The effect of paracetamol on care dependency and daily functioning in persons with advanced dementia living in long-term care facilities

• Published in: BMC geriatrics Vol. 24; no. 1; p. 279
• Main Authors: van Dam, Paulien H, Achterberg, Wilco P, Husebo, Bettina S, Caljouw, Monique Aa
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22-03-2024; BioMed Central; BMC
• Subjects: Acetaminophen; Activities of daily living; Analgesics; Care dependency; Dementia; Dementia disorders; Dosage and administration; Drug therapy; Evaluation; Long term health care; Long-term care facilities; Long-term care of the sick; Methods; Nursing; Nursing home; Older people; Pain; Paracetamol; Placebos; Psychotropic drugs; Quality of life; Services; Netherlands; Care dependency; Daily functioning; Paracetamol; Acetaminophen; Nursing home; Dementia; Quality of life
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-024-04795-8

Pain medication may have an impact on the quality of life (QoL) in persons with dementia, but may also influence care dependency and daily functioning. The aim of this study is to investigate the effect of regularly scheduled paracetamol on care dependency and daily functioning in persons with advanced dementia with low QoL living in long-term care facilities.
The Quality of life and Paracetamol In advanced Dementia (Q-PID) study was a (block) randomized double-blind placebo-controlled crossover trial with paracetamol and placebo across seventeen long-term care facilities across 9 care organizations in the western region of the Netherlands. Participants were ≥ 65 years, had advanced dementia (Global Deterioration Scale 5-7), and low QoL (QUALIDEM-6D score ≤ 70). Measurements were performed by nursing staff at the start and at the end of each treatment period of six weeks. Repeated linear mixed models were used to compute differences between randomization groups, with adjustment for period and order effects, and psychotropic use.
Ninety-five persons (mean age of 83.9 years, 57.4% female) were enrolled in the Q-PID study. The mean Care Dependency Scale total score was 37.8 (Standard Deviation [SD] 12.9) and the mean Katz-15 total score was 11.9 (SD 2.4). Repeated linear mixed models showed no difference in mean differences of care dependency (paracetamol - 1.0 [95% Confidence Interval (CI) -2.4-0.3], placebo + 0.1 [-1.3-1.5]), and daily functioning (paracetamol + 0.2 [95% CI -0.2-0.6], placebo + 0.1 [-0.3-0.4]).
Compared to placebo, no effect of scheduled administration of paracetamol was found on care dependency and daily functioning in persons with advanced dementia with low QoL. Future research should focus on which specific items of care dependency need special attention to improve the care for persons with advanced dementia. A multi-domain approach is needed to enhance and/or maintain QoL of persons with advanced dementia.
Netherlands Trial Register (NTR6766); http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6766 ; Trial registration date: 20/10/2017.