ANALGESIC DRUG PRESCRIPTION AND USE IN COGNITIVELY IMPAIRED NURSING-HOME RESIDENTS

Background: Prior research has documented the high prevalence of pain in elderly adults and the difficulties associated with properly assess ing and treating pain in elders with cognitive impairment. Objectives: To investigate the prescription and administration of analgesic medic ations to treat pain in cognitively impaired nursing home residents. M ethod. The current sample consisted of 339 nursing home residents (295 women and 44 men) with a mean age of 87 years (range 66-104). Forty-s ix percent of the sample had diagnosed cognitive impairment, and 55% h ad at least one diagnosed painful condition. Data for this correlation al study were drawn from four nursing homes in Western Pennsylvania. T he Multidimensional Observation Scale for Elderly Subjects was used to assess behavioral indicators of cognitive impairment, and chart revie w was used to obtain demographic, medication, and diagnostic data. Res ults: The results indicated that cognitively impaired nursing home res idents are prescribed and administered significantly less analgesic me dication, both in number and in dosage of pain drugs than their more c ognitively intact peers. In multiple regression analyses holding the p resence of painful conditions constant, more disoriented and withdrawn residents were prescribed significantly less analgesia by physicians; more disoriented, withdrawn, and functionally impaired residents were administered significantly less analgesia by nursing staff. Conclusio ns: The findings highlight the difficulties of assessing pain in cogni tively impaired elders and the lack of knowledge among health care pro viders about effective pain management.