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Providers improving pain management for people with dementia: research

Residential aged care providers may be more effectively recognising and managing pain among people with dementia than they have been in the past, according to a forthcoming study.

The research from a collaborative of universities and a provider found that the usage rates of pain medication were similar among residents both with and without dementia.

This finding is in contrast to past research that indicated people with dementia were typically prescribed fewer pain medicines, as they may experience and express pain differently, such as through agitation, and this can be under-recognised by clinicians. These behavioural symptoms of pain may often be managed inappropriately or unnecessarily with psychotropic medicines

Simon Bell

Simon Bell

However, the soon-to-be published research suggests that efforts to better manage pain for those with dementia are improving.

The study was led by Monash University in collaboration with the University of Adelaide, University of South Australia, University of Sydney and aged care provider Resthaven, and funded by the Alzheimer’s Australia Dementia Research Foundation.

The researchers looked at the prevalence of pain and pain-relieving medicine among 383 aged care residents – both with and without dementia –  across six facilities.

They found that both residents with and without dementia experienced similar levels of clinician-observed pain, though those with dementia were less likely to be able to self-report.

That pain medication usage rates are at the same level suggested that providers were learning to better recognise and manage pain among people with dementia, said lead researcher Simon Bell, Associate Professor at the Centre for Medicine Use and Safety at Monash University.

“Our results suggest we are doing a much better job now than we have been in the past,” he told Australian Ageing Agenda.

Managing the risks

However, the benefits of pain-reliving medicines, such as opioids, must be measured against the potential for side effects, including daytime drowsiness and falls, which already occur at higher rates among those with dementia.

For this reason, the research also measured the association between the use of opioid pain medication and daytime drowsiness. Results found that while residents with dementia were typically drowsier than those without dementia, this was not related to the prescribing of opioid pain-relievers.

“We’re not suggesting that opioid pain medicines don’t cause sleepiness, because the overwhelming majority of research would suggest that they do,” said Associate Professor Bell. “It may be that in this particular study, clinicians noted which residents were likely to be susceptible to drowsiness and then avoided prescribing opioid medicines to these residents.”

These results suggested it was possible for clinicians to assess and balance the risk of daytime drowsiness against benefits of alleviating pain when prescribing opioid medication to people with dementia at the individual resident level, Associate Professor Bell said.

“We shouldn’t necessarily withhold opioid pain medicines from all residents for fear of causing sleepiness,” he said. However, he cautioned that daytime sleepiness was just one side effect of opioid pain medicines and other side effects such as constipation and the risk of falls were not investigated in the present study.

Future research

The study was cross-sectional, which meant it only measured at residents’ levels of drowsiness and pain medication at that particular point in time. In the future, Professor Bell said it would be useful to conduct a longitudinal study to investigate whether residents become drowsier after over time after they initiate an opioid pain medicine. He also said it would be useful to replicate the study with different providers in order to explore whether the encouraging results in the Resthaven facilities were generalisable.

“Prescribing patterns differ from facility to facility, so I think it’s probably a little bit early to say that the findings are widely generalisable, but I think it’s a good indication that clinicians are balancing the risks and benefits of opioids,” he said.

Professor Bell is currently undertaking further studies with Resthaven, looking at if certain patterns of medicine use are associated with quality of life and/or hospitalisation.

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