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Expert opinion on the management of pain in hospitalised older patients with cognitive impairment: a mixed methods analysis of a national survey.

Rodger KT, Greasley-Adams C, Hodge Z, Reynish E - BMC Geriatr (2015)

Bottom Line: Unequivocally responses suggested paracetamol is safe and should be first choice analgesic, newer opiates should be used preferentially in renal impairment and nefopam is unsafe.The use of paracetamol first line, newer opiates in renal impairment and avoidance of nefopam are immediately transferrable to clinical practice.Further review, evaluation and comparison of the risks associated with other specific analgesics are necessary before a comprehensive clinical guideline can be produced.

View Article: PubMed Central - PubMed

Affiliation: Department of Geriatric Medicine, NHS Fife, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, UK. kirstyrodger@nhs.net.

ABSTRACT

Background: Hospitalised older patients are complex. Comorbidity and polypharmacy complicate frailty. Significant numbers have dementia and/or cognitive impairment. Pain is highly prevalent. The evidence base for pain management in cognitively impaired individuals is sparse due to methodological issues. A wealth of expert opinion is recognised potentially providing a useful evidence base for guiding clinical practice. The study aimed to gather expert opinion on pain management in cognitively impaired hospitalised older people.

Methods: Consultant Geriatricians listed as dementia leads in the National Dementia Audit were contacted electronically and invited to respond. The questionnaire sought information on their role, confidence and approach to pain management in cognitively impaired hospitalised patients. Responses were analysed using a mixed methods approach.

Results: Respondents considered themselves very confident in the clinical field. Awareness of potential to do harm was highly evident. Unequivocally responses suggested paracetamol is safe and should be first choice analgesic, newer opiates should be used preferentially in renal impairment and nefopam is unsafe. A grading of the safety profile of specific medications became apparent, prompting requirement for further evaluation and holistic assessment.

Conclusion: The lack of consensus reached highlights the complexity of this clinical field. The use of paracetamol first line, newer opiates in renal impairment and avoidance of nefopam are immediately transferrable to clinical practice. Further review, evaluation and comparison of the risks associated with other specific analgesics are necessary before a comprehensive clinical guideline can be produced.

No MeSH data available.


Related in: MedlinePlus

Medication use by respondents in older people with cognitive impairment.
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Related In: Results  -  Collection

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Fig1: Medication use by respondents in older people with cognitive impairment.

Mentions: When responding to the section of questionnaire examining use of specific medications the caution exhibited in prescribing at the top end of the ladder was also in evidence but a grading of the safety profile of individual medications became apparent (FigureĀ 1).Figure 1


Expert opinion on the management of pain in hospitalised older patients with cognitive impairment: a mixed methods analysis of a national survey.

Rodger KT, Greasley-Adams C, Hodge Z, Reynish E - BMC Geriatr (2015)

Medication use by respondents in older people with cognitive impairment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4419491&req=5

Fig1: Medication use by respondents in older people with cognitive impairment.
Mentions: When responding to the section of questionnaire examining use of specific medications the caution exhibited in prescribing at the top end of the ladder was also in evidence but a grading of the safety profile of individual medications became apparent (FigureĀ 1).Figure 1

Bottom Line: Unequivocally responses suggested paracetamol is safe and should be first choice analgesic, newer opiates should be used preferentially in renal impairment and nefopam is unsafe.The use of paracetamol first line, newer opiates in renal impairment and avoidance of nefopam are immediately transferrable to clinical practice.Further review, evaluation and comparison of the risks associated with other specific analgesics are necessary before a comprehensive clinical guideline can be produced.

View Article: PubMed Central - PubMed

Affiliation: Department of Geriatric Medicine, NHS Fife, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, UK. kirstyrodger@nhs.net.

ABSTRACT

Background: Hospitalised older patients are complex. Comorbidity and polypharmacy complicate frailty. Significant numbers have dementia and/or cognitive impairment. Pain is highly prevalent. The evidence base for pain management in cognitively impaired individuals is sparse due to methodological issues. A wealth of expert opinion is recognised potentially providing a useful evidence base for guiding clinical practice. The study aimed to gather expert opinion on pain management in cognitively impaired hospitalised older people.

Methods: Consultant Geriatricians listed as dementia leads in the National Dementia Audit were contacted electronically and invited to respond. The questionnaire sought information on their role, confidence and approach to pain management in cognitively impaired hospitalised patients. Responses were analysed using a mixed methods approach.

Results: Respondents considered themselves very confident in the clinical field. Awareness of potential to do harm was highly evident. Unequivocally responses suggested paracetamol is safe and should be first choice analgesic, newer opiates should be used preferentially in renal impairment and nefopam is unsafe. A grading of the safety profile of specific medications became apparent, prompting requirement for further evaluation and holistic assessment.

Conclusion: The lack of consensus reached highlights the complexity of this clinical field. The use of paracetamol first line, newer opiates in renal impairment and avoidance of nefopam are immediately transferrable to clinical practice. Further review, evaluation and comparison of the risks associated with other specific analgesics are necessary before a comprehensive clinical guideline can be produced.

No MeSH data available.


Related in: MedlinePlus