The edition · Geriatrics
Regular paracetamol probably does not ease pain in care-home residents with advanced dementia
Four randomised trials find no measurable benefit from scheduled dosing, an AGA update says when to stop pancreatic cyst and liver cancer surveillance in older adults, and activity-limiting back pain was linked to later frailty.
The edition in brief
A meta-analysis of four randomised trials in 482 long-term care residents with moderate to severe dementia and mild to moderate pain found regularly scheduled paracetamol (2.5 to 3 g a day) did not reduce observed pain compared with placebo or usual care (SMD -0.14, 95% CI -0.39 to 0.11; moderate certainty). An American Gastroenterological Association expert update advises discussing an end to surveillance for small, stable pancreatic cysts after five years in people over 65 (15 mm or less) or over 75 (under 30 mm), counselling against surveillance in those with significant comorbidity, and stopping liver cancer surveillance when life expectancy is under one to two years. In 2,554 older men from the MrOS cohort, activity-limiting back pain was associated with higher odds of becoming frail rather than pre-frail seven years later (OR 1.40). A network meta-analysis of 28 trials in adults with mild cognitive impairment linked exercise to fewer depressive symptoms, with dancing and multicomponent programmes looking most favourable. The pearl: assess pain in dementia with an observational scale.
When to stop pancreatic cyst and liver cancer surveillance in older adults
Use the AGA thresholds to discuss stopping surveillance of small, stable pancreatic cysts after five years in older adults, and stop liver cancer surveillance when life expectancy is short.
Activity-limiting back pain linked to later frailty in older men
In older adults with back pain, ask whether it limits activity; activity-limiting pain was associated with progression to frailty.
Exercise linked to fewer depressive symptoms in mild cognitive impairment
Recommend structured exercise, such as dance or multicomponent programmes, to older adults with mild cognitive impairment and low mood.
Assess pain in dementia by watching, not only asking
In dementia, assess pain with an observational scale during movement, and consider pain before attributing agitation to behaviour.
Scheduled paracetamol in advanced dementia: no measurable pain benefit
Review regular paracetamol in care-home residents with advanced dementia using an observational pain scale, and stop it where there is no evident benefit.
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