TREATMENT OF PAIN IN COGNITIVELY IMPAIRED VERSUS COGNITIVELY INTACT POST HIP FRACTURED ELDERS (DEMENTIA).
Contributors: University of Minnesota.
Published: 1996
Number of pages: 178
Subjects: Health Sciences, Nursing.; Gerontology.; Health Sciences, Medicine and Surgery.
Description: The purpose of this study was to compare the experience and treatment of pain for two groups (cognitively impaired and cognitively intact) of postoperative elders following hip fracture repair. Eighty-eight subjects (53 cognitively impaired and 35 cognitively intact), aged 65 years or older, were interviewed between day two and day five postoperatively and 59 subjects were interviewed again at post-discharge settings between day 17 and 24 postoperatively. Subjects whose Folstein Mini Mental State Exam (MMSE) score was 23 or lower were categorized as cognitively impaired.

In the hospital there were no significant differences between the groups with regard to pain report, pain intensity ratings, documentation of pain, nonpharmacological therapies administered, or prescribed amounts of opioid analgesics. One third of hospitalized subjects in both groups reported pain intensity of "severe" or higher. The cognitively impaired group had significantly more nonverbal indicators of pain observed with movement and received significantly less opioid analgesic and acetaminophen than intact patients. Cognitive status had a significant main effect on amounts of opioid analgesics administered in the first 48 hours postoperatively when separately controlled for age, illness severity, and estimated creatinine clearance. Regression analysis revealed that age, mental status, and observed pain during movement accounted for 27% of the variance in the amount of administered opioid analgesic in the first 48 hours postoperatively.

In the post-discharge settings, there were no significant differences between groups with regard to pain report, pain intensity, observed pain with movement, or documentation of pain. Prescribed amounts of opioid analgesics were significantly lower for cognitively impaired subjects; administered amounts did not differ significantly between the groups.

Cognitive impairment and patient age have a strong influence on the amount of analgesic nurses are willing to administer. Nurses who fear that pain medications will increase confusion administer less opioid medication to confused patients without providing non-opioid or non-pharmacological alternatives. If the provision for patient comfort and relief from pain and suffering is a fundamental ethical obligation of health care providers, then nurses need to consider how this goal is to be met for all elders including those who are cognitively impaired.
Notes: Source: Dissertation Abstracts International, Volume: 57-09, Section: B, page: 5574.

Thesis (PH.D.)--UNIVERSITY OF MINNESOTA, 1996.

School code: 0130.