Quality of Life and Pain Medication Use in Persons With Advanced Dementia Living in Long-Term Care Facilities |
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| Affiliation: | 1. Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands;2. Department of Global Public Health and Primary Care, Centre for Elderly – and Nursing Home Medicine, University of Bergen, Bergen, Norway;3. Municipality of Bergen, Bergen, Norway;1. GeneYouIn Inc, Toronto, Ontario, Canada;2. Department of Anesthesia, McMaster University Hamilton, Ontario, Canada;3. Think Research, Toronto, Ontario, Canada;4. Baycrest Center for Geriatric Care, Toronto, Ontario, Canada;5. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada;1. Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada;2. Translating Research in Elder Care (TREC), University of Alberta, Edmonton, Alberta, Canada;3. Faculty of Kinesiology, Western University, London, Ontario, Canada;1. Department of General Practice, University of Helsinki, Helsinki, Finland;2. Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland;3. Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland;1. Unidad de Oncología Médica, Instituto Clínico de Enfermedades Hematológicas y Oncológicas, Hospital Clínic de Barcelona, Barcelona, Spain;2. Departamento de Enfermería del Instituto de Medicina y Dermatología, Hospital Clínic de Barcelona, Barcelona, Spain;1. Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King''s College London, London, United Kingdom;2. Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS foundation Trust, London, United Kingdom;3. University of Exeter Medical School, University of Exeter, St Luke''s Campus, Exeter, United Kingdom;4. Psychological Services, Oxford Health NHS Foundation Trust, Fulbrook Center, Oxford, United Kingdom;5. Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom;6. Institute of Rehabilitation, Dementia Applied Research Center, University of Hull, Hull, United Kingdom;7. Dementia Services Development Center, Wales, Institute of Medical and Social Care Research, Bangor University, Bangor, United Kingdom;8. Section of Mental Health and Aging, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King''s College London, London, United Kingdom;9. Whitaker Research Ltd, Bangor, United Kingdom;10. Psychological Services, Oxford Health NHS Foundation Trust, The Fulbrook Center, Oxford, United Kingdom;11. London School of Economics and Political Science, London, United Kingdom;12. Alzheimer Society, Devon House, London, United Kingdom;13. Wolfson Center for Age-Related Diseases, King''s College London, London, United Kingdom;14. Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway |
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| Abstract: | ObjectivesIn residents with dementia living in a long-term care facility (LTCF), un(der)treated pain may trigger behavioral disturbances, mood syndromes, and deterioration of physical functioning and self-maintenance. Because these factors can have considerable impact on the quality of life (QoL), this study aimed to (1) compare characteristics of persons with advanced dementia living in LTCFs with and without pain medication; (2) compare QoL in these persons with and without pain, stratified by type of pain medication use; and (3) explore associations between the use of paracetamol and QoL in persons with advanced dementia living in LTCFs.Design and settingThis study analyzed baseline data from the Communication, Systematic Assessment and Treatment of Pain, Medication Review, Occupational Therapy, and Safety Study; a multicenter, cluster-randomized effectiveness-implementation clinical hybrid trial in 67 Norwegian LTCF clusters.ParticipantsIn total, 407 LTCF residents (rural and urban areas) aged ≥65 years, with Functional Assessment Staging scores of 5–7 (ie, moderate to advanced dementia).Main outcome measureQoL as assessed by the 6 QUALIDEM (validated questionnaire to measure QoL in persons with dementia living in LTCF) domains applicable to persons with moderate to severe dementia. The association between QoL and paracetamol was estimated using linear mixed-effect models, adjusting for confounding variables.Results62.0% used pain medication (paracetamol, opioids, or both). QoL was lower in residents using pain medication, compared with those without pain medication [mean QUALIDEM score 68.8 (standard deviation 17.4 vs) 75.5 (standard deviation 14.6), respectively, P < .001). Multilevel analysis showed that paracetamol use was not associated with QoL.Conclusions and ImplicationsPersons with advanced dementia living in LTCF using pain medication have a lower QoL compared with those not using pain medication. These results are of key importance for the clinician because they stress the need for regular medication review and pain management. When measured cross-sectionally, use of paracetamol is not associated with increased QoL. |
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| Keywords: | Quality of life nursing home dementia pain medication paracetamol |
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