Factors Associated with the Variation in Drug Prescription of Analgesics in Long-Term Care Facilities: A Systematic Review

TL;DR

This review explores why analgesic drug prescriptions vary in long-term care facilities, focusing on factors like dementia and facility conditions.

Contribution

The study systematically identifies patient and facility factors influencing analgesic use in LTCFs, emphasizing dementia-related challenges.

Findings

Dementia is strongly linked to lower analgesic prescriptions due to pain assessment difficulties.

Facility staffing and staff qualifications influence analgesic prescribing practices.

Pain severity and comorbidities are patient-related factors affecting analgesic use.

Abstract

Background/Objectives: Chronic pain conditions are common among older residents in long-term care facilities (LTCFs), often leading to increased demand for analgesic drugs. Despite this, pain is frequently underdiagnosed and undertreated, especially in individuals with cognitive impairments such as dementia. Both underuse and overuse of analgesics remain a challenge in LTCFs, affecting patient outcomes and quality of life. This systematic review aimed to identify patient- and facility-level factors associated with variation in analgesic use in LTCFs. Methods: This review followed PRISMA guidelines. A comprehensive literature search was conducted in PubMed, CINAHL, Cochrane Library, and Scopus for studies published between 2013 and 2024. Eligible studies were focused on adults aged ≥ 60 years in LTCFs and examined patient and facility factors related to analgesic prescription. Risk of bias was assessed independently by two reviewers using STROBE, JBI, and MMAT tools. Disagreements were resolved by a third reviewer. Results: A total of 6266 studies were retrieved; 13 papers met the eligibility criteria after screening. Dementia was the most frequently reported factor associated with lower analgesic prescribing, largely due to difficulties in assessing pain and communication barriers. Other patient-related factors included pain severity and comorbidities. Facility-level factors such as staffing levels, staff qualifications, and facility size were also associated with variation in prescribing practices. Conclusions: Dementia highly impacts pain management due to assessment and communication challenges. Improved pain assessment tools and staff training are needed to recognize pain in cognitively impaired residents and ensure appropriate analgesic use in LTCFs.

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