Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study

The expression of pain is altered in people with dementia (PWD), increasing the risk of undertreatment in that population. The objective of this study was to determine whether dementia and the absence of pain assessment in the patients' medical chart reduced the probability of analgesic use in a large sample of nursing home (NH) residents. This is a cross-sectional study using data from 6275 residents (mean age 86 ± 8.2 years; 73.7% women) from 175 NHs located in France. Information on residents' health status (including dementia and pain assessment) and NHs' structure and organisation were recorded by the NH staff. The NH staff sent to the research team drug prescriptions participants were taking. They were screened for the use of analgesics (dependent variable) and other medications potentially used for pain management. The prevalence of analgesic use was 46.8% (42.3% for PWD and 52% for people with no dementia). A binary logistic regression showed that PWD (odds ratio 0.75; 95% confidence interval 0.66-0.85) and those who had no pain assessment records (odds ratio 0.64; 95% confidence interval 0.53-0.79) had significant lower probabilities of taking analgesics; these results were independent of pain complaints. Results remained fairly unchanged after performing several sensitivity analyses. Our results suggest that improvements are needed in pain management in NHs, particularly for PWD. Implementing systematic evaluations of pain in NHs' routine would contribute to a better management of pain, which can lead to important benefits for residents.