Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T04:37:16.645Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive impairment is a risk factor for delayed analgesia in older people with long bone fracture: a multicenter exploratory study

Published online by Cambridge University Press:  27 August 2014

Margaret Fry ,
Glenn Arendts ,
Lynn Chenoweth  and
Casimir MacGregor
Margaret Fry*
Affiliation:
Research and Practice Development, Northern Sydney Local Health District, St Leonards, NSW, Australia School of Nursing, University of Sydney, Sydney, NSW, Australia
Glenn Arendts
Affiliation:
School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia
Lynn Chenoweth
Affiliation:
Aged and Extended Care Nursing, University of Technology, Sydney, NSW, Australia Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
Casimir MacGregor
Affiliation:
Research and Practice Development, Northern Sydney Local Health District, St Leonards, NSW, Australia
*
Correspondence should be addressed to: Professor Margaret Fry, Research and Practice Development, Nursing and Midwifery Directorate, Northern Sydney Local Health District, Level 7, Kolling Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Phone: +61-2-9926-4693. Email: [email protected].
Get access

Abstract

Background:

Older people who present to the emergency department (ED) often experience a significant delay to analgesia. This study compares the time to analgesia for cognitively impaired and cognitively intact older people diagnosed with a long bone fracture.

Methods:

The aim of the study was to determine if cognitive impairment is associated with a delayed analgesic response. A 12-month exploratory study, using patient data, was conducted across four EDs. Medical records of 264 patients with long bone fractures were randomly selected.

Results:

The majority of patients waited longer than 60 minutes for analgesia. The median time to analgesia was longer for the cognitively impaired (149 minutes) compared with cognitively intact (72 minutes; Mann–Whitney U test: p < 0.001).

Conclusions:

This study suggests that cognitive impairment is a significant risk factor for delayed analgesia response in the ED.

Keywords

analgesiapain managementgeriatricsemergency departmentsmusculoskeletal conditionsdementiamild cognitive impairment
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 2 , February 2015 , pp. 323 - 328
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adunsky, A., Levy, R., Mizrahi, E. and Arad, M. (2002). Exposure to opioid analgesia in cognitively impaired and delirious elderly hip fracture patients. Archives of Gerontology and Geriatrics, 35, 245–251.Google Scholar
American College of Emergency Physicians (2005). Clinical policy: procedural sedation and analgesia in the emergency department. Annals of Emergency Medicine, 45, 177–196.Google Scholar
American Nurses Association (1991). Endorsement of Position Statement on the Role of the Registered Nurse (RN) in the Management of Patients Receiving IV Conscious Sedation for Short-term Therapeutic, Diagnostic, or Surgical Procedures, ANA, USA. Silver Spring, MD: American Nurses Association.Google Scholar
Arendts, G. and Fry, M. (2006). Factors associated with delay to opiate analgesia in emergency departments. The Journal of Pain, 7, 682–683.Google Scholar
Australian and New Zealand College of Anesthetists (2008). Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical or Surgical Procedures. Melbourne, Australia: Australian and New Zealand College of Anesthetists.Google Scholar
Chenoweth, L. et al. (2009). Caring for aged dementia care resident study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurology, 8, 419.CrossRefGoogle ScholarPubMed
Davies, E. et al. (2004). Pain assessment and cognitive impairment: part 1. Nursing Standard, 19, 39–42.Google Scholar
Dewaters, T., Popovich, J. and Faut-Callahan, M. (2003). An evaluation of clinical tools to measure pain in older people with cognitive impairment. British Journal of Community Nursing, 8, 226–34.Google Scholar
Dewaters, T. et al. (2008). Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery. Orthopaedic Nursing, 27, 21–28.Google Scholar
Duignan, M. and Dunn, V. (2008). Congruence of pain assessment between nurses and emergency department patients: a replication. International Emergency Nursing, 16, 23–28.Google Scholar
Ersek, M. et al. (2010). Comparing the psychometric properties of the checklist of nonverbal pain behaviors (CNPI) and the pain assessment in advanced dementia (PAIN-AD) instruments. Pain Medicine, 11, 395–404.CrossRefGoogle ScholarPubMed
Folstein, M., Folstein, S and Mchugh, P. (1975). Mini mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189–198.Google Scholar
Fry, M., Bennetts, S. and Huckson, S. (2011). An Australian audit of ED pain management patterns. Journal of Emergency Nursing, 37, 269–274 Google Scholar
Fry, M., Hearn, J. and Mclaughlin, T. (2012). Pre-hospital pain management patterns and triage nurse documentation. International Emergency Nursing, 20, 83–87.Google Scholar
Fry, M. and Holdgate, A. (2002). Nurse initiated intravenous morphine in the emergency department: efficacy, rate of adverse events and impact on time to analgesia. Emergency Medicine, 14, 249–254.Google Scholar
Fry, M., Ryan, J. and Alexander, N. (2004). A prospective study of nurse initiated panadeine forte: expanding pain management in the ED. Accident and Emergency Nursing, 12, 136–140 CrossRefGoogle ScholarPubMed
Gerson, L., Counsell, S., Fortanarosa, P. and Smucker, W. (1994). Case finding for cognitive impairment in elderly emergency department patients. Annals of Emergency Medicine, 23, 813–817.Google Scholar
Hancock, K., Chang, E., Chenoweth, L., Clarke, M., Carroll, A. and Jeon, Y.-H. (2003). Nursing needs of acutely ill older people. Journal of Advanced Nursing, 44, 507–516.CrossRefGoogle ScholarPubMed
Herr, K. et al. (2006). Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Management Nursing, 7, 44–52.Google Scholar
Hjermstad, M. J. et al. (2011). Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. Journal of Pain and Symptom Management, 41, 1073–1093.Google Scholar
Holdcroft, A. and Power, I. (2003). Recent developments: management of pain. British Medical Journal, 326, 635–639.Google Scholar
Holdgate, A., Asha, S., Craig, J. and Thompson, J. (2003). Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emergency Medicine, 15, 441–446.Google Scholar
Hwang, U., Richardson, L. D., Harris, B. and Morrison, R. S. (2010). The quality of emergency department pain care for older adult patients. Journal of the American Geriatrics Society, 58, 2122–8.Google Scholar
Jannings, W., Underwood, E., Almer, M. and Luxfor, B. (2010–2011). How useful is the expert practitioner role of the clinical nurse consultant to the generalist community nurse? Australian Journal of Advanced Nursing, 28, 33–40.Google Scholar
Lukas, A., Barber, J. B., Johnson, P. and Gibson, S. J. (2013). Observer-rated pain assessment instruments improve both the detection of pain and the evaluation of pain intensity in people with dementia. European Journal of Pain, 17, 1558–1568.Google Scholar
Platts-Mills, T. et al. (2011). Older US emergency department patients are less likely to receive pain medication than younger patients: results from a national survey. Annals of Emergency Medicine, 60, 199–206.Google Scholar
Tcherny-Lessenot, S. et al. (2003). Management and relief of pain in an emergency department from the adult patients’ perspective. Journal of Pain and Symptom Management, 25, 539–546.Google Scholar
Wilber, S, Carpenter, C. and Hustey, F. (2008). The Six Item Screener to detect cognitive impairment in older emergency department patients. Academic Emergency Medicine, 15, 613–616.Google Scholar
Zwakhalen, S. M. G., Hamers, J. P. H., Abu-Saad, H. H. and Berger, M. P. F. (2006). Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatrics, 6, 3.Google Scholar