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Analgesic Use and Daytime Sleepiness in Residents With and Without Dementia in Residential Aged Care Facilities

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Abstract

Background

Managing pain in residents of residential aged care facilities (RACFs) is challenging, especially for people with dementia. Clinicians must weigh the benefits of analgesic use against the potential for adverse events, particularly daytime sleepiness.

Objectives

The aim was to investigate the association between analgesic use and daytime sleepiness in residents with and without dementia in RACFs.

Methods

This was a cross-sectional study of 383 permanent residents from six low-level and high-level RACFs in South Australia. Main measures included analgesic use in the previous 24 h, analgesic load and self-reported daytime sleepiness. Covariates included relevant comorbidities (insomnia, depression, painful conditions), Charlson’s Comorbidity Index, sedative load, self-reported and clinician-observed pain and dementia severity. Logistic regression was used to compute odds ratios (ORs) and confidence intervals (CIs) for the association between analgesic use and daytime sleepiness.

Results

Analgesics were used by 288 residents (75.2 %) in the previous 24 h. These included paracetamol (n = 264, 68.9 %), opioids (n = 110, 28.7 %) and oral NSAIDs (n = 14, 3.7 %). Overall, 116 (30.3 %) residents were categorized as having daytime sleepiness. Of those with dementia, 77 (45.6 %) were categorized as having daytime sleepiness. Opioid use in the previous 24 h was not associated with daytime sleepiness in unadjusted or adjusted analyses. Paracetamol use was positively associated with daytime sleepiness (OR 2.31; 95 % CI 1.20–4.42).

Conclusion

Although daytime sleepiness occurred in a large number of residents, especially those with dementia, this sleepiness was not necessarily associated with use of opioids. The risk of opioid-induced sedation may have been managed by strategies including preferential prescribing of paracetamol to residents at risk of sleepiness, opioid discontinuation in residents who experienced sleepiness, and use of low doses of opioids.

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Acknowledgments

We would like to thank the Resthaven management team, research nurses, facility staff and participants for their valuable support and cooperation.

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Authors and Affiliations

  1. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia

    Edwin C. K. Tan, Jessica M. Hughes, Mary J. Jones, Sarah Moawad, Jenni Ilomäki & J. Simon Bell

  2. Discipline of Medicine, University of Adelaide, Adelaide, Australia

    Renuka Visvanathan

  3. Aged and Extended Care Services, The Queen Elizabeth Hospital and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, University of Adelaide, Adelaide, Australia

    Renuka Visvanathan

  4. Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, The University of Sydney, Sydney, Australia

    Sarah N. Hilmer

  5. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia

    Sarah N. Hilmer & J. Simon Bell

  6. Resthaven Incorporated, Adelaide, Australia

    Tina Emery & Leonie Robson

  7. Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

    Agnes I. Vitry & J. Simon Bell

  8. Consumer Dementia Research Network, Alzheimer’s Australia, Scullin, Australia

    Tara Quirke

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  1. Edwin C. K. Tan
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  2. Renuka Visvanathan
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  12. J. Simon Bell
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Corresponding author

Correspondence to J. Simon Bell.

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Conflict of interest

All authors declare they have no conflict of interest.

Funding

This work is supported by the Alzheimer’s Australia Dementia Research Foundation via the Resthaven Incorporated Dementia Research Award, with additional funding provided by Resthaven Incorporated. J.I. is supported by a National Health and Medical Research Council Early Career Fellowship.

Ethical approval and informed consent

The study was approved by the Royal Australian College of General Practitioners (RACGP) National Research and Evaluation Ethics Committee and the Monash University Human Research Ethics Committee. Written informed consent was obtained from the residents if they had the capacity to consent. In situations where residents were unable to provide written informed consent, consent was obtained from their guardian, next of kin or significant other. All study procedures were conducted in accordance with the ethical principles for involving people with cognitive impairment in research studies that are outlined in the Australian National Statement for Ethical Conduct in Human Research.

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Tan, E.C.K., Visvanathan, R., Hilmer, S.N. et al. Analgesic Use and Daytime Sleepiness in Residents With and Without Dementia in Residential Aged Care Facilities. Drugs Aging 32, 1045–1053 (2015). https://doi.org/10.1007/s40266-015-0325-2

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  • DOI: https://doi.org/10.1007/s40266-015-0325-2

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