Prescription and dosage of analgesic medication in relation to resident behaviors in the nursing home

Abstract

Objectives: To examine correlates of analgesic medication prescription and administration in communicative, cognitively impaired nursing home residents. Residents' behaviors were assessed using computer-assisted real-time observations as potential adjunctive indicators of pain.

Design: Cross-sectional study over a 4-week period.

Setting: Five nursing homes in the greater Birmingham, Alabama, area.

Participants: Ninety-two residents (mean age +/- standard deviation = 83.86 +/- 8.55) with a mean Mini-Mental State Examination (MMSE) score of 13.81 +/- 6.34.

Measurements: Data were obtained via chart review, resident assessments, questionnaire completion by certified nursing assistants familiar with residents' care, and direct observation of residents' daily behaviors.

Results: Receipt of analgesic medication was related to self-report of pain (F2,89 = 9.89, P =.0001), MMSE (F2,88 = 3.98, P =.022), and time spent inactive (F2,89 = 3.04, P =.053). Residents who received analgesic medication reported greater intensity of pain than other residents. Residents who received analgesics had higher MMSE scores than those who did not receive analgesics. Residents who received analgesics spent less time being inactive than those not prescribed analgesics. Receipt of higher dosage of opioid analgesic medication was associated with more time spent with others in verbal interaction (r =.22, P =.03).

Conclusion: This study refines the methodology of measuring analgesic medication dosage and its effect on resident behavior. Analgesic prescription and administration patterns are related to time residents spend being inactive. Results suggest that opioid analgesics may hold particular promise in alleviating pain, as indicated by resident behaviors.