Cognitive status and analgesic provision in nursing home residents

Although it is becoming acknowledged that pain management is generally poor for older people, little is known about pain management for nursing home residents in the United Kingdom, and the specific problems for those with cognitive impairments.

This section of a larger study of pain aimed to explore analgesic prescription and administration according to nursing home residents' cognitive status.

A survey of nursing home residents and their medication documentation.

The sample included 113 nursing home residents from 15 nursing homes in large city in the north of England.

Residents' cognitive status was assessed using the mini-mental state examination (MMSE). Pain was measured with a four-point verbal rating scale and a 10-point horizontal numeric rating scale. Residents' medications--including name, dose, and frequency of administration--were noted, as well as provision within the previous 24 hours.

There were no statistically significant differences in pain scores according to level of cognitive impairment. The prescription and administration of opioid and non-opioid analgesics were highest for residents with low cognitive impairment; these decreased as impairment increased. Those who were prescribed neither opioid nor non-opioid analgesics had significantly lower MMSE scores than those who were. A low MMSE score indicates a high level of cognitive impairment.

It is not clear why those with greater cognitive impairment received fewer analgesics than others. More research is needed into the relationships between pain assessment, pain experience, cognitive impairment, and analgesic provision. It is likely that improvements in carers' knowledge of pain assessment and the risks and benefits of commonly used analgesics could improve analgesic provision.