背景:通常有报道称,养老院(NH)居民患有痴呆症的疼痛可能会对生活质量(QoL)产生负面影响。很少有纵向研究探讨从进入NH开始,患有痴呆症的NH居民的疼痛和QoL是如何发展的。
目的:目的是探索疼痛,QoL,和疼痛和QoL之间的关系随着时间的推移痴呆症患者承认一个NH。
方法:方便示例,来自68个非营利性NHs,包括总共996名患有痴呆症的挪威NH居民(平均年龄84.5岁,SD7.6,36.1%男性)在NH入院时(A1),每年随访两年(A2和A3)。使用动员-观察-行为-强度-痴呆-2(MOBID-2)疼痛量表和晚期痴呆(QUALID)量表的生活质量评估疼痛和QoL,分别,在所有的评估。痴呆的严重程度,个人日常生活活动水平,一般医疗健康,神经精神症状,在所有评估中还评估了精神药物和镇痛药(阿片类药物和/或扑热息痛)的处方.
结果:平均(SD)MOBID-2疼痛强度评分为2.1(2.1),2.2(2.2)、和2.4(2.1)分别在A1、A2和A3处。在所有评估中,处方镇痛药的参与者的疼痛强度评分均高于未处方镇痛药的参与者。每次评估的平均(SD)QUALID评分为19.8(7.1),20.8(7.2),和22.1(7.5)分别在A1,A2和A3。在调整后的线性混合模型中,较高的疼痛强度评分,阿片类药物的处方,和对乙酰氨基酚的处方在同时评估时与较差的QoL(较高的QUALID总分和较高的悲伤和紧张的QoL维度得分)相关。在这些调整后的分析中没有发现QoL的时间趋势。
结论:患有痴呆的NH患者,疼痛强度评分较高或服用镇痛药的患者QoL较差。临床医生,NH管理员,和国家医疗保健当局需要研究药物和非药物疼痛治疗的策略和行动,以减少疼痛强度,同时避免疼痛治疗的负面副作用,阻碍QoL。
BACKGROUND: Pain in nursing home (NH) residents with dementia is commonly reported and may affect Quality of Life (QoL) negatively. Few longitudinal studies have explored how pain and QoL develop in NH residents with dementia starting from their admission to the NH.
OBJECTIVE: The aim was to explore pain, QoL, and the association between pain and QoL over time in persons with dementia admitted to a NH.
METHODS: A convenience sample, drawn from 68 non-profit NHs, included a total of 996 Norwegian NH residents with dementia (mean age 84.5 years, SD 7.6, 36.1% men) at NH admission (A1), with annual follow-ups for two years (A2 and A3). Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively, at all assessments. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the prescription of psychotropic drugs and analgesics (opioids and/or paracetamol) were also assessed at all assessments.
RESULTS: Mean (SD) MOBID-2 pain intensity scores were 2.1 (2.1), 2.2 (2.2), and 2.4 (2.1) at A1, A2, and A3, respectively. Participants who were prescribed analgesics had higher pain intensity scores at all assessments than participants not prescribed analgesics. The mean (SD) QUALID scores at each assessment were 19.8 (7.1), 20.8 (7.2), and 22.1 (7.5) at A1, A2, and A3, respectively. In the adjusted linear mixed model, higher pain intensity score, prescription of opioids, and prescription of paracetamol were associated with poorer QoL (higher QUALID total score and higher scores in the QoL dimensions of sadness and tension) when assessed simultaneously. No time trend in QoL was found in these adjusted analyses.
CONCLUSIONS: NH residents with dementia who have higher pain intensity scores or are prescribed analgesics are more likely to have poorer QoL. Clinicians, NH administrators, and national healthcare authorities need to look into strategies and actions for pharmacological and non-pharmacological pain treatment to reduce pain intensity while simultaneously avoiding negative side effects of pain treatment that hamper QoL.