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González-Vaca J, Hernández MG, Cobo CS, Melendo Azuela EM, Tortosa I Moreno A. Non-pharmacological interventions to reduce pain in dementia: A quasi-experimental study. Appl Nurs Res 2022; 63:151546. [PMID: 35034694 DOI: 10.1016/j.apnr.2021.151546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 07/26/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
This study evaluated a non-pharmacological intervention nursing protocol for pain control and assessment of its evolution in a cohort of patients with moderate-to-severe dementia residing in three long-term care facilities in a metropolitan area in Spain. The study was a quasi-experimental pre- and post-exploratory intervention. The presence of pain was evaluated before and after the interventions of nursing protocol for 7 days, carried out by nurses. 157 residents of three centers participated (mean age 81.8 years, 58.1% were women, 83.2% had severe or moderately severe dementia and 65.2%) had regularly scheduled analgesic treatment. At baseline evaluation, the prevalence of pain, assessed with the PAINAD scale was 43.9% and this increased to 73.5% when pain was measured during bathing. The implementation of the nursing protocol of non-pharmacological interventions produced a decrease in pain of 11% (p = 0.0001). Multivariate Ancova analysis demonstrated that non-pharmacological interventions were effective independently of other factors as pressure sores or gender. The implementation of non-pharmacological interventions in social health care centers can produce a decrease in pain for those with dementia.
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Affiliation(s)
- Julia González-Vaca
- Department of Fundamental Care and Medical Surgical Nursing, Nursing School, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | - Misericordia García Hernández
- Department of Fundamental Care and Medical Surgical Nursing, Nursing School, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Carmen Sarabia Cobo
- Nursing School, University of Cantabria, Nursing Research Group IDIVAL, Cantabria, Spain
| | - Eva M Melendo Azuela
- Health Department, Generalitat de Catalunya, Barcelona, Spain; Grupo de investigación en Cronicidad de la Catalunya Central (C3RG), Vic, Barcelona, Spain
| | - Avelina Tortosa I Moreno
- Department of Fundamental Care and Medical Surgical Nursing, Nursing School, Faculty of Medicine and Health Sciences, University of Barcelona, and Apoptosis and Cancer Group, ONCOBELL, IDIBELL, Barcelona, Spain
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52
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Vaughan CL, Bruno V. What neurologists wish palliative care physicians knew. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:93-104. [PMID: 36055723 DOI: 10.1016/b978-0-323-85029-2.00005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the incidence of neurologic (particularly neurodegenerative) diseases continues to rise, so too will the palliative needs in this patient population. To appropriately care for these patients and families, neurologists and palliative care providers will need to strengthen collaboration. Palliative care providers not formally trained in neurology may feel ill-equipped to manage some of the distinct neuropalliative care needs of these patients. Here, we provide insights into the unique characteristics of patients with neurologic disease and emphasize the relevance of the palliative care skillset in this population to aid the collaboration between palliative care providers and neurologists.
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Affiliation(s)
- Christina L Vaughan
- Department of Neurology and Medicine, Anschutz Medical Center, University of Colorado, Aurora, CO, United States; Department of Neurology, VA Eastern Colorado Health System, Aurora, CO, United States.
| | - Veronica Bruno
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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53
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Koyama K, Wada K, Kumagai G, Kudo H, Tanaka S, Asari T, Jung S, Ando M, Ishibashi Y. Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: A cross-sectional study. PLoS One 2021; 16:e0258852. [PMID: 34665835 PMCID: PMC8525772 DOI: 10.1371/journal.pone.0258852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
Lumbar degenerative disease and dementia are increasing in super-aging societies and are both related to physical dysfunction and pain. However, the relationship between these diseases remains unclear. This cross-sectional study aimed to investigate the comorbidity rates of lumbar spinal canal stenosis (LSS) and mild cognitive impairment (MCI) and clarify the association between LSS presence, lumbar symptoms, and quality of life (QOL) related to low back pain and cognitive impairment in the Japanese population. We enrolled 336 participants (men 124; women 212; mean age 72.2 years) from a medical checkup program. LSS was diagnosed using a self-administered questionnaire, and lumbar symptoms were evaluated using the visual analog scale (low back pain, and pain and numbness of the lower limb). QOL related to low back pain was evaluated using the Japanese Orthopedic Association Back-Pain Evaluation Questionnaire (JOABPEQ: pain, and lumbar, and gait function). Radiological lumbar degeneration was classified using Kellgren-Lawrence grading and lateral radiographs of the lumbar spine. Cognitive function was measured using the Mini Mental State Examination (MMSE), and MCI was defined by a summary score of MMSE ≤27. Logistic and multiple linear regression analyses were performed to analyze the association between MCI, summary score of MMSE, and lumbar degenerative disease. The comorbidity rate of MCI and LSS was 2.1%, and the rate of MCI was 41% in participants with LSS. Lumbar function in JOABPEQ was associated with MCI. The presence of LSS and lumbar function in JOABPEQ were associated with MMSE. Over one-third of the people with LSS had MCI. The presence of LSS and deterioration of QOL due to low back pain were related to cognitive impairment. We recommend evaluating cognitive function for patients with LSS because the rate of MCI was high in LSS participants.
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Affiliation(s)
- Kazushige Koyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
- * E-mail:
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Sunao Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Songee Jung
- Department of Digital Nutrition and Health Sciences, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Masataka Ando
- Department of Diet and Health Sciences, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
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Gustafsson M, Lövheim H, Sjölander M. Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder. Drugs Aging 2021; 38:1017-1023. [PMID: 34664213 PMCID: PMC8593018 DOI: 10.1007/s40266-021-00897-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
Background and Objective Pain is highly prevalent among older people, and treatment is complicated because of comorbidities and polypharmacy. Among people with major neurocognitive disorder additional difficulties might arise. The aim of this study was to describe analgesic drug use in 2012 and 2017 and associated factors among older people with major neurocognitive disorder. Methods In this register-based study, the Swedish Dementia Registry and the Swedish Prescribed Drug Register were combined in order to obtain data regarding analgesic drug use among older people with major neurocognitive disorder. One or more filled prescriptions during the timeframe of 6 months (1 July–31 December 2012 and 1 July–31 December 2017) defined drug use during the respective period. A comparison between 2012 and 2017 was made, including a total of 56,101 people (20,889 and 35,212 respectively) with a mean age of 81.9 and 82.7 years, respectively. Results The overall use of analgesic drugs increased significantly from 41.6% of individuals to 46.0% between the years 2012 and 2017. Users of opioid analgesics (15.2% vs 17.3%) and paracetamol (37.0% vs 42.3%) increased, while the users of non-steroidal anti-inflammatory drugs (4.9% vs 2.7%) declined between the two data collections. Multiple logistic regression analyses were performed for different drugs and drug classes, and it was found that the use of opioids and paracetamol was associated with older age and a longer time since diagnosis. In contrast, non-steroidal anti-inflammatory drugs were associated with younger age and a shorter time since diagnosis. Conclusions The results indicate that on a population level, pharmacological drug treatment has changed in line with guidelines between 2012 and 2017, with an increase in paracetamol and strong opioids and a decrease in non-steroidal anti-inflammatory drugs and tramadol. The relatively high prevalence of opioids warrants concern given the significant risk of adverse effects among older people with major neurocognitive disorder. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00897-9.
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Affiliation(s)
- Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Liao YJ, Parajuli J, Jao YL, Kitko L, Berish D. Non-pharmacological interventions for pain in people with dementia: A systematic review. Int J Nurs Stud 2021; 124:104082. [PMID: 34607070 DOI: 10.1016/j.ijnurstu.2021.104082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Pain commonly occurs in people living with dementia but is often undertreated. Non-pharmacological interventions are a safer first-line option for pain management, but evidence-based interventions for people living with dementia have not been established. An increasing number of studies have examined the effect of non-pharmacological interventions in pain management. However, the evidence that specifically focuses on people living with dementia has not been systematically reviewed. OBJECTIVES This review aimed to systematically synthesize current evidence on non-pharmacological interventions to manage pain in people living with dementia. METHODS A comprehensive search of the literature was conducted in PubMed, CINAHL, Scopus, and Web of Science databases. Studies were included if they were 1) peer-reviewed original quantitative research, 2) tested the effect of non-pharmacological interventions on pain in people with dementia, and 3) English language. Studies were excluded if they 1) included both pharmacological and non-pharmacological interventions and did not report separate results for the non-pharmacological interventions; 2) enrolled participants with and without dementia and did not have separate results reported for individuals with dementia; 3) tested dietary supplements as the intervention; and 4) were not original research, such as reviews, editorials, commentaries, or case studies. Title, abstract, and full text were screened. Quality assessment was conducted using the Cochrane Risk of Bias tool and Johns Hopkins Level of Evidence. Pain assessment tools, participant characteristics, study designs, intervention condition, and results were extracted. Results were synthesized through grouping the type of the interventions and weighting evidence based on quality and design of the studies. RESULTS A total of 11 articles and 12 interventions were identified. A total of 486 participants were included. Interventions that have shown a positive impact on pain include ear acupressure, music therapy, reflexology, tailored pain intervention, painting and singing, personal assistive robot, cognitive-behavioral therapy, play activity, and person-centered environment program. Nevertheless, a majority of the interventions were only evaluated once. Moreover, most studies had similar sample characteristics and setting. CONCLUSION Overall, the quality of included studies were mostly low to mixed quality and most participants only had mild to moderate baseline pain, which limits detection of the intervention's effect. Hence, these findings need to be duplicated in studies with a greater sample size, a more diverse population (race, gender, and settings), and a more rigorous design to validate the results.
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Affiliation(s)
- Yo-Jen Liao
- Pennsylvania State University, Ross and Carol Nese College of Nursing, 307 Nursing Sciences Building, University Park, PA, 16802, United States.
| | - Jyotsana Parajuli
- Assistant Professor, University of North Carolina at Charlotte, School of Nursing, 9201 University City Blvd, Charlotte, NC, 28223, United States.
| | - Ying-Ling Jao
- Assistant Professor, Pennsylvania State University, Ross and Carol Nese College of Nursing, 307B Nursing Sciences Building, University Park, PA, 16802, United States.
| | - Lisa Kitko
- Associate Professor, Pennsylvania State University, Ross and Carol Nese College of Nursing, 311 Nursing Sciences Building, University Park, PA, 16802, United States.
| | - Diane Berish
- Assistant Research Professor, Pennsylvania State University, Ross and Carol Nese College of Nursing, 304A Nursing Sciences Building, University Park, PA, 16802, United States.
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Wang J, Cato K, Conwell Y, Yu F, Heffner K, Caprio TV, Nathan K, Monroe TB, Muench U, Li Y. Pain treatment and functional improvement in home health care: Relationship with dementia. J Am Geriatr Soc 2021; 69:3545-3556. [PMID: 34418061 DOI: 10.1111/jgs.17420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Pain management is important to post-acute functional recovery, yet older persons with Alzheimer's disease and related dementias (ADRD) are often undertreated for pain. The main objectives were (1) to examine the relationship between ADRD and analgesic use among Medicare home health care (HHC) recipients with daily interfering pain, and (2) to examine the impact of analgesic use on functional outcome in patients with and without ADRD. METHODS We analyzed longitudinal data from the Outcome and Assessment Information Set, Medicare HHC claims, and HHC electronic medical records during a 60-day HHC episode. The sample included 6048 Medicare beneficiaries ≥65 years receiving care from an HHC agency in New York in 2019 who reported daily interfering pain. Analgesic use was assessed during HHC medication reconciliation and included any analgesic, non-opioid analgesic, and opioid. ADRD was identified from ICD-10 codes (HHC claims) and cognitive impairment symptoms (Outcome and Assessment Information Set [OASIS]). Functional outcome was measured as change in the composite Activity of Daily Living (ADL) limitation score in the HHC episode. RESULTS ADRD was related to a lower likelihood of using any analgesic (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.49, 0.90, p = 0.008) and opioids (OR = 0.54, 95% CI: 0.47, 0.62, p < 0.001), but not related to non-opioid analgesic use (OR = 0.94, 95% CI: 0.74, 1.18, p = 0.58). Stratified analyses showed that any analgesic use (β = -0.43, 95% CI: -0.73, -0.13, p = 0.004) and non-opioid analgesic use (β = -0.31, 95% CI: -0.56, -0.06, p = 0.016) were associated with greater ADL improvement in patients with ADRD, but not in patients without ADRD. Opioid use was not significantly related to ADL improvement regardless of ADRD status. CONCLUSIONS HHC patients with ADRD may be undertreated for pain, yet pain treatment is essential for functional improvement in HHC. HHC clinicians and policymakers should ensure adequate pain management for older persons with ADRD for improved functional outcomes.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Kenrick Cato
- Columbia University School of Nursing, New York, New York, USA.,Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, New York, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kathi Heffner
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, New York, New York, USA.,Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.,UR Medicine Home Care, University of Rochester Medical Center, New York, New York, USA.,Finger Lakes Geriatric Education Center, University of Rochester Medical Center, New York, New York, USA
| | - Kobi Nathan
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.,Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York, USA
| | - Todd B Monroe
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Ulrike Muench
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, New York, New York, USA
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Kaufmann L, Moeller K, Marksteiner J. Pain and Associated Neuropsychiatric Symptoms in Patients Suffering from Dementia: Challenges at Different Levels and Proposal of a Conceptual Framework. J Alzheimers Dis 2021; 83:1003-1009. [PMID: 34366340 PMCID: PMC8543251 DOI: 10.3233/jad-210263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Old age is critically associated with multi-morbidity, chronic pain, and high risk for dementia. Recognizing and treating pain is very much dependent on language comprehension and production. Both may be impaired in dementia. Moreover, neuropsychiatric symptoms may interact with pain perception. The main aims of the present article were 1) to identify key areas for future research to elucidate the relation between pain and associated neuropsychiatric symptoms in dementia, and 2) to provide a conceptual framework for ameliorating the clinical process of recognizing, assessing, and managing pain in non-communicating patients with advanced dementia.
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Affiliation(s)
- Liane Kaufmann
- Depatment of Psychology, University of Innsbruck, Austria.,Department of Psychiatry and Psychotherapy A, General Hospital Hall in Tirol, Austria
| | - Korbinian Moeller
- School of Science, Centre for Mathematical Cognition, Loughborough University, United Kingdom.,Leibniz-Institut fuer Wissensmedien, Tuebingen, Germany.,LEAD Graduate School & Research Network, University of Tuebingen, Germany
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital Hall in Tirol, Austria
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Essential oil therapy for the short-term treatment of behavioral and psychological symptoms of dementia: a monocentric randomized pilot study. Aging Clin Exp Res 2021; 33:2251-2259. [PMID: 33184771 DOI: 10.1007/s40520-020-01754-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) can be severely distressing for both patients and caregivers. AIMS This study assessed the efficacy of environmental diffusion essential oil therapy (EOT) combined with psychotropic drug therapy (group A) in BPSD management, compared with psychotropic drug therapy alone (group B). The stress responses of attending caregivers were also assessed. METHODS Thirty-two patients with dementia and BPSD were enrolled. The presence and severity of BPSD were assessed using the Italian version of the NPI-NH scale, which also measures the stress felt by professional caregivers. Global geriatric evaluations were performed to rule out acute diseases that could contribute to delirium and worsen patients' mental status. RESULTS Following treatment, the average NPI-NH value was significantly reduced in group A compared with group B (p < 0.001). Caregiver distress was also significantly reduced in group A (p < 0.01). DISCUSSION This pilot study showed that BPSD were better treated using EOT combined with standard pharmacological treatment, compared with standard pharmacological treatment alone. No adverse effects of EOT were observed. Reductions in caregiver distress could be due either to reductions in BPSD severity and frequency resulting in decreased caregiver burden, and/or the emotional benefit for caregivers of exposure to essential oils. CONCLUSIONS This study supports the combined use of EOT and psychotropic drugs in the treatment of BPSD. Essential oils may improve the wellbeing of both patients and caregivers, without adverse effects. Additionally, EOT is easy to administer by environmental diffusion.
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Bao Z, Landers M. Non-pharmacological interventions for pain management in patients with dementia: A mixed-methods systematic review. J Clin Nurs 2021; 31:1030-1040. [PMID: 34254373 DOI: 10.1111/jocn.15963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, summarise and compare evidence from studies related to the non-pharmacological interventions used to manage pain in patients with dementia. Secondly, this study aims to provide evidence on the effectiveness of non-pharmacological interventions used to manage pain in patients with dementia. BACKGROUND The number of people diagnosed with dementia is rising rapidly in the context of ageing. Pain is considered to be one of the most common neuropsychiatric symptoms of dementia. To date, little research has focused on non-pharmacological interventions to manage pain in patients with dementia. Therefore, a systematic review on the non-pharmacological interventions used to manage pain in patients with dementia and how effective these interventions are, is warranted. METHOD The extensive search strategy included electronic database searches for CINAHL, MEDLINE and PsycINFO from January 2009 to February 2020. A mixed-methods systematic review was undertaken in accordance with the PRISMA statement and relevant papers were chosen based on inclusion criteria and quality assessment measures. Eligibility criteria defined the characteristics of inclusion studies using the PICO framework. Results were extracted to a synthesis table. The quality appraisal was conducted using JBI and CASP checklist. RESULTS Eight studies met the inclusion criteria. These included six randomised controlled trials, one quasi-experimental study and one qualitative descriptive study. The current review identified various non-pharmacological interventions for pain management in patients with dementia including singing, painting, massage, ear acupressure, play activities program and robot. The most common intervention was massage while the most effective intervention was play activities program. All studies provided evidence that non-pharmacological interventions have an effect on pain management in patients with dementia or that there was a tendency for non-pharmacological intervention to reduce pain in patients with dementia. Overall, the quality of the included studies was interpreted as strong (n = 8). CONCLUSIONS Overall, interactive pharmacological interventions were more effective than non-interactive non-pharmacological interventions. While this review highlighted a limited number of studies investigating the use of non-pharmacological interventions to manage pain in patients with dementia, it did however uncover a range of non-pharmacological interventions used to manage pain in these patients along with their level of effectiveness. RELEVANCE TO CLINICAL PRACTICE Further research is required to explore which non-pharmacological interventions are most effective in the management of pain in patients with varying degrees of cognitive impairment. Further qualitative research is also needed to explore nurses' views on the use of non-pharmacological interventions to manage pain in patients with dementia.
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Affiliation(s)
| | - Margaret Landers
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Cantón-Habas V, Carrera-González MDP, Moreno-Casbas MT, Rich-Ruiz M. Spanish adaptation and validation of the Pain Assessment Scale in Advanced Dementia (PAINAD) in patients with dementia and impaired verbal communication: cross-sectional study. BMJ Open 2021; 11:e049211. [PMID: 34158307 PMCID: PMC8220480 DOI: 10.1136/bmjopen-2021-049211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish. DESIGN Cross-sectional observational study. SETTING Two health districts of Andalusian provinces, located in the south of Spain, through the Andalusian network of Primary Healthcare centres and four institutions dedicated to the care of patients with dementia. PARTICIPANTS A total of 100 older people, with a medical diagnosis of dementia and a score on the Global Deterioration Scale between 5 and 7 were assessed using the PAINAD scale. PRIMARY AND SECONDARY OUTCOME MEASURES Psychometric properties including content validity, construct validity and reliability of the scale have been tested. RESULTS The overall Item Content Validity Index was excellent (0.95). Regarding construct validity, it was confirmed that a lower use of analgesics implied a lower score on the PAINAD scale (p<0.05). The internal consistency of the scale was 0.76 and it increases to 0.81 if we remove the breathing item. Furthermore, the intraclass correlation coefficient (ICC) used to assess interobserver reliability was 0.94, whereas the ICC used to assess temporary stability was 0.55. CONCLUSIONS The Spanish version of the PAINAD scale is a valid tool to assess pain in patients with dementia and inability to communicate verbally.
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Affiliation(s)
- Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
| | - María Del Pilar Carrera-González
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
- Experimental and Clinical Physiopathology Research Group, Department of Health Sciences, University of Jaen Faculty of Experimental Sciences, Jaen, Spain
| | - María Teresa Moreno-Casbas
- Ciber Fragility and Healthy Aging (CIBERFES), Madrid, Spain
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
- Ciber Fragility and Healthy Aging (CIBERFES), Madrid, Spain
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
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Habiger TF, Achterberg WP, Flo-Groeneboom E, Mannseth J, Husebo BS. Managing Pain and Psychosis Symptoms in Nursing Home Patients: Results from a Cluster-Randomized Controlled Trial (COSMOS). J Am Med Dir Assoc 2021; 22:1692-1698. [PMID: 34087225 DOI: 10.1016/j.jamda.2021.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In nursing homes (NHs), 30% to 60% of patients experience daily pain and >80% have dementia. This can lead to neuropsychiatric symptoms, including psychosis symptoms such as delusion. We investigated if there was a relationship between pain and psychosis symptoms over time. We also aimed to investigate the effect of a multicomponent intervention (COSMOS) on pain, psychosis symptoms, and analgesic prescription. DESIGN COSMOS is a cluster-randomized, single blinded, controlled trial. Each NH unit was defined as a cluster and randomized to either the COSMOS intervention or care as usual. The COSMOS intervention is a multicomponent intervention, consisting of staff training in communication, pain treatment, medication review, organization of activities, and safety. The intervention lasted for 4 months with a follow-up at month 9. SETTING AND PARTICIPANTS Sixty-seven units from 33 Norwegian NHs in 8 municipalities. The study included 723 patients aged ≥65 years, residing at the NH ≥2 weeks before inclusion. Patients with a life expectancy <6 months were excluded. MEASURES Pain was measured using the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale. Psychosis symptoms were measured using the Neuropsychiatric Inventory-NH version. Measurements were performed at baseline, and months 4 and 9. RESULTS Multilevel Mixed-Effect statistical analysis found that psychosis symptoms as a group (odds ratio [OR] 2.03, P = .009), and delusion (OR 2.12, P = .007) were associated with pain over time. No significant intervention effect on psychosis symptoms was observed. Compared with the control group, people with dementia in the intervention group experienced less musculoskeletal pain (β: -0.47, P = .047). Analgesic prescription was not affected by the intervention. CONCLUSION AND IMPLICATIONS Pain is associated with psychosis symptoms, and pain assessment should be done when making treatment decisions on psychosis symptoms in NH patients. The COSMOS intervention improved musculoskeletal pain in people with dementia, but not psychosis symptoms, and there is need for further studies on treatment of psychosis symptoms in NH patients.
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Affiliation(s)
- Torstein F Habiger
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
| | - Wilco P Achterberg
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, Leiden University Medical Centre, Netherlands
| | - Elisabeth Flo-Groeneboom
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Janne Mannseth
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Municipality of Bergen, Bergen, Norway
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Wagatsuma S, Yamaguchi T, Berge LI, Husebo B, Habiger TF, Nouchi R, Angeles RC. How, Why and Where it Hurts—Breaking Down Pain Syndrome Among Nursing Home Patients With Dementia: A Cross-Sectional Analysis of the COSMOS Trial. Pain Manag Nurs 2021; 22:319-326. [DOI: 10.1016/j.pmn.2020.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
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Atee M, Morris T, Macfarlane S, Cunningham C. Pain in Dementia: Prevalence and Association With Neuropsychiatric Behaviors. J Pain Symptom Manage 2021; 61:1215-1226. [PMID: 33068708 DOI: 10.1016/j.jpainsymman.2020.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT Pain is linked to behaviors and psychological symptoms of dementia (BPSD); however, it often remains underrecognized in this population. OBJECTIVES We aimed to investigate the prevalence and intensity of pain in people living in aged care homes with BPSD and by dementia subtypes and the association between pain intensity and BPSD. METHODS A 1-year retrospective cross-sectional analysis was conducted on BPSD and the presence of pain in referrals to a national BPSD support service using the Neuropsychiatric Inventory and PainChek®, respectively. Referrals were categorized into two groups: pain group and no pain group. RESULTS Of the 479 referrals (81.9 ± 8.3 years old) included in the analysis, two-thirds (65.6%) had pain identified, with almost half (48.4%) of these categorized as experiencing moderate-severe pain. Pain was highly prevalent (range: 54.6-78.6%) in all subtypes of dementia, particularly in mixed dementia and dementia with Lewy bodies. Compared with the no pain group, the pain group had 25.3% more neuropsychiatric behaviors, 33.6% higher total severity of these behaviors, and 31.4% higher total distress caused to caregivers. For all results, effect sizes were small to medium (η²p = 0.04-0.06). Despite a high prevalence of aggressive or agitated behaviors across the entire group, the pain group was 3.8 times more likely to experience these behaviors than referrals not in pain. CONCLUSION There is a strong need to consider the possibility of pain as a contributor to behavioral changes in aged care residents living with dementia.
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Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Wembley, Western Australia, Australia; Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia.
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Babicova I, Cross A, Forman D, Hughes J, Hoti K. Evaluation of the Psychometric Properties of PainChek® in UK Aged Care Residents with advanced dementia. BMC Geriatr 2021; 21:337. [PMID: 34049501 PMCID: PMC8161561 DOI: 10.1186/s12877-021-02280-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 05/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to further validate PainChek®, an electronic pain assessment instrument, with a population living with dementia in a UK care home. METHOD This study utilised a correlational design to evaluate the psychometric properties of PainChek® when compared to the Abbey Pain Scale (APS). Blinded paired pain assessments were completed at rest and immediately post-movement by a researcher and a nurse. A total of 22 participants with a diagnosis of moderate-to-severe dementia and a painful condition were recruited using opportunity sampling. RESULTS Overall, 302 paired assessments were collected for 22 participants. Out of these 179 were conducted during rest and 123 were immediately post-movement. The results demonstrated a positive significant correlation between overall PainChek® pain scores and overall APS pain scores (r = 0.818, N = 302, p < .001, one-tailed), satisfactory internal consistency (α = 0.810), moderate single measure intraclass correlation (ICC = 0.680) and substantial inter-rater agreement (κ = 0.719). CONCLUSIONS PainChek® has demonstrated to be a valid and reliable instrument to assess the presence and severity of pain in people with moderate-to-severe dementia living in aged care.
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Affiliation(s)
- Ivana Babicova
- College of Health, Psychology & Social Care, University of Derby, Derby, UK.
| | - Ainslea Cross
- University of Derby Online Learning, University of Derby, Derby, UK
| | - Dawn Forman
- College of Health, Psychology & Social Care, University of Derby, Derby, UK
| | - Jeffery Hughes
- Curtin Medical School, Curtin University, Perth, Australia
| | - Kreshnik Hoti
- Curtin Medical School, Curtin University, Perth, Australia
- Division of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
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65
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Bentur N, Cohen-Mansfield J, Radomyslsky Z. Is Pain Assessment of Community-Dwelling Persons With Advanced Dementia by Family and Paid Care Workers Feasible? J Pain Symptom Manage 2021; 61:1028-1034. [PMID: 33186731 DOI: 10.1016/j.jpainsymman.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Abstract
CONTEXT The experience of pain is aggravated among older persons with advanced dementia (OPAD). It is often undetected and therefore untreated because of their limited capacity to identify and report their symptoms. Therefore, it is crucial to improve the pain identification skills of those who know and live with them. OBJECTIVES To compare the identification of pain among OPAD between family members and paid care workers and to compare the detection of pain through the use of two common assessment tools. METHODS This study is a cross-sectional comparison conducted between 82 dyads of informants: the family member of OPAD and the paid care worker, a total of 164 individuals. MEASUREMENTS The study used two previously validated pain assessment tools for persons suffering from dementia: the Pain Assessment in Noncommunicative Elderly persons tool (PAINE) and Pain Assessment in Advanced Dementia tool (PAINAD), and a general impression question. RESULTS Both family members and paid care workers were able to successfully use both tools. The correlation between family members' ratings and paid care workers' ratings was statistically significant for all the assessments. The correlations between raters were higher when family members lived with the OPAD. The correlations between PAINE and PAINAD scores were moderate and significant, both among family members and paid care workers. CONCLUSION This study shows that it is feasible to improve the assessment and identification of pain among OPAD, through the use of validated tools by family members and paid care workers, suggesting the potential to improve quality of care and quality of life of OPAD.
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Affiliation(s)
- Netta Bentur
- Tel Aviv University Sackler Faculty of Medicine, Stanley Steyer School of Health Professionals, Tel Aviv, Israel.
| | - Jiska Cohen-Mansfield
- Sackler Faculty of Medicine, Department of Health Promotion, School of Public Health, Minerva Center for the Interdisciplinary Study of End of Life, Igor Orenstein Chair for the Study of Geriatric, TelAviv University, Tel Aviv, Israel
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Blytt KM, Flo-Groeneboom E, Erdal A, Bjorvatn B, Husebo BS. Sleep and its Association With Pain and Depression in Nursing Home Patients With Advanced Dementia - a Cross-Sectional Study. Front Psychol 2021; 12:633959. [PMID: 33959072 PMCID: PMC8093870 DOI: 10.3389/fpsyg.2021.633959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Previous research suggests a positive association between pain, depression and sleep. In this study, we investigate how sleep correlates with varying levels of pain and depression in nursing home (NH) patients with dementia. Materials and methods: Cross-sectional study (n = 141) with sleep-related data, derived from two multicenter studies conducted in Norway. We included NH patients with dementia according to the Mini-Mental State Examination (MMSE ≤ 20) from the COSMOS trial (n = 46) and the DEP.PAIN.DEM trial (n = 95) whose sleep was objectively measured with actigraphy. In the COSMOS trial, NH patients were included if they were ≥65 years of age and with life expectancy >6 months. In the DEP.PAIN.DEM trial, patients were included if they were ≥60 years and if they had depression according to the Cornell Scale for Depression in Dementia (CSDD ≥ 8). In both studies, pain was assessed with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and depression with CSDD. Sleep parameters were total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), early morning awakening (EMA), daytime total sleep time (DTS) and time in bed (TiB). We registered use of sedatives, analgesics, opioids and antidepressants from patient health records and adjusted for these medications in the analyses. Results: Mean age was 86.2 years and 76.3% were female. Hierarchical regressions showed that pain was associated with higher TST and SE (p < 0.05), less WASO (p < 0.01) and more DTS (p < 0.01). More severe dementia was associated with more WASO (p < 0.05) and TiB (p < 0.01). More severe depression was associated with less TST (p < 0.05), less DTS (p < 0.01) and less TiB (p < 0.01). Use of sedative medications was associated with less TiB (p < 0.05). Conclusion: When sleep was measured with actigraphy, NH patients with dementia and pain slept more than patients without pain, in terms of higher total sleep time. Furthermore, their sleep efficiency was higher, indicating that the patients had more sleep within the time they spent in bed. Patients with more severe dementia spent more time awake during the time spent in bed. Furthermore, people with more severe depression slept less at daytime and had less total sleep time Controlling for concomitant medication use did not affect the obtained results.
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Affiliation(s)
- Kjersti Marie Blytt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Ane Erdal
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Municipality of Bergen, Norway
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Boltz M, Resnick B, Kuzmik A, Mogle J, Jones JR, Arendacs R, BeLue R, Cacchione P, Galvin JE. Pain Incidence, Treatment, and Associated Symptoms in Hospitalized Persons with Dementia. Pain Manag Nurs 2021; 22:158-163. [PMID: 32921569 PMCID: PMC7943650 DOI: 10.1016/j.pmn.2020.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Moderate to severe pain has been frequently reported in hospitalized older adults. Pain in hospitalized persons with dementia within the context of other common symptoms, functional decline, delirium, and behavioral and psychological symptoms of dementia (BPSD), has received little attention. AIMS Describe the incidence of pain, the pharmacologic management of pain, and the association of pain with physical function, delirium, and BPSD in hospitalized persons with dementia. DESIGN Descriptive, cross-sectional study. SETTING Six medical units in three hospitals. PARTICIPANTS Baseline data from 299 hospitalized persons with dementia enrolled in the Family-centered Function-focused Care (Fam-FFC) cluster randomized trial. METHODS Descriptive analyses of pain used the Pain Assessment in Advanced Dementia (PAINAD) scale and the use of medication for pain management. Linear regression analyses tested relationships between pain and:1) physical function (Barthel Index), 2) delirium severity (Confusion Assessment Method Severity Short Form) and 3) BPSD severity (Neuropsychiatric Inventory- Questionnaire). RESULTS The majority of the sample was female (61.9%), non-Hispanic (98%), and Black (53.2%), with a mean age of 81.58 (SD=8.54).Of the 299 patients, 166 (56%) received pain medication. Of the 108 individuals who demonstrated pain, 40% (n=43) did not receive pain medication. When controlling for age, gender, cognition, and comorbidities, pain was significantly associated with function, delirium severity, and BPSD severity. CONCLUSIONS Results suggest that pain may be undertreated in hospitalized persons with dementia, and should be considered upon admission to optimize function, decrease delirium, and prevent or decrease BPSD.
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Affiliation(s)
- Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, PA.
| | | | - Ashley Kuzmik
- College of Nursing, Pennsylvania State University, University Park, PA
| | | | | | - Rachel Arendacs
- College of Nursing, Pennsylvania State University, University Park, PA
| | | | - Pamela Cacchione
- College of Nursing, Pennsylvania State University, University Park, PA
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Affiliation(s)
- Wilco Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, Niederlande.
| | | | - Bettina Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, Faculty of Medicine, University of Bergen, Bergen, Norwegen
| | - Ane Erdal
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, Faculty of Medicine, University of Bergen, Bergen, Norwegen
| | - Keela Herr
- University of Iowa College of Nursing, Iowa City, IA, USA
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69
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Anderson AR, Iversen WL, Carter MA, Moss KO, Cowan RL, Monroe TB. Experimentally evoked pain in Alzheimer's disease. J Am Assoc Nurse Pract 2021; 34:18-25. [PMID: 33731557 PMCID: PMC9118535 DOI: 10.1097/jxx.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pain continues to be underrecognized and undertreated in Alzheimer's disease (AD) while existing guidance about pain assessment and management in dementia is not widespread. Brain regions involved in pain processing and modulation are damaged during AD, and the pain experience in AD is not well understood. Experimental pain studies using psychophysics can further our understanding of the pain experience in AD, which may lead to improved assessment and management of pain in people living with AD. OBJECTIVE A systematic review was conducted to explicate the current understanding of experimentally evoked pain in AD from primary research using psychophysical methods. DATA SOURCES Peer-reviewed publications were found via PubMed, CINAHL, and PsycINFO. A total of 18 primary research, peer-reviewed full articles that met inclusion criteria were included, representing 929 total participants. CONCLUSIONS Experimentally evoked pain in people with AD demonstrates that despite cognitive impairment and a reduced ability to effectively communicate, individuals with AD experience pain similar to or more unpleasant than cognitively intact older adults. This may mean amplified pain unpleasantness in people with AD. IMPLICATIONS FOR PRACTICE Our current best practices need to be widely disseminated and put into clinical practice. Self-report of pain continues to be the gold standard, but it is ineffective for noncommunicative patients and those unable to understand pain scales or instructions because of memory/cognitive impairment. Instead, pain treatment should be ethically initiated based on patient reports and behaviors, caregiver/surrogate reports, review of the medical record for painful conditions, analgesic trials, and regular reassessments.
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Affiliation(s)
| | | | - Michael A. Carter
- University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee
| | - Karen O. Moss
- The Ohio State University College of Nursing, Columbus, Ohio
| | - Ronald L. Cowan
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Todd B. Monroe
- The Ohio State University College of Nursing, Columbus, Ohio
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Stopyn RJN, Hadjistavropoulos T, Loucks J. An Eye Tracking Investigation of Pain Decoding Based on Older and Younger Adults' Facial Expressions. JOURNAL OF NONVERBAL BEHAVIOR 2021; 45:31-52. [PMID: 33678933 PMCID: PMC7900079 DOI: 10.1007/s10919-020-00344-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/30/2022]
Abstract
Nonverbal pain cues such as facial expressions, are useful in the systematic assessment of pain in people with dementia who have severe limitations in their ability to communicate. Nonetheless, the extent to which observers rely on specific pain-related facial responses (e.g., eye movements, frowning) when judging pain remains unclear. Observers viewed three types of videos of patients expressing pain (younger patients, older patients without dementia, older patients with dementia) while wearing an eye tracker device that recorded their viewing behaviors. They provided pain ratings for each patient in the videos. These observers assigned higher pain ratings to older adults compared to younger adults and the highest pain ratings to patients with dementia. Pain ratings assigned to younger adults showed greater correspondence to objectively coded facial reactions compared to older adults. The correspondence of observer ratings was not affected by the cognitive status of target patients as there were no differences between the ratings assigned to older adults with and without dementia. Observers' percentage of total dwell time (amount of time that an observer glances or fixates within a defined visual area of interest) across specific facial areas did not predict the correspondence of observers' pain ratings to objective coding of facial responses. Our results demonstrate that patient characteristics such as age and cognitive status impact the pain decoding process by observers when viewing facial expressions of pain in others.
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Affiliation(s)
- Rhonda J N Stopyn
- Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | | | - Jeff Loucks
- Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
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Kisvetrová H, Herzig R, Bretšnajdrová M, Tomanová J, Langová K, Školoudík D. Predictors of quality of life and attitude to ageing in older adults with and without dementia. Aging Ment Health 2021; 25:535-542. [PMID: 31870177 DOI: 10.1080/13607863.2019.1705758] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study explored the quality of life (QoL) and attitudes to aging in older adults with and without dementia, and ascertained the main factors that predict QoL and attitude to ageing. METHODS A cross-sectional study involving 563 community-dwelling adults with (PwD) and without dementia (PwoD) >60 years of age was conducted in three Czech regions. A tools battery including the Quality of Life-Alzheimer's Disease Scale, Geriatric Depression Scale, Patient Dignity Inventory, Attitude to Aging Questionnaire (AAQ), Short Physical Performance Battery, and Barthel Index, were administered. RESULTS PwD had worse scores in QoL and AAQ (both p = 0.0001). Less depression (p < 0.001), better sense of dignity (p < 0.05), and lower pain (p < 0.05) in PwoD predicted better scoring for QoL and AAQ. Physical ability in PwoD (p < 0.05), living alone (p < 0.05) and self-sufficiency (p < 0.001) in PwDwere predictors influencing QoL.Age (p < 0.01) in PwoD, gender (p < 0.05) and physical ability (p < 0.001) in PwD influenced AAQ. CONCLUSIONS This research is the first study to show that dignity can influence the QoL and attitude to aging in community-dwelling older adults. Our findings suggest that depression and dignity are common predictors of QoL and AAQ in older adults with and without dementia.
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Affiliation(s)
- Helena Kisvetrová
- The Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Roman Herzig
- Neurology Clinic, University Hospital, Hradec Králové, Czech Republic
| | - Milena Bretšnajdrová
- 2nd Internal Clinic of Gastroenterology and Geriatrics, University Hospital, Olomouc, Czech Republic
| | - Jitka Tomanová
- The Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Kateřina Langová
- The Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - David Školoudík
- Neurology Clinic, University Hospital, Ostrava, Czech Republic
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Anderson AR, Hyden K, Failla MD, Carter MA. Policy Implications for Pain in Advanced Alzheimer's Disease. Pain Manag Nurs 2021; 22:3-7. [PMID: 32684495 PMCID: PMC7854970 DOI: 10.1016/j.pmn.2020.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
Untreated pain in people with Alzheimer's disease continues to be a serious public health problem. Pain is a subjective and complex experience that becomes increasingly challenging to assess as cognition declines. Our understanding of pain processing is incomplete, particularly for special populations such as people living with Alzheimer's disease, and especially in the advanced stages of the disease. Pain-processing networks in the brain are altered in Alzheimer's disease, yet evidence suggests people living with Alzheimer's disease do not experience less pain. Rather, their pain is not adequately recognized or treated. Although scholarly publications provide important assistance, recent widespread reports and guidelines do not include sufficient guidance, especially as Alzheimer's disease progresses to the last stages. Additionally, current pain measurements may not accurately evaluate pain in this condition, and the existing definitions of pain are not adequate when considering the effects of Alzheimer's disease on pain-processing in the brain. There is a need for new, widespread policies, guidelines, and definitions to help clinicians adequately manage pain in people with Alzheimer's disease. These will need to hinge on continued research because it remains unclear how Alzheimer's disease impacts central pain processing, pain expression, and communication of pain. In the meantime, policies and guidelines need to highlight current best practices as well as the fact that pain continues in Alzheimer's disease.
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Affiliation(s)
| | - Karen Hyden
- University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Michelle D Failla
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael A Carter
- University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee
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Coronado RA, Albers HE, Allen JL, Clarke RG, Estrada VA, Simon CB, Galloway RV, Fisher SR. Pain-Reducing Effects of Physical Therapist-Delivered Interventions: A Systematic Review of Randomized Trials Among Older Adults With Dementia. J Geriatr Phys Ther 2021; 43:159-169. [PMID: 30998563 DOI: 10.1519/jpt.0000000000000235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Pain is common among older adults with dementia. There are nonpharmacological options for managing pain in this population. However, the effects of physical therapist-delivered interventions have not been summarized. The purpose of this systematic review was to summarize the literature on physical therapist-delivered interventions in randomized trials for reducing pain among older adults with dementia. METHODS A systematic search of MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science was conducted for randomized trials of pain management in individuals 60 years or older with medically diagnosed dementia of any severity. Included studies addressed the effects of nonpharmacological physical therapist-delivered interventions on pain outcomes. Pain outcomes included patient or caregiver self-report, observational or interactive measures. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale. RESULTS AND DISCUSSION Three studies (total = 222 participants; mean age range = 82.2-84.0 years; 178 [80.2%] females) met inclusion criteria. PEDro scores ranged from 4 to 8/10. Interventions included passive movement and massage. Pain outcomes included the observational measures Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), Pain in Advanced Dementia (PAINAD), and Doloplus-2 Scale. Passive movement did not show better results when compared with no treatment, while massage showed pain-reducing effects in 1 study compared with no treatment. CONCLUSIONS The evidence supporting pain-reducing physical therapy interventions for patients with dementia is limited. There is a clear gap in knowledge related to evidence-based physical therapy for managing pain in this population. Future studies should examine active physical therapist-delivered interventions and utilize interactive pain measures.
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Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hannah E Albers
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Jessica L Allen
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Rebecca G Clarke
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Victoria A Estrada
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Corey B Simon
- Division of Physical Therapy, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Rebecca V Galloway
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Steve R Fisher
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
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Vitou V, Gély-Nargeot MC, Bayard S. Interrater Variability in Pain Assessment of Long-term Care Residents with Dementia. Pain Manag Nurs 2021; 22:377-385. [PMID: 33446451 DOI: 10.1016/j.pmn.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE People with dementia are at great risk of their pain being undetected. In long-term care facilities, certified nursing assistants are on the front-line to detect whether a resident with dementia is experiencing pain, but research on certified nursing assistants' abilities to accurately assess pain are scarce. This study aims to examine certified nursing assistants' pain assessment skills using a simulated standardized video context. DESIGN A cross-sectional study was conducted. METHODS Fifty certified nursing assistants and 40 individuals with no professional experience in the field of care (controls) watched the same video of an older adult woman with dementia experiencing pain. Afterwards, they completed visual analog scales (pain intensity, affective distress), an observational pain assessment scale (Algoplus), and a set of questionnaires. RESULTS In both groups, pain intensity assessment and empathic reaction scores showed important interrater variability. Moreover, certified nursing assistants and controls did not differ in detecting the presence of pain or assessing its intensity. But certified nursing assistants displayed lower empathic reactions and dispositions. Certified nursing assistants pain assessment scores decreased with experience and expertise. CONCLUSIONS The practice of pain assessment is challenging for certified nursing assistants in long-term care facilities. Their professional status does not prevent inter-personal inconsistency and tends to lower their empathic dispositions. Personal determinants may interfere with their assessment behaviors and must be considered to enhance pain management for residents with dementia.
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Affiliation(s)
- Valérie Vitou
- University Paul Valéry Montpellier 3, University Montpellier, Montpellier, France; Fondation Partage et Vie, Montrouge, France.
| | | | - Sophie Bayard
- University Paul Valéry Montpellier 3, University Montpellier, Montpellier, France
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Husebo BS, Kerns RD, Han L, Skanderson M, Gnjidic D, Allore HG. Pain, Complex Chronic Conditions and Potential Inappropriate Medication in People with Dementia. Lessons Learnt for Pain Treatment Plans Utilizing Data from the Veteran Health Administration. Brain Sci 2021; 11:86. [PMID: 33440668 PMCID: PMC7827274 DOI: 10.3390/brainsci11010086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease and related dementias (ADRD), pain and chronic complex conditions (CCC) often co-occur leading to polypharmacy and with potential inappropriate medications (PIMs) use, are important risk factors for adverse drug reactions and hospitalizations in older adults. Many US veterans are at high risk for persistent pain due to age, injury or medical illness. Concerns about inadequate treatment of pain-accompanied by evidence about the analgesic efficacy of opioids-has led to an increase in the use of opioid medications to treat chronic pain in the Veterans Health Administration (VHA) and other healthcare systems. This study aims to investigate the relationship between receipt of pain medications and centrally (CNS) acting PIMs among veterans diagnosed with dementia, pain intensity, and CCC 90-days prior to hospitalization. The final analytic sample included 96,224 (81.7%) eligible older veterans from outpatient visits between October 2012-30 September 2013. We hypothesized that veterans with ADRD, and severe pain intensity may receive inappropriate pain management and CNS-acting PIMs. Seventy percent of the veterans, and especially people with ADRD, reported severe pain intensity. One in three veterans with ADRD and severe pain intensity have an increased likelihood for CNS-acting PIMs, and/or opioids. Regular assessment and re-assessment of pain among older persons with CCC, patient-centered tapering or discontinuation of opioids, alternatives to CNS-acting PIMs, and use of non-pharmacological approaches should be considered.
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Affiliation(s)
- Bettina S. Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
- Municipality of Bergen, 5020 Bergen, Norway
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT 06511, USA;
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA;
| | - Ling Han
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT 06511, USA; (L.H.); (H.G.A.)
| | - Melissa Skanderson
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA;
| | - Danijela Gnjidic
- Charles Perkins Centre, Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney 2006 NSW, Australia;
| | - Heather G. Allore
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT 06511, USA; (L.H.); (H.G.A.)
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT 06511, USA
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76
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Carragher RM, MacLeod E, Camargo-Plazas P. The objectivity and subjectivity of pain practices in older adults with dementia: A critical reflection. Nurs Inq 2020; 28:e12397. [PMID: 33368898 DOI: 10.1111/nin.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022]
Abstract
Providing nursing care for people with dementia residing in long-term care facilities poses specific challenges regarding pain practices. With underlying communication barriers unique to dementia pathologies, this population is often unable to communicate verbal sentiments and descriptions of pain. In turn, nurses caring for older persons with dementia have difficulty assessing, managing and treating pain. Objectivity is an imperative factor in healthcare pain practices; however, it is difficult to objectively evaluate someone who cannot accurately communicate their experience of pain. Therefore, the authors believe that subjectivity is also an essential part of evaluating the person with dementia's experience of pain. In this critical reflection, the authors explore objectivity and subjectivity in relation to pain practices for dementia in long-term care. A historical summary of pain is provided outlining the evolution of objectivity and subjectivity related to pain practices. The authors discuss the complexities of assessing and managing pain and offer a new perspective about the role of objectivity (and co-existence of subjectivity) for nurses treating pain in the older adults with dementia.
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Affiliation(s)
| | - Emily MacLeod
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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77
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Pan X, Meng H. Pain management and cognitive function among older adults: an exploratory study of the China Health and Retirement Longitudinal Study. Aging Clin Exp Res 2020; 32:2611-2620. [PMID: 32056155 DOI: 10.1007/s40520-020-01491-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic pain and cognitive decline are common age-related conditions affecting a large segment of older populations. Little is known about the pathway of cognitive functioning during the course of pain management in older adults. AIMS The study aimed to examine the association between chronic body pain management and cognitive function over time among Chinese older adults. METHODS A total of 792 respondents aged 60 and above from urban and rural households in 28 provinces, 150 counties/districts, and 450 communities were selected from the China Health and Retirement Longitudinal Study (2013-2015). Cognitive function was measured in three domains: episodic memory, mental status, and global cognitive function. Difference-in-differences approach and mixed-effects linear regression models were employed to assess the association between chronic body pain management and cognitive function over time. RESULTS Scores of mental status were found to decline slower by 0.49 unit (SE = 0.22, p < 0.05) in respondents who received pain management using analgesics, complementary and alternative medicine, or both from 2013 to 2015 after controlling for basic demographic and health confounders. CONCLUSION Chronic pain management was associated with slower decline in domain-specific cognitive function, mental status over time. Findings of the study may contribute to understanding the mechanism of change in diverse cognitive abilities attributable to pain symptoms. More research is needed to elucidate the mediating effect of pain on cognitive decline, which could lead to testing of the impact of pain management on cognitive function among older population in both clinical and community settings.
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Affiliation(s)
- Xi Pan
- Department of Sociology, Texas State University, San Marcos, TX, USA.
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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78
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Giménez-Llort L, Bernal ML, Docking R, Muntsant-Soria A, Torres-Lista V, Bulbena A, Schofield PA. Pain in Older Adults With Dementia: A Survey in Spain. Front Neurol 2020; 11:592366. [PMID: 33329344 PMCID: PMC7715009 DOI: 10.3389/fneur.2020.592366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022] Open
Abstract
The risk of suffering pain increases significantly throughout life, reaching the highest levels in its latest years. Prevalence of pain in nursing homes is estimated to range from 40 to 80% of residents, most of them old adults affected with dementia. It is already known that pain is under-diagnosed and under-treated in patients with severe cognitive impairment and poor/absent verbal communication, resulting in a serious impact on their quality of life, psychosocial, and physical functioning. Under-treated pain is commonly the cause of behavioral symptoms, which can lead to misuse of antipsychotic treatments. Here, we present two Regional and National Surveys in Spain (2015–2017) on the current practices, use of observational tools for pain assessment, guidelines, and policies. Results, discussed as compared to the survey across central/north Europe, confirm the professional concerns on pain in severe dementia, due to poor standardization and lack of guidelines/recommendations. In Spain, observational tools are scarcely used because of their difficulty and low reliability in severe dementia, since the poor/absent verbal communication and comprehension are considered limiting factors. Behavioral observation tools should be used while attending the patients, in a situation including rest and movement, should be short (3–5 min) and scored using a numeric scale. Among the pain items to score, “Facial expression” and “Verbalization” were considered essential and very useful, respectively. This was in contrast to “Body movements” and “Vocalizations,” respectively, according to the survey in central/north Europe. Scarce time availability for pain assessment and monitoring, together with low feasible and time-consuming tools, can make pain assessment a challenge. The presence of confounding factors, the low awareness and poor knowledge/education of specific tools for this population are worrisome. These complaints draw future directions to improve pain assessment. More time available, awareness, and involvement of the teams would also benefit pain assessment and management in cognitive impairment. The experiences and opinions recorded in these surveys in Spain and other E.U. countries were considered sources of knowledge for designing the “PAIC-15 scale,” a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition and the “Observational pain assessment” in older persons with dementia.
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Affiliation(s)
- Lydia Giménez-Llort
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Institut de Neurociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Maria Luisa Bernal
- Department of Pharmacology and Physiology, University of Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | | | - Aida Muntsant-Soria
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Institut de Neurociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Virginia Torres-Lista
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Institut de Neurociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Antoni Bulbena
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Patricia A Schofield
- Abertay University, Dundee, United Kingdom.,Sheffield Hallam University, Sheffield, United Kingdom
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79
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Zare M, Tagharrobi Z, Sharifi K, Sooki Z, Abolhasani J. Translation and Psychometric Evaluation of the Mahoney Pain Scale Among Iranian Elderly With Dementia: A Methodological Study. Eval Health Prof 2020; 44:371-377. [PMID: 32990030 DOI: 10.1177/0163278720961818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Valid and reliable measurement tools are necessary for pain assessment among the elderly with dementia. This study aimed to translate the Mahoney Pain Scale (MPS) into Persian and evaluate its psychometric properties among Iranian elderly with dementia. In this methodological study, after translating and assessing the face and content validity of MPS, 100 elderly with dementia were selected via convenience sampling from nursing homes and clinics in Kashan in 2018-19; then, MPS was completed for them both at rest and during a movement pain protocol. MPS was assessed by exploratory factor analysis, known-group comparison, convergent validity, internal consistency, equivalence, and stability. The factor analysis revealed a one-factor structure, which explained 57.11% of the total variance. The Persian MPS differentiated patients with and without known painful conditions, as well as pain at rest and during the movement pain protocol (p < .0001). There was a significant positive correlation between the scores of MPS and PACSLAC-II (r = .87, p < .0001). The Cronbach's α, intraclass correlation coefficient and standard error of measurement of MPS were .91, .79, and ±1.37, respectively. As a valid and reliable tool, the Persian MPS can be used for pain assessment among Iranian elderly with dementia.
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Affiliation(s)
- Mohammad Zare
- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Tagharrobi
- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Khadijeh Sharifi
- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Sooki
- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Javad Abolhasani
- Department of Neurology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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80
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Starr LT, Magan KC. Model of Empathic Pain Assessment and Treatment in Persons With Dementia. Res Gerontol Nurs 2020; 13:264-276. [PMID: 32286670 DOI: 10.3928/19404921-20200402-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/04/2020] [Indexed: 12/21/2022]
Abstract
The current article presents an evidence-based model for understanding clinical empathy's relationship with the assessment and treatment of pain in persons with advanced dementia. A literature review informed creation of an interdisciplinary conceptual framework of clinician empathy in pain assessment and treatment among persons with advanced dementia. Driven by observation of behaviors indicating pain in persons with dementia unable to self-report, the model represents the cognitive, affective, ethical, and behavioral components of clinical empathy involved in assessing and treating pain, relevant patient outcomes, and contextual factors influencing empathy and outcomes; and provides a framework for testing clinical empathy interventions to improve adverse outcomes in persons with advanced dementia. Understanding the relationship between clinician empathy and the assessment and treatment of pain in persons with advanced dementia may improve care quality and help reduce pain behaviors in this patient population. This model may be used to inform pain research in persons with dementia and develop clinical interventions and clinician education programs. [Research in Gerontological Nursing, 13(5), 264-276.].
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81
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Steenbeek ED, Ramspek CL, van Diepen M, Dekker FW, Achterberg WP. The Association Between Pain Perception and Care Dependency in Older Nursing Home Residents: A Prospective Cohort Study. J Am Med Dir Assoc 2020; 22:676-681. [PMID: 32868249 DOI: 10.1016/j.jamda.2020.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/05/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Maintenance of independence is a challenge for nursing home residents whose pain is often substantial. The objective of this study was to explore the relationship between pain perception and care dependency in a population of Dutch nursing home residents. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Dutch nursing home residents aged 65 or older, excluding residents with a severe cognitive impairment. METHODS The Numeric Rating Scale (NRS) was used to rate pain perception from 0 to 10 in half-point increments and the Care Dependency Scale (CDS) to measure care dependency, with scores ranging from 15 (completely care dependent) to 75 (fully independent). Both measurements were repeated after a 2-month follow-up. Multiple linear regression analysis was used to adjust for potential confounders. Missing data were dealt with by performing tenfold multiple imputation. RESULTS A total of 1256 residents (65% women, mean age 83 years) were included. At baseline, the median NRS pain score was 3.0 (interquartile range 0.0-6.0) and the mean CDS score was 55.9 (SD 11.5). Cross-sectionally, for 1-point increase in pain score, care dependency increased 0.65 points [95% confidence interval (CI) 0.46-0.83]. More pain at baseline was associated with slightly lower care dependency after 2 months (beta 0.20, 95% CI 0.01-0.39). Compared with residents whose pain decreased over 2 months, residents with stable pain or increased pain had a 2.27-point (95% CI 0.83-3.70) and 2.39-point (95% CI 0.87-3.90) greater increase in care dependency, respectively. CONCLUSIONS AND IMPLICATIONS Pain perception and care dependency are associated in a population of older nursing home residents, and stable or increased pain is associated with increased care dependency progression. The findings of this study emphasize that pain and care dependency should not be assessed nor treated independently.
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Affiliation(s)
- Esli D Steenbeek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Chava L Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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82
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Scuteri D, Matamala-Gomez M, Bottiroli S, Corasaniti MT, De Icco R, Bagetta G, Tonin P. Pain Assessment and Treatment in Dementia at the Time of Coronavirus Disease COVID-19. Front Neurol 2020; 11:890. [PMID: 32982921 PMCID: PMC7479308 DOI: 10.3389/fneur.2020.00890] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Damiana Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Marta Matamala-Gomez
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Sara Bottiroli
- Giustino Fortunato University, Benevento, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Maria Tiziana Corasaniti
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.,School of Hospital Pharmacy, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Roberto De Icco
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giacinto Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
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83
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The Impact of Implementing a Namaste Care Intervention in UK Care Homes for People Living with Advanced Dementia, Staff and Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17166004. [PMID: 32824847 PMCID: PMC7459821 DOI: 10.3390/ijerph17166004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
Care homes can struggle to provide optimal care for residents with advanced dementia. Namaste Care provides a structured daily programme of physical, sensory and emotional care delivered by regular care workers. A three-year, mixed method process study of implementation and impact created a manualised Namaste Care Intervention for UK care homes (NCI-UK). This article reports on the impact of NCI-UK delivered consistently in five care homes for 12–24 weeks. Impact for residents was assessed using, pre-post data, showing significant positive effects for QUALID (t = 2.92, p = 0.01, n = 31) and CMAI (t = 3.31, p = 0.002, n = 32), alongside many qualitative examples of positive impacts on wellbeing, responsiveness and communication. Pre-post staff questionnaire data (n = 20) were not significant. Qualitative data indicated that NCI-UK is a positive staff experience, providing sense of purpose, improved wellbeing and relationships. The care homes reported benefiting from implementing NCI-UK in terms of reputation and quality improvement. Family interviews were also positive, relating to seeing the difference, improving relationships and being involved. NCI-UK can therefore be recommended as an impactful intervention for residents, staff and families.
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84
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Comorbid Pain and Cognitive Impairment in a Nationally Representative Adult Population. Clin J Pain 2020; 36:725-739. [DOI: 10.1097/ajp.0000000000000863] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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85
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Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions. Pain Manag Nurs 2020; 22:36-43. [PMID: 32680825 DOI: 10.1016/j.pmn.2020.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD). AIMS Examine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population. DESIGN Analysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data. SETTINGS/PARTICIPANTS 6,153 patients ≥65 years receiving care from a nonprofit HH agency in 2017. METHODS Study outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission. RESULTS Patients with ADRD (n = 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] = 1.35, p = .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD. CONCLUSIONS HH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.
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86
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[Pain and pain management in old age: special features and recommendations]. Z Gerontol Geriatr 2020; 54:507-512. [PMID: 32676737 DOI: 10.1007/s00391-020-01765-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pain is highly prevalent in older persons and has a variety of causes. In geriatric patients, especially in patients with dementia, pain is often not sufficiently recognized and therefore frequently remains untreated. For the affected patient group this can have far-reaching consequences for their functional and cognitive abilities and may consequently lead to loss of autonomy. OBJECTIVE Existing deficits of pain assessment for geriatric patients are described, with a primary focus on those patients suffering from cognitive impairments and pain. In addition, the influence of multimorbidity on pain management in old age is considered in detail. METHODS The diagnostics and measurement of pain in older individuals are described based on recent literature and corresponding instruments used in the assessment of pain are outloned. The authors pay special attention to the possibilities of pain measurement in patients with higher grade cognitive impairments and non-communicative patients. CONCLUSION A standardized pain assessment should be an integral component in the care and treatment of geriatric patients and individuals suffering from dementia. Validated instruments for pain measurement exist for both groups and should be integrated into daily clinical practice.
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87
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Morrison RA, Jesdale BM, Dubé CE, Nunes AP, Bova CA, Liu SH, Lapane KL. Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment. Dement Geriatr Cogn Disord 2020; 49:243-251. [PMID: 32610321 PMCID: PMC7704920 DOI: 10.1159/000508096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment. METHODS The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010-2016, n = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs. RESULTS Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93-0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85-0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment. CONCLUSIONS The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners' perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.
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Affiliation(s)
- Reynolds A Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carol A Bova
- School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA,
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88
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Lapane KL, Hume AL, Morrison RA, Jesdale BM. Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain. Eur J Clin Pharmacol 2020; 76:1021-1028. [PMID: 32363421 PMCID: PMC7306024 DOI: 10.1007/s00228-020-02878-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity. METHODS Medicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis. RESULTS Of these residents, 27.9% reported mild pain, 46.6% moderate pain, and 25.6% reported severe pain. The prevalence of residents in pain without Part D claims for prescribed analgesic and/or adjuvant medications was 47.3% among those reporting mild pain, 35.7% among those with moderate pain, and 24.8% among those in severe pain. Among residents reporting severe pain, 33% of those ≥ 85 years of age and 35% of those moderately cognitively impaired received no prescription analgesics/adjuvants. Use of all classes of prescribed analgesics and adjuvants increased with resident-reported pain severity, and the concomitant use of medications from multiple classes was common. CONCLUSION Among nursing home residents with recognized pain, opportunities to improve the pharmacologic management of pain, especially among older residents, and those living with cognitive impairments exist.
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Affiliation(s)
- Kate L Lapane
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Anne L Hume
- Department of Family Medicine, Alpert Medical School, Brown University, Memorial Hospital of Rhode Island, Providence, RI, 02903, USA
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA
| | - Reynolds A Morrison
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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89
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Time Trends in Opioid Use by Dementia Severity in Long-Term Care Nursing Home Residents. J Am Med Dir Assoc 2020; 22:124-131.e1. [PMID: 32605815 DOI: 10.1016/j.jamda.2020.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Current information on opioid use in nursing home residents, particularly those with dementia, is unknown. We examined the temporal trends in opioid use by dementia severity and the association of dementia severity with opioid use in long-term care nursing home residents. DESIGN Repeated measures cross-sectional study. SETTING Long-term care nursing homes. PARTICIPANTS Using 20% Minimum Data Set (MDS) and Medicare claims from 2011-2017, we included long-term care residents (n = 734,739) from each year who had 120 days of consecutive stay. In a secondary analysis, we included residents who had an emergency department visit for a fracture (n = 12,927). MEASUREMENTS Dementia was classified as no, mild, moderate, and severe based on the first MDS assessment each year. In the 120 days of nursing home stay, opioid use was measured as any, prolonged (>90 days), and high-dose (≥90 morphine milligram equivalent dose/day). For residents with a fracture, opioid use was measured within 7 days after emergency department discharge. Association of dementia severity with opioid use was evaluated using logistic regression. RESULTS Overall, any opioid use declined by 8.5% (35.2% to 32.2%, P < .001), prolonged use by 5.0% (14.1% to 13.4%, P < .001), and high-dose by 21.4% (1.4% to 1.1%, P < .001) from 2011 to 2017. Opioid use declined across 4 dementia severity groups. Among residents with fracture, opioid use declined by 9% in mild, 9.5% in moderate, and 12.3% in severe dementia. The odds of receiving any, prolonged, and high-dose opioids decreased with increasing severity of dementia. For example, severe dementia reduced the odds of any [23.5% vs 47.6%; odds ratio (OR) 0.56, 95% confidence interval (CI) 0.55-0.57], prolonged (9.8% vs 20.7%; OR 0.69, 95% CI 0.67-0.71), and high-dose (1.0% vs 2.3%; OR 0.69, 95% CI 0.63-0.74) opioids. CONCLUSIONS AND IMPLICATIONS Use of opioids declined in nursing home residents from 2011 to 2017, and the use was lower in residents with dementia, possibly reflecting suboptimal pain management in this population.
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90
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Bullock L, Chew-Graham CA, Bedson J, Bartlam B, Campbell P. The challenge of pain identification, assessment, and management in people with dementia: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101040. [PMID: 32457099 PMCID: PMC7330220 DOI: 10.3399/bjgpopen20x101040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Painful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pain management for community-dwelling people with dementia. AIM To explore pain identification, assessment, and management for community-dwelling people with dementia. DESIGN & SETTING A qualitative study was undertaken, set in England. METHOD Semi-structured interviews took place with people with dementia, family caregivers, GPs, and old-age psychiatrists. Data were analysed thematically. RESULTS Interviews were conducted with eight people with dementia, nine family caregivers, nine GPs, and five old-age psychiatrists. Three themes were identified that related to pain identification and assessment: gathering information to identify pain; the importance of knowing the person; and the use of pain assessment tools. A further three themes were identified that related to pain management: non-drug strategies; concerns related to analgesic medications; and responsibility of the caregiver to manage pain. CONCLUSION Identifying and assessing the pain experienced by people with dementia was challenging. Most people with dementia, family caregivers, and healthcare professionals supported non-drug strategies to manage pain. The minimal concerns associated with non-drug strategies contrasted the multifactorial concerns associated with analgesic treatment for people with dementia. Given the complexity of pain identification, assessment, and management, primary care should work together with family caregivers and community services, with case finding for pain being considered in all assessment and management plans.
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Affiliation(s)
- Laurna Bullock
- School of Primary Community and Social Care, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- School of Primary Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, UK
| | - John Bedson
- School of Primary Community and Social Care, Keele University, Keele, UK
| | - Bernadette Bartlam
- School of Primary Community and Social Care, Keele University, Keele, UK
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University Singapore, Singapore, UK
| | - Paul Campbell
- School of Primary Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, UK
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91
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Ersek M, Neradilek MB, Herr K, Hilgeman MM, Nash P, Polissar N, Nelson FX. Psychometric Evaluation of a Pain Intensity Measure for Persons with Dementia. PAIN MEDICINE 2020; 20:1093-1104. [PMID: 30204895 DOI: 10.1093/pm/pny166] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The goal of this study was to conduct initial psychometric analyses of a seven-item pain intensity measure for persons with dementia (PIMD) that was developed using items from existing pain observational measures. DESIGN AND METHODS We evaluated validity by examining associations with an expert clinician's pain intensity rating (ECPIR) and an established pain observation tool (Mobilization Observation Behaviour Intensity Dementia [MOBID]). We also examined correlations between the PIMD and known correlates of pain: depression, sleep disturbances, agitation, painful diagnoses, and caregiver pain reports. We examined the differences between PIMD scores for "at rest" and "during movement" observations. We assessed reliability by calculating Cronbach's alpha and estimating inter-rater reliability using intraclass correlations (ICCs). Finally, we examined whether six additional "recent changes in behavior" items improved the PIMD's ability to predict expert clinicians' pain ratings. SETTING Sixteen nursing homes located in Alabama, Georgia, Pennsylvania, and New Jersey. PARTICIPANTS One hundred ninety residents with moderate to severe cognitive impairment, mean age of 84 years, 49.5% female, and 70% white. RESULTS PIMD during movement scores were highly correlated with the ECPIR and overall MOBID scores. As expected, there were large differences between at rest and during movement PIMD scores. Associations of PIMD with known correlates of pain were generally low and statistically nonsignificant. Internal consistency was supported with a Cronbach alpha of 0.72 and an inter-rater ICC of 0.82 for during movement PIMD scores. CONCLUSIONS Initial evaluation of the PIMD supports its validity and reliability. Additional testing is needed to evaluate the tool's sensitivity to changes in pain intensity.
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Affiliation(s)
- Mary Ersek
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Michelle M Hilgeman
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama.,Department of Psychology, Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Nayak Polissar
- The Mountain-Whisper-Light Statistics, Seattle, Washington
| | - Francis X Nelson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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92
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Ding J, Johnson CE, Lee YCO, Gazey A, Cook A. Characteristics of People with Dementia vs Other Conditions on Admission to Inpatient Palliative Care. J Am Geriatr Soc 2020; 68:1825-1833. [PMID: 32329901 DOI: 10.1111/jgs.16458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care-related problems to patients with other chronic diseases. DESIGN Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018). SETTING A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration. PARTICIPANTS A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862). MEASUREMENTS This study reported the data collected at the time of admission to inpatient palliative care services including patients' self-rated levels of distress from seven common physical symptoms, clinician-rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases. RESULTS At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND. CONCLUSION The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825-1833, 2020.
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Affiliation(s)
- Jinfeng Ding
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Claire E Johnson
- Monash Nursing and Midwifery, Monash University, Clayton, Australia.,Supportive and Palliative Care, Eastern Health, Victoria, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Australia
| | | | - Angela Gazey
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
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93
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Ersek M, Nash PV, Hilgeman MM, Neradilek MB, Herr KA, Block PR, Collins AN. Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment. J Am Geriatr Soc 2020; 68:794-802. [PMID: 31868921 PMCID: PMC9460938 DOI: 10.1111/jgs.16293] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To examine the frequency and severity of pain and use of pain therapies among long-term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity. DESIGN Prospective individual data were collected over 1 to 3 days for each participant. SETTING Sixteen long-term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. PARTICIPANTS Residents with moderate to severe cognitive impairment residing in a long-term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years). MEASUREMENTS A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep). RESULTS Experts' pain evaluations indicated that residents' usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week. CONCLUSION Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week. J Am Geriatr Soc 68:794-802, 2020.
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Affiliation(s)
- Mary Ersek
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Administration (VA) Medical Center, Philadelphia, Pennsylvania
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Princess V. Nash
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama
| | - Michelle M. Hilgeman
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama
- Department of Psychology and the Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington
| | - Keela A. Herr
- The University of Iowa College of Nursing, Iowa City, Iowa
| | - Phoebe R. Block
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama
- Department of Psychology and the Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama
| | - Amber N. Collins
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama
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94
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Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995) 2020; 48:37-47. [PMID: 31825689 DOI: 10.1080/21548331.2019.1703707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Center for Palliative Medicine & Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Center for Palliative Medicine & Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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95
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Lintula E, Tiihonen M, Taipale H, Tolppanen AM, Tanskanen A, Tiihonen J, Hartikainen S, Hamina A. Opioid Use After Hospital Care due to Hip Fracture Among Community-Dwelling Persons With and Without Alzheimer's Disease. Drugs Aging 2020; 37:193-203. [PMID: 31879863 PMCID: PMC7044157 DOI: 10.1007/s40266-019-00734-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hip fractures are common among persons with Alzheimer's disease (AD), but problems in pain assessment may lead to insufficient analgesia after hospitalization. OBJECTIVE We investigated the prevalence of opioid use in the 6 months after discharge from hospital care due to hip fracture among community-dwellers with and without AD. SETTING AND METHOD The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, consisting of all community-dwelling persons newly diagnosed with AD during 2005-2011 in Finland and their comparison persons without AD matched on age, sex, and region of residence at the time of AD diagnosis. Data were collected from nationwide healthcare registers. MAIN OUTCOME MEASURES We investigated opioid use versus non-use in persons with and without AD in the 6 months after discharge from hospital care due to hip fracture. RESULTS Altogether 2342 persons with AD and 1615 persons without AD, discharged to community settings within ≤ 120 days after a hip fracture, were included. A higher percentage of persons with AD used opioids compared to those without AD, 39.5% [95% confidence interval (CI) 37.5-41.5] versus 31.2% (95% CI 28.9-33.5). Persons with AD used more frequently strong opioids during the first 3 months and buprenorphine during the 6-month period, and used weak opioids less frequently after the first month after discharge compared to those without AD. CONCLUSIONS Frequent opioid use after hospital care due to hip fracture may indicate increased attention to pain among persons with AD. Nevertheless, the benefits and harms of opioid use should be evaluated regularly in community-dwelling older persons.
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Affiliation(s)
- Eveliina Lintula
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland.
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland.
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Niuvankuja 65, 70240, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Niuvankuja 65, 70240, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Niuvankuja 65, 70240, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
| | - Aleksi Hamina
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
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96
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Krupic F, Grbic K, Senorski EH, Lepara O, Fatahi N, Svantesson E. Experience of Intensive Care Nurses in Assessment of Postoperative Pain in Patients with Hip Fracture and Dementia. Mater Sociomed 2020; 32:50-56. [PMID: 32410892 PMCID: PMC7219725 DOI: 10.5455/msm.2020.32.50-56] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Patients with hip fracture are one of the most demanding groups in the health-care system. One of the most important tasks for nurses is to assess pain and ensure the patients are pain free. Pain assessment in patients with dementia is a well-known challenge for health-care professionals due to the patients’ difficulties in verbalising pain problems. Aim: The aim of this study was to explore the experience of intensive care nurses in assessment of pain in patients with hip fracture and dementia in the postoperative setting. Methods: Data were collected through five focus group discussions using open-ended questions and qualitative content analysis. Twenty-one intensive care nurses (6 men and 15 women) participated in the focus group interviews. Results: Analysis of the data resulted in three main categories: “Communication”, “Visual assessment of pain”, and “Practical issues” including a number of subcategories. Some of the factors which influence assessment of pain in patients with dementia are the lack of information and knowledge about the patients, which causes loss of time and increased stress. The different forms of communication and ways of assessing pain in these patients were other factors mentioned by nurses as hindrances regarding assessment of the pain. Conclusion: In order to improve assessment of pain, more knowledge and information about the patients are needed and better coordination between the pre- and postoperative departments regarding these patients. In this context, different intervention studies on patient’s hip fracture and dementia are needed to increase knowledge and awareness regarding this group of patients.
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Affiliation(s)
- Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesiology. Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kemal Grbic
- Clinical of Thoracic Surgery, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Eric Hamrin Senorski
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Orhan Lepara
- Department of Human Physiology, Shool of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nabi Fatahi
- Department of Learning and Ledarship for Health care Professionals, Sahlgrenska Akademin at University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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MacNeil-Vroomen JL, Nagurney JM, Allore HG. Comorbid conditions and emergency department treat and release utilization in multimorbid persons with cognitive impairment. Am J Emerg Med 2020; 38:127-131. [PMID: 31337598 PMCID: PMC6917961 DOI: 10.1016/j.ajem.2019.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND There is an increasing focus in the emergency department (ED) on addressing the needs of persons with cognitive impairment, most of whom have multiple chronic conditions. We investigated which common comorbidities among multimorbid persons with cognitive impairment conferred increased risk for ED treat and release utilization. METHODS We examined the association of 16 chronic conditions on use of ED treat and release visit utilization among 1006 adults with cognitive impairment and ≥ 2 comorbidities using the nationally-representative National Health and Aging Trends Study merged with Fee-For-Service Medicare claims data, 2011-2015. RESULTS At baseline, 28.5% had ≥6 conditions and 35.4% were ≥ 85 years old. After controlling for sex, age, race, education, urban-living, number of disabled activities of daily living, and sampling strata, we found significantly increased adjusted risk ratios (aRR) of ED treat and release visits for persons with depression (aRR 1.38 95% CI 1.15-1.65) representing 78/100 person-years, and osteoarthritis or rheumatoid arthritis (aRR 1.32 95% CI 1.12-1.57) representing 71/100 person-years. At baseline 93.9% had ≥1 informal caregiver and 69.7% had a caregiver that helped with medications or attended physician visits. CONCLUSION These results show that multimorbid cognitively impaired older adults with depression or osteoarthritis or rheumatoid arthritis are at higher risk of ED treat and release visits. Future ED research with multimorbid cognitively impaired persons may explore behavioral aspects of depression and/or pain and flairs associated with osteoarthritis or rheumatoid arthritis, as well as the role of informal caregivers in the care of these conditions.
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Affiliation(s)
- Janet L MacNeil-Vroomen
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven 06511, CT, United States of America; Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam 110Z AZ, the Netherlands.
| | - Justine M Nagurney
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston 02215-5321, MA, United States of America
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven 06511, CT, United States of America; Department of Biostatistics, Yale School of Public Health, New Haven 06511, CT, United States of America
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98
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Abstract
The ageing revolution is changing the composition of our society with more people becoming very old with higher risks for developing both pain and dementia. Pain is normally signaled by verbal communication, which becomes more and more deteriorated in people with dementia. Thus, these individuals unnecessarily suffer from manageable but unrecognized pain. Pain assessment in patients with dementia is a challenging endeavor, with scientific advancements quickly developing. Pain assessment tools and protocols (mainly observational scales) have been incorporated into national and international guidelines of pain assessment in aged individuals. To effectively assess pain, interdisciplinary collaboration (nurses, physicians, psychologists, computer scientists, and engineers) is essential. Pain management in this vulnerable population is also preferably done in an interdisciplinary setting. Nonpharmacological management programs have been predominantly tested in younger populations without dementia. However, many of them are relatively safe, have proven their efficacy, and therefore deserve a first place in pain management programs. Paracetamol is a relatively safe and effective first-choice analgesic. There are many safety issues regarding nonsteroidal anti-inflammatory drugs, opioids, and adjuvant analgesics in dementia patients. It is therefore recommended to monitor both pain and potential side effects regularly. More research is necessary to provide better guidance for pain management in dementia.
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99
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Cantón-Habas V, Carrera-González MDP, Moreno-Casbas MT, Quesada-Gómez JM, Rich-Ruiz M. Correlation between biomarkers of pain in saliva and PAINAD scale in elderly people with cognitive impairment and inability to communicate: descriptive study protocol. BMJ Open 2019; 9:e032927. [PMID: 31712347 PMCID: PMC6858249 DOI: 10.1136/bmjopen-2019-032927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Pain is an under-diagnosed problem in elderly people, especially in those with cognitive impairment who are unable to verbalise their pain. Although the Pain assessment in advanced dementia scale (PAINAD) scale is a tool recognised for its clinical interest in this type of patients, its correlation with the saliva biomarkers reinforced its utility. The aim of this research will be to correlate the scores of this scale with the levels of biomarkers of pain found in saliva samples of patients with cognitive impairment and inability to communicate. METHODS AND ANALYSIS This is an observational study. The level of pain will be evaluated using the PAINAD scale. Moreover, pain biomarkers, in particular secretory IgA and soluble tumour necrosis factor receptor type II, will be determined in saliva. Both assessments will be conducted in 75 patients aged over 65 years with advanced cognitive impairment and inability to communicate. The PAINAD scores will be correlated with the levels of these biomarkers of pain. A control group consisting of 75 healthy subjects aged over 65 years will be included in the study. Moreover, sociodemographic variables and variables related to pain, dementia and other clinical conditions will be recorded. The analysis will be performed with the statistical package SPSS V.22 and the software R. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Andalusian Human Research Ethics Committee. In addition, this study has been financed by the Junta de Andalucía through a regional health research fund (Research code: PI-0357-2017). The results will be actively disseminated trough a high-impact journal in our study area, conference presentations and social media.
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Affiliation(s)
- Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica (IMIBIC)/ Universidad de Córdoba/ Hospital Universitario Reina Sofía, University of Cordoba, Cordoba, Spain
| | - María Del Pilar Carrera-González
- Instituto Maimónides de Investigación Biomédica (IMIBIC)/ Universidad de Córdoba/ Hospital Universitario Reina Sofía, University of Cordoba, Cordoba, Spain
| | - María Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Ministry of Science and Innovation, Madrid, Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - José Manuel Quesada-Gómez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) & Unidad de Gestión Clínica (UGC) de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica (IMIBIC)/ Universidad de Córdoba/ Hospital Universitario Reina Sofía, University of Cordoba, Cordoba, Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
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Cao S, Fisher DW, Yu T, Dong H. The link between chronic pain and Alzheimer's disease. J Neuroinflammation 2019; 16:204. [PMID: 31694670 PMCID: PMC6836339 DOI: 10.1186/s12974-019-1608-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic pain often occurs in the elderly, particularly in the patients with neurodegenerative disorders such as Alzheimer's disease (AD). Although studies indicate that chronic pain correlates with cognitive decline, it is unclear whether chronic pain accelerates AD pathogenesis. In this review, we provide evidence that supports a link between chronic pain and AD and discuss potential mechanisms underlying this connection based on currently available literature from human and animal studies. Specifically, we describe two intertwined processes, locus coeruleus noradrenergic system dysfunction and neuroinflammation resulting from microglial pro-inflammatory activation in brain areas mediating the affective component of pain and cognition that have been found to influence both chronic pain and AD. These represent a pathological overlap that likely leads chronic pain to accelerate AD pathogenesis. Further, we discuss potential therapeutic interventions targeting noradrenergic dysfunction and microglial activation that may improve patient outcomes for those with chronic pain and AD.
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Affiliation(s)
- Song Cao
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Street, Zunyi, 56300, Guizhou, China
- Guizhou Key Lab of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, 149 Dalian Street, Zunyi, 56300, Guizhou, China
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Daniel W Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Tain Yu
- Guizhou Key Lab of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, 149 Dalian Street, Zunyi, 56300, Guizhou, China
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA.
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