Management of pain and burdensome symptoms in nursing home patients

Reidun K. Sandvik’s thesis aimed to investigate whether use of pain medication can improve the lives of people with dementia and agitation. She also studied patients in their last phase of life in Norwegian nursing homes. 

Sandvik found that individual treatment with pain medication reduced the intensity of pain in people with dementia. The use of pain medication in Norwegian nursing homes shows that people with dementia were undertreated compared to patients without dementia from 2000 to 2009, while in 2011 it was the same for both groups. Sandvik also revealed that pain medicine prescribed to nursing home patients increased by 65 % between 2000 and 2011. Strong opioids such as morphine were prescribed nine times more often.   

Another important finding was that healthcare professionals found it difficult to recognize signs of imminent dying. Almost 40 % of patients were not considered dying when death occurred, something that may affect the assessment of symptoms and treatment.

The thesis revealed a need for better implementation of guidelines and staff education regarding the treatment of nursing home patients with and without dementia.

Articles:

Sandvik J, Selbaek G, Aarsland D, Ballard C, Seifert R, Husebo BS. Impact of a Stepwise Protocol for Treating Pain on Pain Intensity in Nursing Home Patients with Dementia: A Cluster Randomized Trial Eur J Pain. 2014;10:1490-500

Reidun Sandvik, Geir Selbæk, Øyvind Kirkevold, Dag Aarsland, Bettina Sandgathe Husebø. Analgesic prescribing patterns in Norwegian nursing homes from 2000 to 2011: trend analyses of four data samples. Age and Ageing 2016; 45: 54–60

Reidun K. Sandvik, Geir Selbaek, Sverre Bergh, Dag Aarsland, Bettina S. Husebo. Signs of Imminent Dying and Change in Symptom Intensity During Pharmacological Treatment in Dying Nursing Home Patients: A Prospective Trajectory Study. JAMDA, Published Online: June 16, 2016