The use of nonpharmacological interventions for chronic pain treatment in community-dwelling older adults with a certified need for care.

BACKGROUND: Chronic pain is a major health issue and rapid population ageing exacerbates the burden to health systems in countries like Germany. Nonpharmacological interventions (NPIs) are essential in pain care and the prioritization of active NPIs is emphasized in guidelines. This paper examines the utilization of NPIs for chronic pain management in community-dwelling older adults with a certified need of care in Berlin, Germany. METHODS: Cross-sectional data was collected through standardized face-to-face surveys with older adults (≥65 years), using validated instruments (e.g., Brief Pain Inventory), and structured lists for NPI utilization. Categorization into active and passive NPIs was performed through a literature-based, iterative process by an interdisciplinary team. For not normally distributed data, non-parametric tests were used as appropriate. Logistic regression was conducted for multivariate analysis. RESULTS: In total, 250 participants were included in this analysis (aged 65-104, x̅ = 81.8, 68.8% female). Most (92%) use NPIs for chronic pain management: 85.6% use active NPIs, 50.4% active movement and only 5.6% use solely passive approaches. Most common NPIs are distraction, thermotherapy/compresses, and physiotherapy. The odds of utilizing physiotherapy are three times higher for those with high educational status when compared to those with low education while those with low educational status had higher odds of using thermotherapy/compresses. CONCLUSIONS: In our sample, most community-dwelling older adults with a certified need of care use active NPIs for chronic pain management with about half using active movement approaches. Considering the high vulnerability of this population, physiotherapy (in the form of therapeutic exercise) is a particularly appropriate intervention, and it was the third most frequent NPI in our sample. However, there is a social gradient in the utilization of physiotherapy for chronic pain management which might be rooted in issues around awareness, appeal, and access to such measures. It is important to take socioeconomic differences into account when planning the care for older chronic pain patients but also when designing research or user-friendly guidelines for this target group. TRIAL REGISTRATION: Ethical approval from the Ethics Committee of Charité - Universitätsmedizin Berlin (EA1/368/14) and study registration with the Central Study Register (ZSR no. 20009093).

Mobility enhancement among older adults 75 + in rural areas: Study protocol of the MOBILE randomized controlled trial.

BACKGROUND: Maintaining mobility in old age is crucial for healthy ageing including delaying the onset and progress of frailty. However, the extent of an individuals´ mobility relies largely on their personal, social, and environmental resources as outlined in the Life-Space Constriction Model. Recent studies mainly focus on facilitating habitual out-of-home mobility by fostering one type of resources only. The MOBILE trial aims at testing whether tablet-assisted motivational counselling enhances the mobility of community-dwelling older adults by addressing personal, social, and environmental resources. METHODS: In the MOBILE randomized controlled trial, we plan to enrol 254 community-dwelling older adults aged 75 and older from Havelland, a rural area in Germany. The intervention group will receive a tablet-assisted motivational counselling at the participant´s home and two follow-up telephone sessions. Main focus of the counselling sessions lays on setting and adapting individual mobility goals and applying action planning and habit formation strategies by incorporating the personal social network and regional opportunities for engaging in mobility related activities. The control group will receive postal general health information. The primary mobility outcome is time out-of-home assessed by GPS (GPS.Rec2.0-App) at three points in time (baseline, after one month, and after three months for seven consecutive days each). Secondary outcomes are the size of the GPS-derived life-space convex hull, self-reported life-space mobility (LSA-D), physical activity (IPAQ), depressive symptoms (GDS), frailty phenotype, and health status (SF-12). DISCUSSION: The MOBILE trial will test the effect of a motivational counselling intervention on out-of-home mobility in community-dwelling older adults. Novel aspects of the MOBILE trial include the preventive multi-level intervention approach in combination with easy-to-use technology. The ecological approach ensures low-threshold implementation, which increases the benefit for the people in the region. TRIAL REGISTRATION: The MOBILE trial is prospectively registered at DRKS (Deutsches Register Klinischer Studien, German Registry of Clinical Trials) DRKS00025230 . Registered 5 May 2021.

Pain-coping types among older community-dwelling care receivers with chronic pain.

OBJECTIVES: There is a lack of knowledge on coping with pain and sub-group specific pain-coping profiles among older home care receivers with chronic pain. To describe pain-coping strategies, identify subgroups based on cognitive and behavioral pain-coping strategies and pain-related psychological impairment and to compare these groups with regard to socio-demographic, medical, pharmacological and psychological characteristics. METHOD: Data of 212 care receivers were examined using the German pain-coping questionnaire (FESV) to determine how they cope with pain. Subgroups were identified using hierarchic agglomerative cluster analysis, using Ward's algorithm and squared Euclidean distance, and characterized using socio-demographic, medical, pharmacological and psychological parameters. Multinomial logistic regression was used to identify variables associated with the subgroups. RESULTS: Older care receivers apply cognitive and behavioral strategies to manage pain. Three subgroups were identified: Cluster 1 (25.9%) with good coping competences and little psychological impairment, Cluster 2 (40.1%) with poor coping competences and high psychological impairment, and Cluster 3 (34%) with good coping competences and high psychological impairment. Significant differences between the clusters were observed for age, pain intensity, pain-related interference, daily activities, depression and resilience. Logistic regression demonstrated that belonging to Cluster 2 was associated with the number of pain-reducing medications, depression and resilience. Belonging to Cluster 3 was significantly linked to daily activities, the number of pain medications, depression and the level of care required. CONCLUSION: Differentiating between pain-coping profiles in the group of older care receivers with chronic pain necessitates target group-specific pain-oriented psychotherapeutic interventions, which can result in improved pain management.

Caregiving adult children's perceptions of challenges relating to the end of life of their centenarian parents.

BACKGROUND: The number of centenarians in Europe is increasing; many face health impairments. Adult children often play a key role in their care, but there is a lack of research into what it means for these caregiving relatives to be confronted for many years with their parents' end of life (EOL), dying and death as well as their own advancing age. AIM: This study aims to analyse the challenges of caregiving adult children regarding their parents' end of life and the related burdens and barriers they report. MATERIAL AND METHODS: Semi-structured interviews were conducted with 13 caregivers following a theory-based and tested guideline. The computer-aided coding and evaluation followed the structured content analysis approach. RESULTS: The analysis showed three main themes: 'Confronting EOL', 'Communicating about death and dying' and 'Assisting in the terminal phase'. The respondents commented on burdensome demands and concerns about the future. Further, a strong underlying presence of intra- and interpersonal conflicts relating to EOL became apparent. DISCUSSION: The results indicate several potential burdens for centenarians' caregiving offspring. They are confronted with a double challenge resulting from the combination of their own advanced age and experiencing the burdens of their parents' very old age. Further, some participants struggled with their own unclear perspective on the future because of the relative but unclear proximity of the parent's death. Multiple conflicts and overlapping conflict dimensions emphasise the potential of the EOL topic to influence the well-being of family caregivers and care recipients. LIMITATIONS: The convenience sample used for the study may cause limitations, for example, the fact that persons with a formally lower educational status are not represented. CONCLUSION: The findings suggest that interventions designed for family-related care situations should include topics like 'Finiteness and grief', 'Communicating about dying and death' and 'Decisions and dispositions at EOL'.

[Action-related resilience in people with longevity-sociological approach]. / Handlungsbezogene Resilienz bei Langlebigen ­ eine soziologische Annäherung.

With increasing longevity, questions about the psychosocial conditions for extraordinary life spans come to the fore. From the field of psychology the concept of resilience is used to describe special capabilities to resist as a personal competence to maintain or regain certain levels of functioning. As such, resilience is seen as a relatively stable personality trait that, however, may forfeit its relevance in old age.The present article, in contrast to the usual phases of life view, adopts a sociological perspective on the entire life span. The rational choice approach is utilized to describe and discuss conditions, foundations, strategies and results of action decisions based on 15 qualitative biographical interviews with centenarians. Resilience in this context is seen as a capacity to act.The results demonstrate that potentials for resilient action persist throughout the entire life span including oldest age but capacities to act are highly context-specific.

[Pain management in nursing care in outpatient older adults in need of care]. / Pflegerisches Schmerzmanagement bei ambulant versorgten Pflegebedürftigen.

Pain management in nursing care in outpatient older adults in need of care Abstract. Background: International data report a prevalence rate for chronic pain of up to 50 % in community dwelling older adults (> 65 years). A national study reported a prevalence rate of 68,5 % among outpatient adults (≥ 18 years). Nursing care has an important meaning in pain management. However, previous research on the quality of pain management in nursing care is insufficient. Aim: The aim of this study is to evaluate the appropriateness of pain management in nursing care in our target group. Method: The cross-sectional study is based on data from ACHE. The study comprises 219 patients. Information on subjective pain experience and pain management were obtained by face-to-face interviews and nursing documentation. Results: Our findings indicate considerable deficits in terms of pain management in nursing care. Results show a lack of systematic pain assessment as well as missing documentation of therapeutic aims and pain management in nursing care. Conclusions: The identified deficits might be the result of current framework conditions that separate nursing pain treatment in Volume V and Volume XI of the German Social Security Code services. Appropriateness in pain management in nursing care can only be ensured if framework conditions are optimized.

[Pain situation among older adults in need of care in the outpatient care setting and cognitively or physically unable to respond : Challenges and recommendations]. / Schmerzgeschehen bei nichtauskunftsfähigen ambulant versorgten Pflegebedürftigen : Herausforderungen und Empfehlungen.

BACKGROUND: Self-reporting is the gold standard in pain assessment. However, this is not possible among adults who are unable to respond. Thus, the method of choice is to observe behavior in order to assess pain. Nurses rarely conduct pain observations because they do not feel educated enough to use such tools in vulnerable groups. The aim of the study is to analyze the pain situation among older adults (≥65 years) in need of care who are cognitively or physically unable to respond in the outpatient care setting. MATERIALS AND METHODS: Our cross-sectional study is based on data from ACHE, a study on pain in outpatient older adults in need of care. Of 355 care-dependent older adults with chronic pain, 81 (22.8%) who were unable to respond received a pain assessment with the Pain Assessment in Advanced Dementia (PAINAD, German: Beurteilung von Schmerz bei Demenz [BESD]) scale. RESULTS: The study population (n = 81) was very old (mean age = 84.2 years), female (77.8%), and widowed (50.0%). We observed pain-related behavior among 61.7% of older adults in need of care. The mean BESD score was 2.8 ± 2.5 (range 0-8). We identified a significant difference in the BESD score observed calmly (mean = 1.7 ± 2.5) and under mobilization (mean = 3.4 ± 2.3, p = 0.001). Moreover, only 21 older adults in need of care received a pain assessment 4 weeks prior to our study. CONCLUSION: Our findings indicate a deficit in regularly conducted pain assessment among older adults who are unable to respond and are in need of care in the outpatient care setting. An observation tool in that setting is urgently needed and would be a first step in optimizing pain assessment. We recommend conducting observations during regular nursing mobilization.

[Centenarians preparing for the end of life?] / Hundertjährige in Vorbereitung auf das Lebensende?

BACKGROUND: The population of centenarians has grown immensely in Germany but has yet hardly been considered in research on dying and death. Due to their very old age centenarians are especially intensively confronted with the challenge of the end of life. OBJECTIVE: The aim of this study was to analyze how centenarians handle the existential challenge of the end of life and which aspects are especially significant for them. Conclusions drawn from this analysis were used to identify factors to improve the needs-based provision of care. MATERIAL AND METHODS: Trained interviewers interrogated 15 centenarians living in Berlin using semi-structured interviews based on theoretically developed and tested guidelines. Subsequently, the interviews were transcribed, computer coded and analyzed following the method of the qualitative content analysis according to Kuckartz. RESULTS: In the categories "experience with dying and death" and "preparing for the end of life" it was shown to be significant that respondents often referred to the dying of others with respect to their worries and wishes at the end of their life. Additionally, the subcategories "putting things in order", "settling provision of care" and "having conversations" were shown to be highly relevant for the participants in the study. CONCLUSION: Decisions related to care in the process of dying, for example by advance directives, arrangements for inheritance and funeral as well as communication about dying and death, are central needs of centenarians when preparing for the end of life. There is sometimes considerable need for professional support and protection.

Chronic conditions and use of health care service among German centenarians.

Background: there is limited data comparing conditions and health service use across care settings in centenarians. To improve health service delivery in centenarians, the aim of this study was to compare the proportion of centenarians who have chronic conditions, take medication and use health care services across different care settings. Methods: this cohort study uses routine data from a major health insurance company serving Berlin, Germany and the surrounding region, containing almost complete information on health care transactions. The sample comprised all insured individuals aged 100 years and older (N = 1,121). Community-dwelling and institutionalised individuals were included. Charlson comorbidity index was based on 5 years of recordings. Hospital stays, medical specialist visits and medication prescribed in the previous year were analysed. Results: while 6% of the centenarians did not receive any support; 45% received family homecare or homecare by professional care services; 49% were in long-term care. The most frequent conditions were dementia and rheumatic disease/arthritis, with the highest prevalence found among long-term care residents. A total of 97% of the centenarians saw a general practitioner in the previous year. Women were more often in long-term care and less often without any care. Centenarians with long-term care showed higher proportions of comorbidities, greater medication use, and more visits to medical specialists compared with centenarians in other care settings. Conclusions: the higher prevalence of dementia and rheumatic disease/arthritis in long-term care compared to other care settings emphasises the role of these diseases in relation to the loss of physical and cognitive functioning.

Nonpharmacologic Pain Management Interventions in German Nursing Homes: A Cluster Randomized Trial.

The reported prevalence of pain among nursing home residents (NHRs) is high. Insufficient use of analgesics, the conventional pain management strategy, is often reported. Whether and to what extent nonpharmacologic therapies (NPTs) are used to manage the pain of NHRs in Germany is largely unknown. The aim of this cluster-randomized trial was to assess the NPTs provided and to enhance the application and prescription of NPTs in NHRs on an individual level. There were six nursing homes in the intervention group and six in the control group. There were 239 NHRs, aged ≥65 years, with an average Mini-Mental State Examination score of at least 18 at baseline. Pain management interventions (cluster level) included an online course for physicians and 1-day seminar for nurses. Data on NPT applied by nurses and therapeutic NPT prescribed by physicians were obtained from residents' nursing documentation. Face-to-face interviews with NHRs assessed the NPT received. At baseline, 82.6% of NHR (mean age 83 years) were affected by pain, but less than 1 in 10 received NPT. The intervention did not result in a significant increase in the NPT applied by nurses, but did significantly increase the therapeutic NPT prescribed by physicians. Residents were active in using NPT to self-manage their pain. Given the prevalence of pain in NHRs, there is a clear need to improve pain management in this population. Extended use of NPT offers a promising approach. We recommend that nurses provide residents with education on pain-management techniques to support them in taking a proactive role in managing their pain.

[What are the reasons for patient dropout in nursing home residents in an intervention study. An analysis of unit nonresponders in 12 German nursing homes]. / Welche Ausfallursachen liegen bei Pflegeheimbewohner(inne)n in einer Interventionsstudie vor? Eine Analyse der Unit-Nonresponder in zwölf deutschen Pflegeheimen.

BACKGROUND: Non-response bias is a major problem for the validity of survey answers. Analyses of reasons for non-response in surveys with nursing home residents (NHR) are scarce. AIM AND METHOD: The aim of this study was to develop reliable and valid categories which represent reasons for non-response in nursing homes using the "Prozessmodell induktiver Kategorienbildung" following Mayring (2010). Furthermore, characteristics of unit non-responder and responder were compared. RESULTS: Forming of categories of reasons for non-response was conducted with 522 NHR, longitudinally. Four major categories were identified (general refusal, health reasons, accessibility, excessive demand) and further 17 subcategories. Unit-non-responder and responder did not differ in age and sex; however follow-up non-responder showed differences in marital status, training qualification, and cognitive status. CONCLUSIONS: The presented scheme of categories can be used to assess reasons for non-response in nursing homes. Standardised assessment of reasons for non-response may contribute to higher response rates in this setting.

Perceived enactment of autonomy of nursing home residents: A German cross-sectional study.

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample (n = 179) that met screening requirements, including subjects with and without mild cognitive impairment (Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale (HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective.

Physical activity in nursing homes--barriers and facilitators: a cross-sectional study.

PURPOSE: To explore different institutional barriers to and facilitators of physical activity (PA) in nursing homes. METHODS: Cross-sectional survey of 40 German nursing homes and 217 nursing-home residents (NHRs; M ± SD age 80 ± 10.2 yr, 55% women, MMSE ≥20). Quantitative data were collected on the structural characteristics of nursing homes and the PA services available. RESULTS: Forms of exercise available were not adequately communicated to residents. Overall participation was below 50%. Awareness was significantly higher in residents with informed relatives (p = .003). A broad range of forms of exercise was generally available (M ± SD 5 ± 2.22, range 0-10), but they were rarely tailored to NHRs' needs and their effectiveness remains questionable. CONCLUSION: Multidimensional opportunities to promote PA in NHRs are identified.

Prescribing of inappropriate medication in nursing home residents in Germany according to a French consensus list: a cross-sectional cohort study.

PURPOSE: The current use of inappropriate medication in elderly nursing home residents (NHRs) in Germany is unclear. We therefore set out to analyse the frequency and patterns of potentially inappropriate drug prescriptions in elderly NHRs in Germany. METHODS: We utilised prescription data for NHRs 65 years or older from a large German health insurance company during a period of 3 months. Inappropriate drugs were identified from a recently reported French consensus list. RESULTS: Data for 7271 (83.7%) females and 1414 (16.3%) males were available for analysis. The average age was 83.6 ± 7.3 years. Overall 48 inappropriate drugs were prescribed resulting in a total of 3825 inappropriate drug prescriptions which accounted for 4.3% of all documented prescriptions (n = 88,695). One thousand nine hundred and three (21.9%) residents received at least one inappropriate drug prescription. Using logistic regression we detected no significant influence of gender or level of care on frequency of inappropriate prescriptions. However, age had a significant influence; with increasing age the frequency of residents receiving inappropriate medications decreased steadily (r = -0.92, p = 0.003) and ranged from a maximum of 32.8% in the group between 65 and 69 years to a minimum of 15.2% in residents older than 94 years. This observation was paralleled by a significant and continuous decrease of drug prescription rates with increasing age (r = -0.88, p = 0.009). CONCLUSION: The present analysis demonstrates that about one out of five elderly NHRs received at least one inappropriate drug prescription. Additional studies may aim to establish a list of frequently prescribed inappropriate drugs for Germany.

High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems.

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care. Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed. Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0-25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients. Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

[Autonomy in the nursing home--conceptual considerations regarding self-determination and capacity to act on the basis of a model]. / Autonomie im Pflegeheim--Konzeptionelle Uberlegungen zu Selbstbestimmung und Handlungsfähigkeit anhand eines Modells.

Autonomy is an exceptionally complex philosophical concept which is present in ethical considerations in health care settings. Currently, no consistent definition of autonomy exists. From the perspective of the authors, self-determination and capacity to act independently are essential aspects of autonomy. While there are limited general results regarding autonomy in old age, autonomy of nursing home residents and the corresponding critical influence factors still lack in-depth examination. The aim of this article is to contribute to a more thorough understanding of autonomy of nursing home residents. Due to the high percentage of residents with cognitive impairment, this population plays a crucial role regarding the conceptualisation of autonomy. Various approaches combined with the perspectives developed by the interdisciplinary PAiN-Project team (Pain and Autonomy in the Nursing Home), led to the formulation of a novel conceptualisation of autonomy. Based on theoretical and discursive considerations, the model "Determination Factors of Autonomy" focuses on the residents' self-determination and ability to perform activities of daily living in the nursing home context. According to the author's conceptualisation, autonomy occurs in various ranges in regard to self-awareness as well as the appreciation of autonomy by others.

[Pain management for older care receivers in the ambulatory care setting]. / Schmerzmanagement bei älteren Pflegebedürftigen in der ambulanten Versorgung.

PAIN AND PAIN IMPACTS: Chronic pain experienced by care receivers who live in their own homes is an issue of great importance, due to its frequency and intensity. The impacts of pain in this vulnerable group are manifested particularly in the form of marked adverse effects on mobility and activity. COMMUNICATING ABOUT PAIN IN AMBULATORY CARE SERVICES: Both physicians and staff of the ambulatory care services involved communicate too rarely about pain, its intensity and duration, with the pain-affected care receiver. MEDICATION-BASED PAIN THERAPY: The deficient pain therapy provided by ambulatory care services for pain-affected care receivers needs to be checked to ensure that medication is appropriate, that the simultaneous prescription of continuous and acute medication, and the clear information on dosage and dosing intervals is given on binding medication charts. INTERDISCIPLINARY RESOURCES: Too little attention has been paid up to now to the challenges of interdisciplinary care for older care receivers in the ambulatory care setting, although interdisciplinarity in pain management has long been a stated requirement. Multidisciplinary action based on agreed guidelines and standards is the key to appropriate pain management. The interface communication between professional groups needs to be optimized in order to provide adequate care for the care receiver.

Pain-Associated Clusters Among Nursing Home Residents and Older Adults Receiving Home Care in Germany.

CONTEXT: There are no available data regarding pain-associated clusters among nursing home residents (NHRs) and older adults receiving home care with chronic pain. OBJECTIVES: To identify and describe pain-associated clusters in NHRs and older adults receiving home care with chronic pain and to explore associations with clusters in both settings. METHODS: We surveyed 137 NHRs and 205 older adults receiving home care. Clusters were identified using hierarchical agglomerative cluster analysis, using Ward's method with squared Euclidean distances in the proximities matrix. The clusters were characterized based on sociodemographic and clinical characteristics. Multinomial logistic regression was used to identify variables associated with different clusters. RESULTS: In each setting, we identified three clusters: pain relieved, pain impaired, and suffering severe pain. In the nursing home study and home care study, respectively, the participant distributions were 46.72% and 11.71% in the pain-relieved cluster, 22.63% and 33.66% in the pain-impaired cluster, and 30.66% and 54.63% in the severe-pain cluster. Appropriate pain medication was only detected among pain-relieved NHRs. CONCLUSION: Overall, differences in pain management exist within the two care settings presented here. There is potential for improvement in both settings. Moreover, there exists a need for clinical interventions aiming at shifting from pain-affected clusters to pain-relieved status.

Deficits in pain medication in older adults with chronic pain receiving home care: A cross-sectional study in Germany.

OBJECTIVE: To analyze the pattern and appropriateness of pain medications in older adults receiving home care. METHODS: We performed a prospective cross-sectional study in patients ≥65 years old having chronic pain and receiving home care in Berlin, Germany. Data on prescribed pain medications were collected using self-reported information, nursing documents, and medication plans during interviews at home. Pain intensity was determined with the numeric rating scale (NRS) and the Pain Assessment In Advanced dementia (PAINAD) scale. The Pain Medication Appropriateness Scale score (SPMAS) was applied to evaluate inappropriateness (i.e. a score ≤67) of pain medication. RESULTS: Overall 322 patients with a mean age of 82.1 ± 7.4 years (71.4% females) were evaluated. The average pain intensity scores during the last 24 hours were 5.3 ± 2.1 and 2.3 ± 2.3 on NRS and PAINAD scale (range 0-10, respectively). Sixty (18.6%) patients did not receive any pain medication. Among the treated patients, dipyrone was the most frequently prescribed analgesic (71.4%), while 50.8% and 19.1% received systemic treatment with opioids and non-steroidal anti-inflammatory drugs, respectively. The observed median SPMAS was 47.6 (range 0-100) with 58 (18.0%) of patients achieving appropriate values. Half of the patients were treated with scheduled, while 29.9% were only treated with on-demand medications. Cognitive status had no effect on appropriateness of pain treatment. CONCLUSIONS: We observed substantial deficits in dosing patterns and appropriateness of pain medication in older adults with pain receiving home care. This applied to both patients with and without severe cognitive impairment.

Pain, Fear of Falling, and Functional Performance Among Nursing Home Residents: A Longitudinal Study.

The aim of this study was to analyze the impact of being pain-affected and fear of falling on functional performance among nursing home residents, longitudinally. We used 6-month follow-up data from a cluster-randomized trial of 12 nursing homes (cluster level) with 239 nursing home residents at baseline (mean age, 95% confidence interval [CI] = 83.04 [81.40, 84.69], 70% women). The longitudinal analysis provided data on pain, fear of falling, functional mobility, and activities of daily living (individual level). The data revealed a trend indicating that pain-relieved nursing home residents showed better functional mobility over time. The results on fear of falling demonstrate obvious differences in the functional performance of nursing home residents cross-sectionally but not longitudinally. Nevertheless, the results underline the importance of an effective pain treatment to prevent decline in functional mobility among nursing home residents. Further longitudinal surveys are needed to verify the findings on functional performance.