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Cognitive status and analgesic provision in nursing home residents
- Authors:
- CLOSS S. Jose, BARR Bridget, BRIGGS Michelle
- Journal article citation:
- British Journal of General Practice, 54(509), December 2004, pp.919-921.
- Publisher:
- Royal College of General Practitioners
Although it is becoming acknowledged that pain management is generally poor for older people, little is known about pain management for nursing home residents in the UK, and the specific problems for those with cognitive impairments. This study explored analgesic prescription and administration according to nursing home residents' cognitive status using a survey of residents and medication documentation. The sample included 113 residents from 15 homes in large city in northern England. Cognitive status was assessed using the mini-mental state examination (MMSE). Pain was measured with a 4-point verbal rating scale and a 10-point horizontal numeric rating scale. Medications (name, dose, frequency) were noted, and provision within the previous 24 hours. There were no statistically significant differences in pain scores according to level of cognitive impairment. Prescription and administration of opioid and non-opioid analgesics were highest for residents with low cognitive impairment, decreasing as impairment increased. Those prescribed neither opioid nor non-opioid analgesics had significantly lower MMSE scores than those who were. A low MMSE score indicates high cognitive impairment. It is not clear why those with greater impairment received fewer analgesics. More research is needed into relationships between pain assessment, pain experience, cognitive impairment and analgesic provision. It is likely that improvements in carers' knowledge of pain assessment and the risks and benefits of commonly used analgesics could improve analgesic provision.