scholarly journals Management of preoperative pain in elderly patients with moderate to severe cognitive deficits and hip fracture: a retrospective, monocentric study in an orthogeriatric unit

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathilde Ruel ◽  
Bastien Boussat ◽  
Mehdi Boudissa ◽  
Virginie Garnier ◽  
Catherine Bioteau ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Cognitive Deficits ◽  
Preoperative Period ◽  
Preoperative Pain ◽  
Chronic Pain Patients ◽  
Average Quantity ◽  
Strong Opioids ◽  
Cognitively Intact ◽  
Pain Patients

Abstract Background Patients with cognitive deficits are 3 times more likely to suffer a hip fracture than geriatric patients of the same age group without cognitive deficits. The persistence of perioperative pain following hip fracture is a risk factor for the occurrence of delirium, poor functional prognosis, and the development of secondary chronic pain. Patients with cognitive deficits receive 20 to 60% less analgesics than those without cognitive deficits. Our retrospective descriptive monocentric study was performed in an orthogeriatric unit on a cohort of elderly patients hospitalized for hip fracture. The aim of the study was to compare the quantity of strong opioids delivered in a morphine sulfate equivalent daily during the preoperative period after a hip fracture between cognitively intact patients and those with cognitive deficits. Results Our total population of 69 patients had a median age of 90 years old, and 46% of these patients had moderate or severe cognitive deficits. During the preoperative period, the same quantity of strong opioids was administered to both groups of patients (13.1 mg/d versus 10.8 mg/d (p = 0.38)). Patients with moderate to severe cognitive deficits more often experienced delirium during their hospitalization (p < 0.01) and received more psychotropic drugs in the first 3 postoperative days (p = 0.025). Conclusions We reported that with standardized pain management in an orthogeriatric unit, patients aged 75 years and older received the same daily average quantity of strong opioids during the preoperative period regardless of the presence of cognitive deficits.

scholarly journals The impact of cognitive impairment at admission on short-term functional outcome of elderly hip fracture patients

2010 ◽  
Vol 138 (5-6) ◽  
pp. 319-322 ◽  
Author(s):  
Emilija Dubljanin-Raspopovic ◽  
Dragana Matanovic ◽  
Marko Bumbasirevic
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Functional Outcome ◽  
Cognitive Status ◽  
Cognitively Impaired ◽  
Short Term ◽  
Functional Gain ◽  
The Impact ◽  
Cognitively Intact

Introduction The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. Objective To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Methods Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge - FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Results Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p<0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p<0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p<0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p>0.05). Conclusion The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favorable short term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

Cognitive Deficits in Chronic Pain Patients With and Without History of Head/Neck Injury: Development of a Brief Screening Battery

1987 ◽  
Vol 3 (2) ◽  
pp. 94-101 ◽  
Author(s):  
David P. Schwartz ◽  
Jeffrey T. Barth ◽  
Joseph R. Dane ◽  
Sarah E. Drenan ◽  
Douglas E. DeGood ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Deficits ◽  
Neck Injury ◽  
Screening Battery ◽  
Chronic Pain Patients ◽  
History Of ◽  
Brief Screening ◽  
Pain Patients ◽  
Head Neck

Pain Influences Several Levels of Attention

2005 ◽  
Vol 16 (4) ◽  
pp. 235-242 ◽  
Author(s):  
Astrid von Bueren Jarchow ◽  
Bogdan P. Radanov ◽  
Lutz Jäncke
Keyword(s):  
Chronic Pain ◽  
Divided Attention ◽  
Covert Attention ◽  
Attention Task ◽  
Attentional Deficits ◽  
Control Subjects ◽  
Chronic Pain Patients ◽  
Divided Attention Task ◽  
Pain Stimuli ◽  
Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

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