A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes

• Published in: Age and ageing Vol. 53; no. 2
• Main Authors: Dowd, Laura A, Hamada, Shota, Hattori, Yukari, Veal, Felicity C, Taguchi, Reina, Sakata, Nobuo, Jadczak, Agathe D, Visvanathan, Renuka, Koujiya, Eriko, Rajan, Madhu, Doube, Stefan, Suzuki, Ai, Bernoth, Maree, Rawson, Helen, Maruoka, Hiroshi, Wood, Amelia, Wagner, Jo, Hull, Dee-Anne, Katsuhisa, Mizuki, Turner, Justin, Liau, Shin J, Reeve, Emily, Bell, J Simon, Cross, Amanda J
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-02-2024; Oxford Publishing Limited (England)
• Subjects: Acetaminophen; Acetaminophen - therapeutic use; Activities of daily living; Analgesics; Analgesics, Opioid - therapeutic use; Australia; Cancer; Cross-Sectional Studies; Female; Health care; Humans; Inflammation; Japan - epidemiology; Medical personnel; Nonsteroidal anti-inflammatory drugs; Nursing Homes; Opioids; Pain; Pain - diagnosis; Pain - drug therapy; Prescribing; Qualitative Paper; Regulation; Australia; Japan; Qualitative research; Nursing homes; Pain; Analgesics; Older people; Pain management; Residential aged care homes
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afae024

Abstract
Background
Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes.
Aims
To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals’ perspectives on analgesic use.
Methods
Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N = 550) in 2019 and four nursing homes in Tokyo (N = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing.
Results
Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes.
Conclusion
Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference.