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A longitudinal study exploring the use of analgesic medication in English care home residents with dementia

La Frenais, Francesca; (2018) A longitudinal study exploring the use of analgesic medication in English care home residents with dementia. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Background: Analgesic medication is widely used in care homes but little is known about how often this medication is prescribed or administered, or what factors influence its use. // Aim: To describe the prescription and administration of regular and PRN analgesic medication in care homes; to investigate whether individual or care home differences are associated with analgesic use; and to compare analgesic prescribing in English care homes to international prescriptions. // Methods: This study is embedded in a longitudinal study of 86 care homes in England. Data were collected at 0-, 4-, and 12-months. Residents were eligible if they had diagnosed or probable dementia. Analgesic prescriptions are presented by drug and class. Administration of PRN analgesics is described. Individual differences (sociodemographic; agitation [Cohen-Mansfield Agitation Inventory]; dementia severity [Clinical Dementia Rating]; psychotropic drug prescriptions) and care home differences (type; ownership; number of beds; dementia-registered/specialist; CQC rating) are explored using multilevel models. // Results: Data were available for 1483 residents. Around 70% of residents were prescribed analgesics at all study visits, predominantly PRN paracetamol. Overall, PRN analgesics were not administered frequently. There were differences between care homes in administration but these differences were not accounted for by the modelled care home-level variables. Residents with more severe dementia, and males, appear to be more at risk of untreated pain. // Conclusion: This is the largest study to date exploring analgesic administration in care homes. Prescription levels of regular analgesics are lower in England compared to other countries, however it is unclear why. Pain management in care homes is largely reliant on PRN paracetamol that is frequently prescribed but infrequently administered. Care homes differ in how often they administer PRN analgesics and this is likely due to internal factors. Therefore care home residents are likely to have untreated pain, and some groups are more at risk than others.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: A longitudinal study exploring the use of analgesic medication in English care home residents with dementia
Event: UCL
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Third party copyright material has been removed from ethesis.
Keywords: Analgesics, Dementia, Psychotropics, Care homes, Nursing homes, Cognitive impairment
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10058836
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