Pharmacological management of pain in Australian Aged Care Facilities

Abstract

Background: up to 80% of residents in aged care facilities (ACFs) experience pain, and previous studies have found that older patients with pain are often undertreated. Few studies have been conducted in Australia evaluating the use of analgesic therapy in ACF residents.

Objective: to explore the use of analgesics among ACF residents, including independent predictors of analgesic use, evaluate analgesic use against pain management guidelines and identify potential medication management issues.

Methods: a retrospective analysis of 7,309 medicines reviews conducted on Australian ACF residents was undertaken. Medication use was compared with published guidelines relating to the management of pain in elderly patients or ACF residents. Multiple variable logistic regression was used to identify independent predictors of analgesic use.

Results: nearly 91% of residents were prescribed analgesics. Of those, 2,057 residents were taking regular opioids (28.1%). Only 50% of those taking regular opioids received regular paracetamol at doses of 3-4 g/day. The concurrent use of sedatives was high, with 48.4% of those taking regular opioids also taking an anxiolytic/hypnotic.

Conclusion: there is a need to optimise the prescribing and administration of regular paracetamol as a first line and continuing therapy for pain management in ACF residents, to potentially improve pain management and reduce opioid requirements. Furthermore, with the risk of falls and fractures increased by concurrent use of opioids and sedatives, the widespread use of these drugs in a population already at high risk was concerning, indicating a need for better education of health professionals in this area.

Keywords: elderly; older people; opioids; pain.