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3-month outcome of a pain assessment procedure

In nursing home residents with dementia

Janine van Kooten, Martin Smalbrugge, Johannes van der Wouden, Max Stek, Cees Hertogh

De abstractcommissie heeft op verzoek van de congrescommissie 9 abstracts geselecteerd die tijdens het Verenso najaarscongres 'Kiezen voor delen' op 24 november 2016 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.

Objectives

To describe the course of pain and pain management strategies following a guideline based pain assessment procedure in long-term care residents with dementia.

Design

Prospective exploratory study between May 2014 and March 2016. Setting: Dutch Nursing homes (10).

Measurements

A guideline-based assessment was performed that included pain observation with the MOBID-2 Pain Scale (range 0-10), review of the medical record and pharmacist’ files, and a physical examination when MOBID-2 score ≥3. The results of this assessment were communicated to the attending physician together with a written treatment advice. After three months reassessment of pain and a review of the medical records and pharmacist’ files were done.

Results

We obtained follow-up data of 64 (78.6%) of the 84 residents with pain at the initial assessment. A report with the advice to change the current treatment strategy was provided in 48 cases. After three months half of these advices were executed and the mean pain intensity was significantly improved from 4.8 to 3.2 (95% CI 0.95 – 2.17, p=0.00), while the use of analgesic drugs was not significantly increased at follow-up. The proportion of residents with persistent pain was 57.8%.

Conclusions

We found a significant difference in the mean pain intensity score between baseline and follow-up. As pain persisted frequently in residents, we cannot exclude regression to the mean as explanation for our findings. However, guideline based pain assessment procedure including feedback and a written treatment advice might be helpful in improving pain management in nursing home residents with dementia.

Auteur(s)

  • Drs. Janine van Kooten specialist ouderengeneeskunde (ten tijde van onderzoek aioto-specialisme ouderengeneeskunde) afdeling huisartsgeneeskunde en ouderengeneeskunde, VU medisch centrum
  • Dr. Martin Smalbrugge, specialist ouderengsneeskunde afdeling huisartsgeneeskunde en ouderengeneeskunde, VU medisch centrum
  • Dr. Johannes van der Wouden, universitair hoofddocent afdeling huisartsgeneeskunde en ouderengeneeskunde, VU medisch centrum
  • Prof. dr. Max Stek, ouderenpsychiater GGZ InGeest/afdeling psychiatrie, VU medisch centrum 
  • Prof. dr. Cees M.P.M. Hertogh, specialist ouderengeneeskunde afdeling huisartsgeneeskunde en ouderengeneeskunde, VU medisch centrum
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