Objective: To study the presence and adequacy of pain treatment in elderly patients in nursing homes; and to evaluate the effects of daily pain monitoring in daily practice.
Methods: A prospective, quasi-experimental study was conducted. The intervention consisted of daily assessment of pain intensity, after all nurses were educated about pain and pain treatment.
Main Outcome Measures: Pain assessment was based on a Numeric Rating Scale from 0-10. In addition to pain intensity, a muldimdimensional pain assessment tool was used.
Results: 62 nurses working at nursing homes were educated and trained. In total, 222 elderly patients participated in the study. Results showed that 23-35% of patients were not able to fill in a Pain Assessment Tool, primarily because of cognitive impairment. In total, 73-77% suffered from pain. Of these patients, 60-80% reported substantial pain (pain I 4). Of patients with in pain, 66-72% received a WHO level 1 drug, 1-4% a WHO level 2 drug, and 7-12% a WHO level 3 drug. Of patients in pain, 19-21% did not receive any analgesics. Pain monitoring proved to be effective in reducing the percentage of patients with substantial pain (pB/0.05).
Conclusions: Daily pain is prevalent among a majority of nursing home residents. The findings suggest that pain is a major problem in nursing home care. A majority of elderly patients are untreated for their pain. A strategy for improving pain management appear to be the implementation of the Pain Monitoring Program. The implementation of daily pain assessment together with pain eduxcation for nurses is effective in achieving a decrease in patients pain. However, a substantial group of cognitively impaired patients in nursing homes are not able to use a numeric rating scale. Results and methodological issues will be discussed.