

pp. 1057-1063 ◽

Cited By ~ 4

Author(s):

Maria do Carmo de Oliveira Ribeiro ◽

Carlos Umberto Pereira ◽

Ana Maria Calil Sallum ◽

José Antonio Barreto Alves ◽

Marcelly Freitas Albuquerque ◽

...

Keyword(s):

Postoperative Period ◽

Pain Assessment ◽

Analytical Study ◽

Pain Treatment ◽

Assessment Methods ◽

Institutional Policies ◽

Cross Sectional ◽

Pain Scales ◽

Assessment Scales ◽

Doctors And Nurses

The study objectives were to characterize the profile of the doctors and nurses caring for patients in the craniotomy postoperative period, checking pain assessment methods and to identify the existence of analgesia protocols. Cross-sectional and analytical study. The casuistry is constituted of 30 doctors and 30 nurses. The results revealed that 83.3 % of the nurses were female, 63.3% knew pain scales, and 16.6% said that analgesia protocols exist. Regarding doctors 60% were male, 70% knew the pain scales, 3.3% had specialization in pain treatment, 13.3% they stated that there are analgesia protocols. The ignorance on the part of doctors and nurses about the assessment scales and pain assessment methods reveals the need for the creation of institutional policies on controlling pain, the use of instruments for the measurement of the pain phenomenon and analgesia protocols in the institution.

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Predicting poorer health outcomes in older community-dwelling patients with multimorbidity: prospective cohort study assessing the accuracy of different multimorbidity definitions

BMJ Open ◽

10.1136/bmjopen-2018-023919 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023919 ◽

Cited By ~ 2

Author(s):

Maxime Sasseville ◽

Susan M Smith ◽

Lisa Freyne ◽

Ronald McDowell ◽

Fiona Boland ◽

...

Keyword(s):

Quality Of Life ◽

Health Outcomes ◽

Community Dwelling ◽

Health Related Quality ◽

Predictive Values ◽

Related Quality ◽

Health Related ◽

Reported Health

PurposeMultimorbidity is commonly defined and measured using condition counts. The UK National Institute for Health Care Excellence Guidelines for Multimorbidity suggest that a medication-orientated approach could be used to identify those in need of a multimorbidity approach to management.ObjectivesTo compare the accuracy of medication-based and diagnosis-based multimorbidity measures at higher cut-points to identify older community-dwelling patients who are at risk of poorer health outcomes.DesignA secondary analysis of a prospective cohort study with a 2-year follow-up (2010–2012).Setting15 general practices in Ireland.Participants904 older community-dwelling patients.ExposureBaseline multimorbidity measurements based on both medication classes count (MCC) and chronic disease count (CDC).OutcomesMortality, self-reported health related quality of life, mental health and physical functioning at follow-up.AnalysisSensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) adjusting for clustering by practice for each outcome using both definitions.ResultsOf the 904 baseline participants, 53 died during follow-up and 673 patients completed the follow-up questionnaire. At baseline, 223 patients had 3 or more chronic conditions and 89 patients were prescribed 10 or more medication classes. Sensitivity was low for both MCC and CDC measures for all outcomes. For specificity, MCC was better for all outcomes with estimates varying from 88.8% (95% CI 85.2% to 91.6%) for physical functioning to 90.9% (95% CI 86.2% to 94.1%) for self-reported health-related quality of life. There were no differences between MCC and CDC in terms of PPV and NPV for any outcomes.ConclusionsNeither measure demonstrated high sensitivity. However, MCC using a definition of 10 or more regular medication classes to define multimorbidity had higher specificity for predicting poorer health outcomes. While having limitations, this definition could be used for proactive identification of patients who may benefit from targeted clinical care.

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Comparison of the frailty phenotype and the Tilburg Frailty Indicator regarding the prediction of quality of life in a two-year follow-up

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.405 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S185-S185

Author(s):

T. Coelho ◽

C. Paúl ◽

L. Fernandes

Keyword(s):

Quality Of Life ◽

Adverse Outcomes ◽

Community Dwelling ◽

Stressful Events ◽

Early Screening ◽

Frailty Phenotype ◽

Tilburg Frailty Indicator ◽

Frailty Indicator

IntroductionFrail individuals are highly vulnerable to minor stressful events, presenting a higher risk for adverse health outcomes (e.g. falls, disability, hospitalization), which can lead to a decline in quality of life (QoL). In this context, an early screening of elderly frailty is of crucial importance.ObjectiveTo compare how the Frailty Phenotype (FP) and the Tilburg Frailty Indicator (TFI) predict QoL in a two-year follow-up.MethodsA longitudinal study was designed recruiting 110 community-dwelling elderly (≥ 65 years). The presence of frailty was assessed at baseline (FP ≥ 3 and TFI ≥ 6), whereas QoL was measured two years later with two different scales: the WHOQOL-OLD and the EUROHIS-QOL-8. Hierarchical regressions were conducted.ResultsThe mean age of the participants at baseline was 77.7 ± 6.9 years, and most were women (75.5%). According to FP, 33.6% of the participants were classified as frail, while the TFI detected frailty in 50% of the elderly. After adjusting for age and gender, the TFI significantly predicted QoL (WHOQOL-OLD: β = −18.9, t(106) = −6.97, P < 0.001; EUROHIS-QOL-8: β = −6.1, t(106) = −6.71, P < 0.001), whereas the effect of the FP on the outcome measures was non-significant.ConclusionsFrailty at baseline was associated with a lower QoL at follow-up. A multidimensional frailty operationalization (TFI) showed a stronger predictive validity than an exclusively physical one (FP). The option of which frailty measure to use in a clinical setting should take into account its ability to predict specific adverse outcomes, conducing to targeted and effective interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Epilepsy in children with shunted hydrocephalus

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.2.4 ◽

1999 ◽

Vol 6 (2) ◽

pp. E3

Author(s):

Marie Bourgeois ◽

Christian Sainte-Rose ◽

Giuseppe Cinalli ◽

Wirginia Maixner ◽

Conor Malucci ◽

...

Keyword(s):

Medical Records ◽

Epileptic Seizures ◽

Developmental Outcome ◽

Improve Quality ◽

Intellectual Outcome ◽

History Of ◽

A Prospective Study ◽

Significant Data

The incidence of epilepsy among children with hydrocephalus and its relation to shunts and their complications, raised intracranial pressure (ICP), and developmental outcome are explored in a retrospective study. The authors studied a series of 802 children with hydrocephalus due to varying causes, who were treated by ventriculoperitoneal shunt placement between 1980 and 1990, with a mean follow-up period of 8 years. Patients who had tumoral hydrocephalus and those whose files lacked significant data were excluded. Data extracted from medical records, including history of the hydrocephalus and history of seizures, if any, were analyzed. Thirty-two percent of the children had epilepsy, the onset of which frequently occurred at approximately the same time that the diagnosis of hydrocephalus was made. The majority of the affected children had severe uncontrolled epilepsy. The incidence of epilepsy was significantly affected by the original cause of the hydrocephalus. The presence of radiological abnormalities was also found to be a significant predictor of epilepsy. Similarly, shunt complications predisposed to epilepsy. Episodes of raised ICP related to hydrocephalus or in association with shunt malfunction may also predispose to epileptic seizures. Furthermore, the presence of a shunt by itself seems able to promote an epileptogenic focus. Finally, epilepsy appears to be an important predictor of poor intellectual outcome in hydrocephalic children with shunts. A prospective study is needed to identify clearly and confirm avoidable factors predisposing to seizures in these children so that we can strive to reduce the incidence of these seizures and, subsequently, improve quality of life.

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