Analgesic use and daytime sleepiness in residents with and without dementia in residential aged care facilities

Abstract

Background: Managing pain in residents of residential aged care facilities (RACFs) is challenging, especially for people with dementia. Clinicians must weigh the benefits of analgesic use against the potential for adverse events, particularly daytime sleepiness. Objectives: The aim was to investigate the association between analgesic use and daytime sleepiness in residents with and without dementia in RACFs. Methods: This was a cross-sectional study of 383 permanent residents from six low-level and high-level RACFs in South Australia. Main measures included analgesic use in the previous 24 h, analgesic load and self-reported daytime sleepiness. Covariates included relevant comorbidities (insomnia, depression, painful conditions), Charlson’s Comorbidity Index, sedative load, self-reported and clinician-observed pain and dementia severity. Logistic regression was used to compute odds ratios (ORs) and confidence intervals (CIs) for the association between analgesic use and daytime sleepiness. Results: Analgesics were used by 288 residents (75.2 %) in the previous 24 h. These included paracetamol (n = 264, 68.9 %), opioids (n = 110, 28.7 %) and oral NSAIDs (n = 14, 3.7 %). Overall, 116 (30.3 %) residents were categorized as having daytime sleepiness. Of those with dementia, 77 (45.6 %) were categorized as having daytime sleepiness. Opioid use in the previous 24 h was not associated with daytime sleepiness in unadjusted or adjusted analyses. Paracetamol use was positively associated with daytime sleepiness (OR 2.31; 95 % CI 1.20–4.42). Conclusion: Although daytime sleepiness occurred in a large number of residents, especially those with dementia, this sleepiness was not necessarily associated with use of opioids. The risk of opioid-induced sedation may have been managed by strategies including preferential prescribing of paracetamol to residents at risk of sleepiness, opioid discontinuation in residents who experienced sleepiness, and use of low doses of opioids.