Opioid Prescription Use in Nursing Home Residents with Advanced Dementia.

Autor:	Griffioen C; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.; Novicare, Elderly Care, Best, the Netherlands., Husebo BS; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway., Flo E; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway., Caljouw MAA; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands., Achterberg WP; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Jazyk:	angličtina
Zdroj:	Pain medicine (Malden, Mass.) [Pain Med] 2019 Jan 01; Vol. 20 (1), pp. 50-57.
DOI:	10.1093/pm/pnx268
Abstrakt:	Background: Although proper pain treatment may require opioids, discussion continues about possible undertreatment or overtreatment in persons with advanced dementia. Objective: To investigate the prevalence of pain, frequency of opioid prescription use, and factors associated with strong opioid prescription use in nursing homes. Design: Cross-sectional study. Setting and Subjects: Eighteen Norwegian nursing homes; 327 persons with advanced dementia and behavioral disturbances participated. Methods: Potential factors associated with strong opioid prescription use were assessed: demographics (age, gender), medical conditions (comorbidity, number of medications), pain (Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale ≥ 3, pain-related diagnoses, analgesic prescription use), functioning (activities of daily living, Mini-Mental State Examination) and behavior (Neuropsychiatric Inventory-Nursing Home version, Cohen-Mansfield Agitation Inventory). Factors with P < 0.10, age, and gender were included in multivariate regression analysis. Results: The prevalence of moderate to severe pain was 62.1%. Of all participants, 19.3% (N = 63) were prescribed opioids, and of these, 79.4% (N = 50) were still in pain; 66.7% of the opioid prescriptions were less than or equal to the lowest dosage of fentanyl patches (12 mcg/h) or buprenorphine (5 or 10 mcg/h). Pain (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.12-1.42), total number of pain-related diagnoses (OR = 1.47, 95% CI = 1.14-1.90), and depression and anxiety (OR = 1.05, 95% CI = 1.01-1.11) were positively associated with an opioid prescription. Stroke was negatively associated (OR = 0.43, 95% CI = 0.19-0.99). Conclusions: Strong opioid prescription use was mainly associated with pain. However, in this population, despite the relatively prevalent use of strong prescription opioids, pain was still prevalent. This emphasizes the challenge of proper pain treatment and need for regular evaluation of pain and pain management.
Databáze:	MEDLINE
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