Pain among nursing home patients in the Netherlands: prevalence, course, clinical correlates, recognition and analgesic treatment – an observational cohort study

The study-population consisted of 350 elderly NH-patients from 14 Dutch NH's. Pain (pain-subscale Nottingham Health Profile) and clinical characteristics (gender, age, cognition, depression, anxiety, sleeping problems, morbidity and functional status) were measured at baseline and at six months.Association of pain (baseline and six months) with clinical characteristics was assessed with chi-square and multiple logistic regression analyses.Pain-prevalence was 68.0% (40.5% mild pain symptoms, 27.5% serious pain symptoms). 80% of the patients with pain at baseline still experienced pain at six months. Serious pain at baseline was significantly associated with depression (OR: 2.56; 95% CI: 1.34-4.89) and anxiety (OR 2.47; 95% CI: 1.22-4.99). Serious pain at six months was associated with pain at baseline (OR 18.55; 95% CI: 5.19-66.31) and depression at baseline (OR: 2.63; 95% CI:1.10-6.29). Recognition of pain by NH-physicians varied (35% to 69.7%) depending on measurement instrument and severity of pain. Analgesics were received by 64.5% (paracetamol (acetaminophen), NSAIDs, opioids). Paracetamol (acetaminophen) and opioids frequently were prescribed below daily defined doses.Pain occurred frequently also among Dutch NH-patients and was associated with depression and anxiety. Recognition and treatment by NH-physicians proved sub-optimal. Future studies should focus on interventions to improve recognition and treatment of pain.One of the main goals of nursing home care is preservation of the best possible quality of life. A very important aspect of quality of life is being free of pain. Prompt recognition and adequate treatment is therefore requested when nursing home patients are suffering from pain.Previous studies in several countries showed that pain is a common problem in the long-term care setting [1-3]. Prevalence rates ranged from 27% to 83%, with the highest rates in studies that used patients self-report. One longitudinal study furthermore indicated that pain