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Pain, geriatrics, dementia

Ricardo Humberto Felix, Carla Bezerra Lopes Almeida, Renata Carvalho Cremaschi, Fernando Morgadinho Coelho, Fânia Cristina Santos
Objective: To study the quality of sleep in very elderly people with chronic pain. Methods: We investigated 51 very elderly people without dementia and with chronic pain according to the Geriatric Pain Measure. Katz and Lawton questionnaires were used to evaluate functionality. The Geriatric Depression Scale and Geriatric Psychosocial Assessment of Pain-induced Depression were also used. Self-perceptions of sleep and quality of sleep were checked using the Pittsburgh Sleep Quality Index...
January 2017: Arquivos de Neuro-psiquiatria
O Kada, H Janig, G Pinter, K Cernic, R Likar
BACKGROUND: Nursing homes are confronted more and more with palliative care patients, which present a challenge for nursing and medical personnel. Deficits in the palliative care of geriatric patients have been repeatedly demonstrated and many nursing home residents, especially those suffering from dementia, are undersupplied regarding pain management. OBJECTIVES: The present study was carried out to measure the knowledge and self-efficacy of nursing staff in the province of Carinthia (Austria) regarding palliative care of nursing home residents...
January 11, 2017: Der Schmerz
Jennifer L Schroeck, James Ford, Erin L Conway, Kari E Kurtzhalts, Megan E Gee, Krista A Vollmer, Kari A Mergenhagen
PURPOSE: Insomnia is problematic for older adults. After behavioral modifications fail to show adequate response, pharmacologic options are used. The pharmacokinetics of agents used to treat insomnia may be altered. This review focuses on the safety and efficacy of medications used to treat insomnia. METHODS: A literature search of Medline, PubMed, and Embase was conducted (January 1966-June 2016). It included systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on insomnia in an older population...
November 2016: Clinical Therapeutics
Mark E Kunik, A Lynn Snow, Nancy Wilson, Amber B Amspoker, Shubhada Sansgiry, Robert O Morgan, Jun Ying, Gayle Hersch, Melinda A Stanley
OBJECTIVES: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). DESIGN: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX. PARTICIPANTS: A total of 203 community-dwelling veterans with pain and dementia and their caregivers...
February 2017: American Journal of Geriatric Psychiatry
Kirsten Hermans, Joachim Cohen, Nele Spruytte, Chantal Van Audenhove, Anja Declercq
AIM: The aims of the present study were: (i) to describe palliative care needs and symptoms of older adults anticipated to be in the last year of their life in Flemish nursing homes (Belgium); and (ii) to evaluate whether these needs differ between residents with and without dementia. METHODS: A cross-sectional study was carried out in 2014. Nurses and nursing assistants in 15 Flemish nursing homes (Belgium) completed the Palliative care Outcome Scale for 109 residents with palliative care needs...
September 16, 2016: Geriatrics & Gerontology International
Christine S Ritchie, Amy S Kelley, Irena Stijacic Cenzer, Alexander K Smith, Margaret L Wallhagen, Kenneth E Covinsky
CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care. OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture...
October 2016: Journal of Pain and Symptom Management
Robert M Kaiser, Susan L Kaiser
As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams-and with patients and families-is ubiquitous...
August 6, 2016: Gerontologist
Danielle Ní Chróinín, Adrian Montalto, Shahrzad Jahromi, Nicholas Ingham, Alexander Beveridge, Peter Foltyn
OBJECTIVES: To investigate oral health status and abnormalities in older adults admitted acutely to the hospital and explore the association with common medical comorbidities. DESIGN: Cross-sectional study. SETTING: Hospital. PARTICIPANTS: All individuals aged 70 and older (mean age 84.4, 61.4% female) admitted to a geriatric service over 3 months (N = 202). MEASUREMENTS: In-person assessment using the Oral Health Assessment Tool (OHAT) (range 0-2, 2 = poorest) for lips, tongue, gums and soft tissue, saliva, teeth, dentures, oral cleanliness, and dental pain...
August 2016: Journal of the American Geriatrics Society
R Cramer-Ebner, C Dorn, A Feilcke, I Hach
BACKGROUND: Assessment and self-assessment frequently differ, e. g. in psychosomatic disorders and complaints. At the same time the prevalence of corresponding disorders in old age is high. OBJECTIVE: This study investigated psychosocial factors from the perspective of nursing home residents and compared this self-assessment with data collected in other scientific studies with assessments by nursing home staff. The aim was to develop specific recommendations for the nursing home sector...
June 28, 2016: Zeitschrift Für Gerontologie und Geriatrie
Suzanne Timmons, Emma O'Shea, Desmond O'Neill, Paul Gallagher, Anna de Siún, Denise McArdle, Patricia Gibbons, Sean Kennelly
BACKGROUND: Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. METHODS: Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76)...
2016: BMC Geriatrics
Roland Nau, Marija Djukic, Manfred Wappler
The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e...
June 2016: Der Nervenarzt
Mette Marie Tang, Morten Gill Wollsen, Lise Aagaard
OBJECTIVE: To monitor pain intensity, pain symptoms, and medication use in elderly with dementia. METHODS: Nursing home residents above 65 years of age, diagnosed with dementia, and showing pain symptoms were included in the study. The patients' mental status was monitored through a mini-mental state examination score and observations of pain symptoms using Part 1 of the Mobilization-Observation-Behaviour-Intensity-Dementia-2 (MOBID-2) pain scale. Community pharmacists reviewed the patients' medication use, and the prescriptions were compared with guidelines for treatment of geriatric patients...
April 2016: Journal of Research in Pharmacy Practice
Iwona Otremba, Krzysztof Wilczyński, Jan Szewieczek
BACKGROUND: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. OBJECTIVE: Evaluate specific factors for development of delirium in a geriatric ward setting. METHODS: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission...
2016: Clinical Interventions in Aging
Ewa Zasadzka, Sylwia Kropińska, Mariola Pawlaczyk, Roma Krzymińska-Siemaszko, Przemysław Lisiński, Katarzyna Wieczorowska-Tobis
Purpose] The aim of the study was to analyze the impact of inpatient rehabilitation on the functional status of the elderly. [Subjects and Methods] A total of 100 patients (>65 years of age) in a rehabilitation ward were enrolled in this study. Age, absence of depression and signs of dementia in screening tests constituted the inclusion criteria. A comprehensive geriatric assessment was performed of all of the subjects twice, at the beginning and end of hospitalization (Assessments I and II, respectively), and included fall risk assessment (Timed Up and Go Test, TUG), evaluation of physical function (Short Physical Performance Battery Test, SPPB), the handgrip strength test, as well as patients' self-reports of pain intensity, well-being and functional status...
January 2016: Journal of Physical Therapy Science
Agnieszka Neumann-Podczaska, Tomasz Nowak, Aleksandra Suwalska, Dorota Łojko, Roma Krzymińska-Siemaszko, Elżbieta Kozak-Szkopek, Katarzyna Wieczorowska-Tobis
Many age-associated diseases are accompanied by pain. There is no doubt that pain is underrecognized among elderly nursing home residents and the diagnosing of pain is a real challenge in subjects with dementia. The aim of the study was to characterize analgesic use among nursing home residents and to delineate the putative associations between pain management and cognitive functions of elderly persons. The study involved 392 subjects (males:females - 81:311) with a mean age of 83.6±5.9 years. The residents' medical files in relation to diagnoses and drug consumption were analyzed, and the screening of cognitive functions was performed using the Mini-Mental State Examination (MMSE)...
2016: Clinical Interventions in Aging
Deepti Kukreja, Ulf Günther, Julius Popp
Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed...
December 2015: Indian Journal of Medical Research
Davide L Vetrano, Andrea D Foebel, Alessandra Marengoni, Vincenzo Brandi, Agnese Collamati, George A Heckman, John Hirdes, Roberto Bernabei, Graziano Onder
BACKGROUND: Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as falls, delirium etc.). We investigated the association of chronic diseases, alone or in combination, and GS in older adults receiving home care services in 11 European countries and one Canadian province. METHODS: Participants were cross-sectionally evaluated with the multidimensional assessment instrument RAI HC...
January 2016: European Journal of Internal Medicine
Giuseppe Bellelli, Andrea Mazzone, Alessandro Morandi, Nicola Latronico, Sabrina Perego, Sara Zazzetta, Paolo Mazzola, Giorgio Annoni
OBJECTIVE: Impaired arousal is associated with negative outcomes in intensive care units, but studies in acute medical wards are scanty. The study aim was to evaluate the association between impaired arousal, as measured using an ultrabrief screen, and risk of both 1- and 6-month mortality and discharge to nursing home (NH) or hospice. DESIGN: Prospective cohort study with 6-month follow-up. SETTING: An acute geriatric unit (AGU) of a university-based hospital in Northern Italy...
March 1, 2016: Journal of the American Medical Directors Association
E Sirsch, I Gnass, T Fischer
Old people's experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions...
August 2015: Der Schmerz
Sylvia S C Ngu, Maw Pin Tan, Pathmawathi Subramanian, Rasnah Abdul Rahman, Shahrul Kamaruzzaman, Ai-Vyrn Chin, Kit Mun Tan, Philip J H Poi
Pain assessment in older individuals with cognitive impairment is challenging. Evidence on the performance of pain assessment tools in this population remains limited. The aim of this study was to evaluate the performance of self-reported pain, nurse-reported pain, and observational pain tools among older patients with cognitive impairment using a prospective observational design. In all, 152 older individuals admitted to the acute geriatric ward were recruited through convenience sampling. Three methods of pain assessment were compared: self-reported pain (SRP), observational pain using the Pain Assessment in Advanced Dementia (PAINAD) tool, and nurse-reported pain (NRP)...
August 2015: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
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