Disordered Eating Behaviors Among U.S. Children With Neuropsychiatric Conditions: A Nationally Representative Study.

Pain is a commonly reported symptom among older adults living with dementia ranging from 30–80% among those in nursing homes . Approximately 50% of these residents experience moderate to severe pain. Pain has a significant impact on residents including a decline in function, quality of life, increase in behavioral symptoms associated with dementia such as aggression, agitation, repetitive vocalizations, withdrawal, depression and apathy, delirium and increases the risk of emergency room visits . In the United States, the State Operations Manual for Long Term Care , specifically F-Tag F697, requires that nursing homes must identify treat, monitor and manage the resident’s pain to the extent possible in accordance with the comprehensive assessment and care plan and consistent with professional standards of practice, and the residents’ goals and preferences. Although these regulations are provided to communities there are many pain related issues not addressed such as recognition of the challenges to pain assessment and management that communities experience, ways to overcome these challenges, how the community incorporates assessment and management of pain using professional standards of practice, what are the most current standards of practice for long-term care residents, what are the best ways to manage different types of pain (e.g., neuropathic, chronic), and how to make decisions about changing, adding or stopping an analgesic and assessment of appropriateness of use of opioids . The surveyor guidance indicates that when opioids are used, the lowest possible effective dosage should be prescribed for the shortest amount of time possible. That should be done after considering all medical needs of the resident and the resident should be monitored for effectiveness of the opioid and any adverse events . Pharmacological management of pain should be: (1) based on the residents’ underlying comorbidities and other medications; (2) given in the least invasive and most comfortable route available (e.g., oral, topical); and (3) given on a scheduled or as needed basis depending on the resident’s level of pain and need for treatment. Pharmacologic options include non-opioid analgesics (e.g., acetaminophen, lidocaine, non-steroidal anti-inflammatory drugs); adjuvant medications (e.g., antidepressants, anti-convulsants); and opioid analgesics (e.g., morphine, hydrocodone). In prior research use of opioids has been associated with cognitive impairment, female gender, multiple comorbidities, multiple nonopioid pain medications, and more severe pain. Conversely, these prior studies resulted in inconsistencies or did not support a relationship between opioid use and age, or behavioral issues such as aggression or antipsychotic use.