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Appears in Collections:Faculty of Social Sciences Journal Articles
Peer Review Status: Refereed
Title: Expert opinion on the management of pain in hospitalised older patients with cognitive impairment: A mixed methods analysis of a national survey
Authors: Rodger, Kirsty T M
Greasley-Adams, Corinne
Hodge, Zoe
Reynish, Emma
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Keywords: Pain
Cognitive impairment
Issue Date: 29-Apr-2015
Publisher: BioMed Central
Citation: Rodger KTM, Greasley-Adams C, Hodge Z & Reynish E (2015) Expert opinion on the management of pain in hospitalised older patients with cognitive impairment: A mixed methods analysis of a national survey, BMC Geriatrics, 15, Art. No.: 56.
Abstract: Background: Hospitalised older patients are complex. Comorbidity and polypharmacy complicate frailty. Significant numbers have dementia and/or cognitive impairment. Pain is highly prevalent. The evidence base for pain management in cognitively impaired individuals is sparse due to methodological issues. A wealth of expert opinion is recognised potentially providing a useful evidence base for guiding clinical practice. The study aimed to gather expert opinion on pain management in cognitively impaired hospitalised older people. Methods: Consultant Geriatricians listed as dementia leads in the National Dementia Audit were contacted electronically and invited to respond. The questionnaire sought information on their role, confidence and approach to pain management in cognitively impaired hospitalised patients. Responses were analysed using a mixed methods approach. Results: Respondents considered themselves very confident in the clinical field. Awareness of potential to do harm was highly evident. Unequivocally responses suggested paracetamol is safe and should be first choice analgesic, newer opiates should be used preferentially in renal impairment and nefopam is unsafe. A grading of the safety profile of specific medications became apparent, prompting requirement for further evaluation and holistic assessment. Conclusion: The lack of consensus reached highlights the complexity of this clinical field. The use of paracetamol first line, newer opiates in renal impairment and avoidance of nefopam are immediately transferrable to clinical practice. Further review, evaluation and comparison of the risks associated with other specific analgesics are necessary before a comprehensive clinical guideline can be produced.
Type: Journal Article
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Rights: © 2015 Rodger et al.; licensee BioMed Central. 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 work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Affiliation: NHS Fife
ASS Management and Support Team
NHS Fife
Applied Social Science

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