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

Laura A Dowd; Shota Hamada; Yukari Hattori; Felicity C Veal; Reina Taguchi; Nobuo Sakata; Agathe D Jadczak; Renuka Visvanathan; Eriko Koujiya; Madhu Rajan; Stefan Doube; Ai Suzuki; Maree Bernoth; Helen Rawson; Hiroshi Maruoka; Amelia Wood; Jo Wagner; Dee-Anne Hull; Mizuki Katsuhisa; Justin Turner; Shin J Liau; Emily Reeve; J Simon Bell; Amanda J Cross

doi:10.1093/ageing/afae024

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

Age Ageing. 2024 Feb 1;53(2):afae024. doi: 10.1093/ageing/afae024.

Authors

Laura A Dowd¹, Shota Hamada^{2

3

4}, Yukari Hattori⁵, Felicity C Veal⁶, Reina Taguchi², Nobuo Sakata^{4

7}, Agathe D Jadczak^{8

9}, Renuka Visvanathan^{9

10}, Eriko Koujiya¹¹, Madhu Rajan^{12

13}, Stefan Doube¹⁴, Ai Suzuki⁴, Maree Bernoth^{15

16

17}, Helen Rawson¹⁸, Hiroshi Maruoka¹⁹, Amelia Wood²⁰, Jo Wagner²¹, Dee-Anne Hull²², Mizuki Katsuhisa¹¹, Justin Turner^{1

23

24}, Shin J Liau^{1

9}, Emily Reeve^{1

25}, J Simon Bell^{1

9}, Amanda J Cross¹

Affiliations

¹ Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
² Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.
³ Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
⁵ Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁶ Unit for Medication Outcomes Research & Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia.
⁷ Heisei Medical Welfare Group Research Institute, Tokyo, Japan.
⁸ Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁹ National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
¹⁰ Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
¹¹ Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹² Royal Australian College of General Practitioners, Victoria, Australia.
¹³ Aged Care GP, Melbourne, Victoria, Australia.
¹⁴ Transform Physio, Hobart, Tasmania, Australia.
¹⁵ Charles Sturt University, Wagga Wagga, New South Wales, Australia.
¹⁶ Three Rivers Department of Rural Health, Wagga Wagga, New South Wales, Australia.
¹⁷ Murrumbidgee Primary Health Network Aged Care Consortium, Wagga Wagga, New South Wales, Australia.
¹⁸ Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
¹⁹ Yokohama Aobanosato Geriatric Health Services Facility, Yokohama, Japan.
²⁰ Longridge Aged Care, Naracoorte, South Australia, Australia.
²¹ Australian Nursing and Midwifery Federation (SA Branch), Adelaide, South Australia, Australia.
²² Southern Cross Care (SA, NT and VIC), Glenside, South Australia, Australia.
²³ Centre de Recherche, Institue Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
²⁴ Faculté de Pharmacie, Université Laval, Québec city, Québec, Canada.
²⁵ Quality Use of Medicines and Pharmacy Research Centre, University of South Australia: Clinical and Health Sciences, Adelaide, South Australia, Australia.

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.

Keywords: Analgesics; Nursing homes; Older people; Pain; Pain management; Qualitative research; Residential aged care homes.

MeSH terms

Acetaminophen* / therapeutic use
Analgesics, Opioid / therapeutic use
Australia
Cross-Sectional Studies
Female
Humans
Japan / epidemiology
Nursing Homes
Pain* / diagnosis
Pain* / drug therapy

Substances

Acetaminophen
Analgesics, Opioid

Abstract

MeSH terms

Substances

Grants and funding