Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline

Up to 80% of nursing home residents are affected by pain. Pain assessment aims to determine pain intensity, quality, and course of pain to underpin diagnostic decision making. In the nursing home population, pain assessment is frequently compromised by cognitive impairment. Characteristics of the nursing home setting, such as resident's age, staff skill mix, and overall aims of the care provided, also need to be taken into account. Therefore, an interdisciplinary evidence-based clinical practice guideline for pain assessment in the nursing home setting was developed.A systematic literature search was carried out covering publications between 2003 and 2015. Thirty-nine studies were included in the preparation of this guideline, supplemented by 12 international reference guidelines. Recommendations were subjected to a structured consensus-finding process with representatives from 37 scientific and professional organizations and patient representatives. The guideline underwent independent peer review before finalization.It comprises 62 recommendations that are grouped into 4 chapters: (1) context of pain assessment in nursing home care; (2) screening; (3) focused assessment; and (4) reassessment/monitoring of pain. Main recommendations stipulate that clinicians should assess the patient's ability to provide self-report of pain when screening for pain and that each resident should be screened for the presence of pain. A focused assessment of pain, performed during rest and activities, should include pain intensity, changed behaviors, general mobility, pain history, comorbidities, and pain medication. Pain should be re-assessed at regular intervals using the same instruments that were used for the focused assessment. Guideline development demonstrated that many aspects of pain assessment in older persons have not received adequate research attention so far. Available studies predominantly possess only low levels of evidence. Therefore, research into this area needs to be systematically developed to address questions of clinical relevance to support patient care.     

Meeting the challenges for the UK Food and Drink Industry in a single European Market

The removal of barriers to trade will generate ‘marketing wars’ in which profits will come from value added products of high controlled quality. Investments must be made in understanding the new markets and finding marketing niches. Specialist products will benefit from the economies of scale in manufacturing for an enlarged market.     

Treatment of Pain in European Nursing Homes: Results from the Services and Health for Elderly in Long TERm Care (SHELTER) Study

Objective

To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe.

Setting, Participants, and Measurements

Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n = 1900). A deeper analysis was performed for the subsample of residents who reported “current pain,” defined as pain at least 1 day within the past 3 days (n = 838), and those who reported “current pain of moderate to severe intensity” (n = 590).

Results

Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians’ availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians’ availability, and severe pain intensity were negatively associated.

Conclusion

Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement.     

Home and leisure accidents in young persons under 25 years of age in the European Union: challenges for tomorrow

In all industrialised countries, the health status of children and adolescents has improved considerably. Today mortality in youngsters of one year and above is low, with the exception of mortality due to accidents: in childhood and adolescence, accidents (in particular those that occur at home or in leisure activities) represent the major cause of death. The objective of this paper is to assess the epidemiological evolution in the European Union in this respect and to review community actions aimed at reducing home and leisure accidents among youngsters living in the EU-region. Research underlines the multiple factors that bring about injuries caused by accidents and the role of environmental and behavioural factors in particular. The complexity and diversity of these factors suggest that priorities in prevention should be based on the severity of injuries and on the feasibility to prevent them. However, within the European Union, a consistent monitoring of mortality and morbidity related to home and leisure injuries is severely hampered by flaws in reporting current mortality and by the absence of a harmonized reporting system for morbidity. Launched in 1981, the European Home and Leisure Accident Surveillance System (EHLASS) is supposed to repair some of those deficiencies, but has not yet been in operation in all member states. Information from both systems is presented in this paper. Prevention policy itself requires coordination at various levels: between behavioural and environmental interventions and between various actors and intermediary groups involved. In the European Union a number of regulatory measures have been taken in order to improve of the safety of youngsters. However, only through clear-targeted programmes and well-coordinated structures and investments one can expect to achieve any change in injury among youngsters.     

Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care,Post-Acute Care,and Other Settings

It is the position of the Academy of Nutrition and Dietetics that the quality of life and nutritional status of older adults in long-term care, post-acute care, and other settings can be enhanced by individualized nutrition approaches. The Academy advocates that as part of the interprofessional team, registered dietitian nutritionists assess, evaluate, and recommend appropriate nutrition interventions according to each individual’s medical condition, desires, and rights to make health care choices. Nutrition and dietetic technicians, registered assist registered dietitian nutritionists in the implementation of individualized nutrition care, including the use of least restrictive diets. Health care practitioners must assess risks vs benefits of therapeutic diets, especially for frail older adults. Food is an essential component of quality of life; an unpalatable or unacceptable diet can lead to poor food and fluid intake, resulting in malnutrition and related negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life.     

Managing the transitions: a Western European View of Health Care Development in Eastern Europe

The health care systems of Eastern Europe are undergoing rapidchange. Ministries of Health in the Eastern countries are turningto the West for solutions. This paper offers an overview ofthe health systems of four Eastern European countries, the catalystsof reform in those countries, and possible strategies for managingthe transitions. The objectives of health care reform are outlinedas well as the key issues and obstacles facing Eastern governmentsas they attempt to change both the structure and function ofhealth care systems.     

Antipsychotic Deprescription for Older Adults in Long-term Care: The HALT Study

Objectives

Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals.