Differences in pain expression in elderly hip fracture patients with and without dementia: a retrospective review of medical records.

摘要

Pain is a common problem among older adults across many settings. Furthermore, acute pain is a significant problem in the hospitalized older adult. In the outpatient setting, research has consistently found persons with dementia to have pain that is under-recognized and under-treated compared to their cognitively intact counterparts, despite the fact that both persons with and without dementia share similar painful conditions. Research on this topic in the acute setting is sparse, however preliminary results share similar findings and are also revealing that nurses are not in compliance with the standards for pain assessment as established by the Joint Commissions for Health Care Accreditation in the year 2000, that pain be measured as the "fifth vital sign." There are many possible explanations for the under-recognition and under-treatment of pain in persons with dementia. The purpose of this study was to investigate differences in pain expression, pain assessment, and pain management between persons with and without dementia who were hospitalized with acute hip fracture. The group of persons with dementia was further divided into subgroups of persons with Alzheimer's disease and persons with dementia non-specified to investigate these differences between dementia subtypes. A descriptive, retrospective review of medical records, including a comparison group matched for age, gender, race and location was conducted of persons admitted to one of four hospitals in the Jacksonville, Florida region during the years 2005 through 2009. Descriptive statistics as well as analysis of covariance and regression models were utilized for the analysis. Outcome measures for pain expression included verbal and non-verbal measures of pain intensity, and changes in heart rate and systolic blood pressure as measures of phyisiological signs of pain expression. Pain assessment was measured based on the number of nurse-based pain assessment recordings. Pain management was measured as the amount, based on equi-analgesic conversions, and type, opioid versus non-opioid, of pain medication prescribed and administered.;Findings of the current study support differences in verbal pain expression between persons with and without dementia, and suggest these differences may extend to the dementia subtypes. Further, these findings support emerging data that pain in persons with dementia is not only under-recognized and under-treated in the acute care setting, but that current clinical practice guidelines with regards to pain assessment are not being followed.