Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study Philipe de Souto Barreto a,b,⇑ , Maryse Lapeyre-Mestre c,d , Bruno Vellas a,c , Yves Rolland a,c a Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France b UMR7268 Aix-Marseille University, Laboratoire d’Anthropologie bioculturelle, droit, éthique et santé, Marseille, France c UMR INSERM 1027, University of Toulouse III, Toulouse, France d Service de Pharmacologie Clinique, CHU de Toulouse, 37 Allees Jules Guesde, F-31000 Toulouse, France Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. article info Article history: Received 15 January 2013 Received in revised form 11 July 2013 Accepted 15 July 2013 Keywords: Analgesics Institutionalized elderly Nursing home Older adults Recognized pain abstract The expression of pain is altered in people with dementia (PWD), increasing the risk of undertreatment in that population. The objective of this study was to determine whether dementia and the absence of pain assessment in the patients’ medical chart reduced the probability of analgesic use in a large sample of nursing home (NH) residents. This is a cross-sectional study using data from 6275 residents (mean age 86 ± 8.2 years; 73.7% women) from 175 NHs located in France. Information on residents’ health status (including dementia and pain assessment) and NHs’ structure and organisation were recorded by the NH staff. The NH staff sent to the research team drug prescriptions participants were taking. They were screened for the use of analgesics (dependent variable) and other medications potentially used for pain management. The prevalence of analgesic use was 46.8% (42.3% for PWD and 52% for people with no dementia). A binary logistic regression showed that PWD (odds ratio 0.75; 95% confidence interval 0.66–0.85) and those who had no pain assessment records (odds ratio 0.64; 95% confidence interval 0.53–0.79) had significant lower probabilities of taking analgesics; these results were independent of pain complaints. Results remained fairly unchanged after performing several sensitivity analyses. Our results suggest that improvements are needed in pain management in NHs, particularly for PWD. Imple- menting systematic evaluations of pain in NHs’ routine would contribute to a better management of pain, which can lead to important benefits for residents. Ó 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. 1. Introduction Pain is a prevalent [18,21] and disabling condition in older adulthood [12,21]. The expression of pain can be modified in peo- ple with dementia (PWD) [7], rendering its detection by the carer difficult. The rates of unrecognized pain in PWD can be exacer- bated by the disease-related limitations in the ability to communi- cate; this contributes to the well-known undertreatment of pain among PWD [10,13,16]. It is undeniable that dementia constitutes an obstacle to detect pain in older adults. However, although analgesics are considered as the first-line drugs for pain management in older adults [1], the impact of dementia on the prescription of these drugs when pain is a recognized condition has been poorly investigated. This is even more true for the institutionalized elderly, an understudied population [15] characterized by high prevalence of both dementia and pain [14]. Besides the fact that institutionalized patients are frequently polymedicated, multimorbid, and frail, the complexity of the health care provided in the institutional setting is increased by structural and organisational aspects [19]; the lack of assess- ments for the screening of chronic conditions is an example [6]. The main purpose of this study was to determine whether dementia and the absence of pain assessment in the patients’ med- ical chart reduced the probability of analgesic use in a large sample of nursing home (NH) residents. We also looked at the associations of several drugs frequently used as pain relievers and dementia. 2. Methods This work used the baseline data (cross-sectional design) from the IQUARE study. IQUARE’s research protocol has been described elsewhere [8]; it will be briefly reported here. IQUARE is a multi- centre individually tailored controlled trial developed in NHs from Midi-Pyrénées, Southwestern France (trial registration no. 0304-3959/$36.00 Ó 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.pain.2013.07.017 ⇑ Corresponding author. Address: Gérontopôle de Toulouse, Institut du Vieilliss- ement, 37, Allées Jules Guesde, 31000 Toulouse, France. Tel.: +33 561 145 664; fax: +33 561 145 640. E-mail address: philipebarreto81@yahoo.com.br (P. de Souto Barreto). PAIN Ò 154 (2013) 2427–2431 www.elsevier.com/locate/pain