Dagmar Dräger

Deficits in pain treatment in nursing homes in Germany: a cross-sectional study.

Current knowledge about the quality and appropriateness of pharmacological pain treatment in nursing home residents (NHR), particularly in NHR with moderate to severe cognitive impairment, is poor.

Antipsychotic drugs predominate in pharmacotherapy of nursing home residents with dementia.

INTRODUCTION The aim of this study was to investigate the frequency of benzodiazepines, antidementia and antipsychotic drug prescriptions in nursing home residents (NHR).Data of a German health insurance company were retrospectively analyzed for the year 2008. METHODS The study cohort comprised 13,042 NHR (82% women, mean age 83.6 ± 7 years). Following analgetics, antipsychotic drugs were the second most frequently prescribed drug group with 13.3% of all prescriptions. Dementia was diagnosed in 8 017 (61.5%) NHR. Thereof 51.6% received an antipsychotic, 17.3% a benzodiazepine and 15.2% an antidementia pharmaceutical, respectively. 18.1% of NHR with dementia and antipsychotic drug prescriptions were in combined treatment with antidementia pharmaceuticals. The rate of antipsychotic drug prescribing was significantly doubled in NHR with dementia compared to those without this diagnosis (p<0.01); the most frequently prescribed antipsychotics were melperone, risperidone and pipamperone. DISCUSSION This study demonstrates the wide-spread use of psychotropic drugs in NHR. Moreover, dementia in NHR was associated with antipsychotic drug prescribing in every second patient. This highlights the need for further studies analyzing alternative treatments for dementia-related symptoms.

Prescribing of inappropriate medication in nursing home residents in Germany according to a French consensus list: a cross-sectional cohort study

The current use of inappropriate medication in elderly nursing home residents (NHRs) in Germany is unclear. We therefore set out to analyse the frequency and patterns of potentially inappropriate drug prescriptions in elderly NHRs in Germany.

Interdisziplinäre Handlungsempfehlung zum Management von Schmerzen bei älteren Menschen in Pflegeheimen

ZusammenfassungDie schmerztherapeutische Versorgung älterer Menschen in vollstationären Pflegeeinrichtungen ist defizitär. Daher werden neueste Erkenntnisse aus Forschung und Praxis mit den in Standards und Leitlinien formulierten Anforderungen im Hinblick auf die Behandlung von Schmerzen bei älteren Menschen in dieser Handlungsempfehlung zusammengefasst. Ziel ist die Optimierung der Versorgungsprozesse und -ergebnisse auf individueller und institutioneller Ebene. Dafür ist eine interdisziplinäre Zusammenarbeit unerlässlich.Die Durchführung eines standardisierten Schmerzassessments ist Voraussetzung für eine adäquate Schmerzbehandlung. Zugleich trägt die Ausschöpfung aller Möglichkeiten nichtmedikamentöser Maßnahmen zur größtmöglichen Reduzierung der Schmerzintensität und somit zum Erhalt der Lebensqualität der Bewohner/innen bei. Im Rahmen der Pharmakotherapie ist zu berücksichtigen, dass altersphysiologische Veränderungen die Wirksamkeit und Verträglichkeit von Analgetika beeinflussen können. Zudem sind bei Polypharmazie mögliche Interaktionen von Arzneimitteln zu beachten. Edukative Maßnahmen und die Einbeziehung von Angehörigen erhöhen den Erfolgsgrad der Schmerztherapie.AbstractPain management in nursing home residents (NHR) is insufficient. Hence, this guidance summarizes latest research results and guidelines of particular requirements on treatment of pain in the elderly. The purpose is to improve health care processes and outcomes on individual and institutional level. To reach this aim a multidisciplinary collaboration is essential.The prerequisite for adequate pain treatment is to conduct a standardized pain assessment. Likewise, the application of all opportunities of non-medical pain treatment strategies contributes to the reduction of occurrence of pain and therefore to the preservation of quality of life in NHR. Age-related changes in physiology may affect tolerance and effects of analgesics. Besides, drug interactions need to be considered. After all, education of NHR and involvement of their relatives in pain management foster successful management and treatment of pain.Pain management in nursing home residents (NHR) is insufficient. Hence, this guidance summarizes latest research results and guidelines of particular requirements on treatment of pain in the elderly. The purpose is to improve health care processes and outcomes on individual and institutional level. To reach this aim a multidisciplinary collaboration is essential. The prerequisite for adequate pain treatment is to conduct a standardized pain assessment. Likewise, the application of all opportunities of non-medical pain treatment strategies contributes to the reduction of occurrence of pain and therefore to the preservation of quality of life in NHR. Age-related changes in physiology may affect tolerance and effects of analgesics. Besides, drug interactions need to be considered. After all, education of NHR and involvement of their relatives in pain management foster successful management and treatment of pain.

Chronic conditions and use of health care service among German centenarians

Background there is limited data comparing conditions and health service use across care settings in centenarians. To improve health service delivery in centenarians, the aim of this study was to compare the proportion of centenarians who have chronic conditions, take medication and use health care services across different care settings. Methods this cohort study uses routine data from a major health insurance company serving Berlin, Germany and the surrounding region, containing almost complete information on health care transactions. The sample comprised all insured individuals aged 100 years and older (N = 1,121). Community-dwelling and institutionalised individuals were included. Charlson comorbidity index was based on 5 years of recordings. Hospital stays, medical specialist visits and medication prescribed in the previous year were analysed. Results while 6% of the centenarians did not receive any support; 45% received family homecare or homecare by professional care services; 49% were in long-term care. The most frequent conditions were dementia and rheumatic disease/arthritis, with the highest prevalence found among long-term care residents. A total of 97% of the centenarians saw a general practitioner in the previous year. Women were more often in long-term care and less often without any care. Centenarians with long-term care showed higher proportions of comorbidities, greater medication use, and more visits to medical specialists compared with centenarians in other care settings. Conclusions the higher prevalence of dementia and rheumatic disease/arthritis in long-term care compared to other care settings emphasises the role of these diseases in relation to the loss of physical and cognitive functioning.

Auswirkungen der Pflegeversicherung auf die Situation pflegender Töchter – Die Rolle der professionellen Pflegedienste

Angesichts der demografischen Entwicklung gewinnt das Thema «Pflege alterer Angehoriger» innerhalb der pflegewissenschaftlichen Forschung an Bedeutung. Ziel der hier beschriebenen Studie war es, di...

Interventions to address deficits of pharmacological pain management in nursing home residents – A cluster-randomized trial

To evaluate the effect of interventions for general practitioners and nursing home staff to improve pain severity and appropriateness of pain medication in nursing home residents (NHR).

Interdisciplinary guidance for pain management in nursing home residents

ZusammenfassungDie schmerztherapeutische Versorgung älterer Menschen in vollstationären Pflegeeinrichtungen ist defizitär. Daher werden neueste Erkenntnisse aus Forschung und Praxis mit den in Standards und Leitlinien formulierten Anforderungen im Hinblick auf die Behandlung von Schmerzen bei älteren Menschen in dieser Handlungsempfehlung zusammengefasst. Ziel ist die Optimierung der Versorgungsprozesse und -ergebnisse auf individueller und institutioneller Ebene. Dafür ist eine interdisziplinäre Zusammenarbeit unerlässlich.Die Durchführung eines standardisierten Schmerzassessments ist Voraussetzung für eine adäquate Schmerzbehandlung. Zugleich trägt die Ausschöpfung aller Möglichkeiten nichtmedikamentöser Maßnahmen zur größtmöglichen Reduzierung der Schmerzintensität und somit zum Erhalt der Lebensqualität der Bewohner/innen bei. Im Rahmen der Pharmakotherapie ist zu berücksichtigen, dass altersphysiologische Veränderungen die Wirksamkeit und Verträglichkeit von Analgetika beeinflussen können. Zudem sind bei Polypharmazie mögliche Interaktionen von Arzneimitteln zu beachten. Edukative Maßnahmen und die Einbeziehung von Angehörigen erhöhen den Erfolgsgrad der Schmerztherapie.AbstractPain management in nursing home residents (NHR) is insufficient. Hence, this guidance summarizes latest research results and guidelines of particular requirements on treatment of pain in the elderly. The purpose is to improve health care processes and outcomes on individual and institutional level. To reach this aim a multidisciplinary collaboration is essential.The prerequisite for adequate pain treatment is to conduct a standardized pain assessment. Likewise, the application of all opportunities of non-medical pain treatment strategies contributes to the reduction of occurrence of pain and therefore to the preservation of quality of life in NHR. Age-related changes in physiology may affect tolerance and effects of analgesics. Besides, drug interactions need to be considered. After all, education of NHR and involvement of their relatives in pain management foster successful management and treatment of pain.Pain management in nursing home residents (NHR) is insufficient. Hence, this guidance summarizes latest research results and guidelines of particular requirements on treatment of pain in the elderly. The purpose is to improve health care processes and outcomes on individual and institutional level. To reach this aim a multidisciplinary collaboration is essential. The prerequisite for adequate pain treatment is to conduct a standardized pain assessment. Likewise, the application of all opportunities of non-medical pain treatment strategies contributes to the reduction of occurrence of pain and therefore to the preservation of quality of life in NHR. Age-related changes in physiology may affect tolerance and effects of analgesics. Besides, drug interactions need to be considered. After all, education of NHR and involvement of their relatives in pain management foster successful management and treatment of pain.

Verordnung von Antihypertensiva bei geriatrischen Pflegeheimbewohnern in Deutschland

OBJECTIVE To analyse and evaluate the use of antihypertensive medication in elderly patients of nursing homes in Germany. METHODS Data from a large German health insurance company were collected in a cross sectional study. Included were all insured persons aged 65 years or older, who were residents of a nursing home between 1 April and 30 June 2007 throughout Germany. Antihypertensive drugs were those classified according to the current guidelines published by the German Hypertension Society. RESULTS The study comprised 8,685 residents of nursing homes, 84 % women. The mean age was 84 years (range 65 - 106 years). Antihypertensive drug prescriptions accounted for 17 % of all drug prescriptions and about 70 % of all residents received at least one prescription for antihypertensive drugs. The most frequently prescribed antihypertensive drugs were diuretics, of which 70 % were loop diuretics. Potentially inappropriate combinations of antihypertensive drugs were noted in 5.2 % of patients receiving these drugs. CONCLUSION Antihypertensive drugs account for a notable part (17 %) of all drug prescriptions in elderly residents of nursing homes throughout Germany. These results indicate that only a minority of all residents were treated with potentially inappropriate or potentially harmful drug combinations. However, the relatively high rate of prescriptions for loop diuretics is a matter of potential concern in this vulnerable group of patients.

Centenarians Differ in Their Comorbidity Trends During The 6 Years Before Death Compared to Individuals Who Died in Their 80s or 90s

Background While compression of morbidity has now been studied in multiple cohorts, we hypothesize that centenarians might also have fewer chronic conditions as well. We assume that individuals who die as centenarians have less comorbidities and have a less steep rise of the number of comorbidities over the final years before death compared to those who died as nonagenarians (90-99 years) or octogenarians (80-89 years of age). Methods This German cohort study used health insurance data. The data contain complete information on diagnoses and health care transactions for the 6 years prior to death. The sample (N = 1,398; 34,735-person calendar quarters) is comprised of three groups of individuals; those who died as centenarians were compared with random samples of individuals who died as nonagenarians or as octogenarians. Community-dwelling and institutionalized individuals were included. Results One quarter prior to death, individuals who died as centenarians had, on average, 3.3 comorbidities. Octogenarians had 4.6 comorbidities one quarter prior to death. Further, there was a significant time-to-death by age-at-death interaction (B = -.03, p < .001), where centenarians showed a less steep increase in the number of comorbidities than the comparison groups in their last 6 years prior to death. Conclusions The lower prevalence of comorbidities in individuals who died as centenarians compared with those who died at a younger age reinforces the notion of centenarians as a selective group. Avoiding the confounding and potentially synergistic effects of having multiple chronic illnesses is likely vital to being able to survive to extreme ages.