In senior citizens, there may be an underrecognized link between pain and falls. Even if this link is not as strong as suspected, assessments for both need to be enhanced since in the nursing home, pain and falls are key quality measures.
More than half of nursing home residents fall each year, comprising 20% of all fall-related deaths. Cognitively impaired nursing home residents are 4-5 times more likely to fall than age-matched cognitively intact individuals.
Overall, the prevalence of pain syndromes in nursing home residents is approximately 30%. The impact of cognitive impairment upon pain reporting is clear when it is recognized that reporting of pain is essentially half as frequent among persons with severe cognitive impairment as compared to the nursing home resident population as a whole. Despite cognitive impairment, clinical trial data indicate that almost two-thirds of severe dementia patients can meaningfully utilize at least one pain scale.
Falls in nursing home residents are often attributed to psychoactive medications such as sedatives, antiparkinsonian agents, anticonvulsants, opioid analgesics, and antihistamines. There are several lines of evidence to suggest that review and potential revision of psychotropic agents can have a positive effect. In one study, daily administration of acetaminophen 3g allowed reduction of psychotropics by 75%. Similarly, a trial of psychotropic substitution with buspirone as a preferred anxiolytic resulted in reduced falls and was even associated with improved cognition. The authors provide a two-page Checklist of Nonverbal Indicators of Chronic Pain/Fall Risk Assessment Guideline with permission for free use by clinicians.
Source: Burfield AH, Cooper JW. Assessing pain and falls risk in residents with cognitive impairment: Associated problems with overlooked assessments. Ann Long-Term Care: Clin Care Aging 2014;22:36-41.