Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home – A longitudinal study

PLOS ONE RESEARCH ARTICLE Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home – A longitudinal study Anne-Sofie Helvik ID1,2*, Sverre Bergh2,3, Kamile Kabukcuoğlu4, Jūratė Šaltytė Benth3,5,6, Bjørn Lichtwarck3, Bettina Husebø7,8, Kjerstin Tevik1,2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway, 2 Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway, 3 Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway, 4 Faculty of Nursing, Akdeniz University, Campus Antalya, Antalya, Türkiye, 5 Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway, 6 Institute for Clinical Medicine, University of Oslo, Oslo, Norway, 7 Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway, 8 Municipality of Bergen, Bergen, Norway * OPEN ACCESS Citation: Helvik A-S, Bergh S, Kabukcuoğlu K, Šaltytė Benth J, Lichtwarck B, Husebø B, et al. (2022) Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home – A longitudinal study. PLoS ONE 17(12): e0279909. https://doi.org/10.1371/ journal.pone.0279909 Editor: Muhammad Shahzad Aslam, Xiamen University - Malaysia Campus: Xiamen University Malaysia, MALAYSIA Received: September 13, 2022 Accepted: December 18, 2022 Published: December 30, 2022 Copyright: © 2022 Helvik et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The datasets generated and/or analyzed for this study are available for researchers in cooperation with the data owners, the Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust. Information is available at the following web page: https.//www.sykehuset-innlandet/avdelinger/ alderspsykiatrisk-forskningssenter. Abstract The overall aim was to explore the prevalence and persistent regular prescription of opioids and paracetamol among nursing home (NH) residents with dementia at admission and over time. A total of 996 residents with dementia, mean (SD) age 84.5 (7.6) years and (36.1% men), were included at admission (A1). Yearly assessments were performed for two years (A2 and A3) or until death. Pain was assessed using the Mobilization-Observation-BehaviorIntensity-Dementia-2 (MOBID-2) Pain Scale. Information regarding prescription of analgesics, general physical health, personal activities of daily living, severity of dementia, neuropsychiatric symptoms, and prescription of psychotropic drugs was collected. A generalized linear mixed model was used to explore whether pain severity was associated with persistent and persistent prescription of opioids and/or paracetamol across timepoints. At A1, 495 of 996 (49.7%) NH residents were prescribed analgesics and prevalence increased at the follow-ups (A2: n = 630, 65.1%; A3: n = 382, 71.2%). Paracetamol was the most frequently prescribed analgesic at all assessments (A1: 45.5%; A2: 59.5%; A3: 67.1%). Opioid prescriptions were quite prevalent (A1: 18.1%; A2: 25.1%; A3: 28.3%), with odds approximately 13 times (OR = 13.3, 95% CI 6.8–26.0) and 9 times (OR = 8.6, 95% CI 3.7–20.3) higher for prescription at follow-up A2 and A3, respectively, relative to prescription at A1. In adjusted analyses, higher pain intensity and poor physical health were associated with prescription and persistent prescription of opioids and paracetamol. In conclusion, prevalence and persistent prescription of analgesics were high in NH residents with dementia. The odds for the prescription of opioids at follow-up were high if prescribed at baseline. Interdisciplinary collaboration, routine assessment of pain at admission and regularly thereafter, and systematic drug reviews are essential to adequately assess and treat pain in NH residents with dementia. PLOS ONE | https://doi.org/10.1371/journal.pone.0279909 December 30, 2022 1 / 19 PLOS ONE Funding: The study was initiated by and was administered and funded by the Public Hospital Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Norway. The Research Centre is public funded, and not relying on funding from industry or commercial interests. The Research centre took part in the design and data collection from the municipality nursing homes, and preparation of the manuscript. Competing interests: The authors have declared that no competing interest exist. Prevalence and persistent prescription of analgesic drugs in nursing home residents Introduction In Europe and the United States, the majority of people with dementia are in a nursing home (NH) at time of death [1, 2], and studies have reported that up to 85% of NH residents have dementia [3–6]. It is further reported that the prevalence and severity of dementia in NH residents have increased over the years, at least in Norway [3, 4], where the jurisdiction to provide NH care lies with local municipalities [7]. To serve the needs of the country’s 5.4 million inhabitants, there are about 40,000 NH places (beds) [8, 9]. The goals of NHs are to limit negative health consequences of diseases and poor functioning, to promote quality of life (QoL) for older adults, and to provide care and treatment around the clock. Pain is not only an unpleasant experience but also found to be quite prevalent in NH residents with dementia. A prevalence up to 80% has been reported in these NH residents but it is reported to vary considerably [10–20], which may be due to differences in participant characteristics, pain treatment, definition of pain, and methodology used in the studies [15]. Pain may have negative health consequences, including poorer physical functioning [21– 23], depression [14], anxiety [14], agitation [24], and aggression [14], but is also found to limit social interaction [21], and contribute to poor QoL [18, 25, 26]. Pain with an intensity that is considered to affect a person’s function and everyday life is defined as clinically relevant [13] and requires attention and treatment by NH care personnel. There has been increasing attention directed toward pain in older adults and in NH residents since the first guidelines for the clinical management of chronic pain among older adults were published by the American Geriatric Society (AGS) in 1998 [27]. The International Association for the Study of Pain (IASP) in 2007 implementation of projects to reduce pain in older persons by initiating an international year against pain in older adults [28]. Paracetamol is recom (...truncated)