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Martorella G, Miao H, Wang D, Park L, Mathis K, Park J, Sheffler J, Granville L, Teixeira AL, Schulz PE, Ahn H. Feasibility, Acceptability, and Efficacy of Home-Based Transcranial Direct Current Stimulation on Pain in Older Adults with Alzheimer's Disease and Related Dementias: A Randomized Sham-Controlled Pilot Clinical Trial. J Clin Med 2023; 12:401. [PMID: 36675330 PMCID: PMC9860690 DOI: 10.3390/jcm12020401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023] Open
Abstract
Although transcranial direct current stimulation (tDCS) is emerging as a convenient pain relief modality for several chronic pain conditions, its feasibility, acceptability, and preliminary efficacy on pain in patients with Alzheimer's disease and related dementias (ADRD) have not been investigated. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary efficacy of 5, 20-min home-based tDCS sessions on chronic pain in older adults with ADRD. We randomly assigned 40 participants to active (n = 20) or sham (n = 20) tDCS. Clinical pain intensity was assessed using a numeric rating scale (NRS) with patients and a proxy measure (MOBID-2) with caregivers. We observed significant reductions of pain intensity for patients in the active tDCS group as reflected by both pain measures (NRS: Cohen's d = 0.69, p-value = 0.02); MOBID-2: Cohen's d = 1.12, p-value = 0.001). Moreover, we found home-based tDCS was feasible and acceptable intervention approach for pain in ADRD. These findings suggest the need for large-scale randomized controlled studies with larger samples and extended versions of tDCS to relieve chronic pain on the long-term for individuals with ADRD.
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Affiliation(s)
| | - Hongyu Miao
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
- Department of Statistics, Florida State University, Tallahassee, FL 32306, USA
| | - Duo Wang
- Department of Statistics, Florida State University, Tallahassee, FL 32306, USA
| | - Lindsey Park
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Kenneth Mathis
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - JuYoung Park
- Phyllis & Harvey Sandler School of Social Work, Florida Atlantic University College of Social Work and Criminal Justice, Boca Raton, FL 33431, USA
| | - Julia Sheffler
- College of Medicine, Florida State University, Tallahassee, FL 32306, USA
| | - Lisa Granville
- College of Medicine, Florida State University, Tallahassee, FL 32306, USA
| | - Antonio L. Teixeira
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Paul E. Schulz
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Hyochol Ahn
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
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Porter LS, Weiner DK, Ramos K, Barnes DE, Schmader KE, Gwyther L, Ritchie CS, Keefe FJ. Partnering to cope with pain: A pilot study of a caregiver-assisted pain coping skills intervention for patients with cognitive impairment and dementia. Palliat Support Care 2022; 20:785-793. [PMID: 36942584 PMCID: PMC10032330 DOI: 10.1017/s1478951521001747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability. METHOD In Phase I, we conducted interviews with 10 patient-caregiver dyads to gather feedback about intervention content and delivery. Phase II was a single-arm pilot test to evaluate the intervention's feasibility and acceptability. Dyads in the pilot study (n = 11) completed baseline surveys, received five intervention sessions, and then completed post-intervention surveys. Analyses focused on feasibility and acceptability. RESULTS Dyads responded positively to the pain coping skills presented in the interviews; their feedback was used to refine the intervention. Findings from the pilot study suggested that the intervention was feasible and acceptable. 69% of eligible dyads consented, 82% completed all five intervention sessions, and 100% completed the post-treatment assessment. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis, and that they found most of the skills helpful and easy to use. SIGNIFICANCE OF RESULTS These preliminary findings suggest that a caregiver-assisted pain coping skills intervention is feasible and acceptable, and that it may be a promising approach to managing pain in patients with cognitive impairment.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Katherine Ramos
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Deborah E Barnes
- University of San Francisco, UCSF Weill Institute for Neurosciences, San Francisco, CA
| | - Kenneth E Schmader
- Department of Medicine, Duke University School of Medicine and GRECC, Durham VA Medical Center, Durham, NC
| | - Lisa Gwyther
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Christine S Ritchie
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Francis J Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Husebo BS, Vislapuu M, Cyndecka MA, Mustafa M, Patrascu M. Understanding Pain and Agitation Through System Analysis Algorithms in People With Dementia. A Novel Explorative Approach by the DIGI.PAIN Study. FRONTIERS IN PAIN RESEARCH 2022; 3:847578. [PMID: 35369536 PMCID: PMC8970316 DOI: 10.3389/fpain.2022.847578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMany people with dementia (PwD) live and die with undiagnosed and untreated pain and are no longer able to report their suffering. Several pain assessment tools have been developed, tested, and implemented in clinical practice, but nursing home patients are reported to be still in pain. Clinicians and research groups worldwide are seeking novel approaches to encode the prediction, prevalence, and associations to pain in PwD.ParticipantsThe data in this analysis are acquired from the COSMOS study, a cluster-randomized controlled trial (2014 to 2015), aimed to improve the quality of life in nursing home patients (N = 723) through the implementation of a multicomponent intervention. We utilize baseline data of PwD (N = 219) with complete datasets of pain and agitation.MethodSystems analysis explores the relationship between pain and agitation using the Mobilization-Observation-Behavior-Intensity-Dementia (MOBID-2) Pain Scale, Cohen-Mansfield Agitation Inventory (CMAI), and Neuropsychiatric Inventory-Nursing Home version (NPI-NH). For each patient, the individualized continuous time trajectory, and rates of change of pain and agitation are estimated. We determine the relationship between these rates by analyzing them across the entire group.ResultsWe found that the new analysis method can generate individualized estimations for pain and agitation evolution for PwD, as well as their relationship. For 189 of 219 PwD, results show that whenever pain increases or decreases, agitation does too, with the same rate. The method also identifies PwD for whom pain or agitation remains constant while the other varies over time, and patients for whom agitation and pain do not change together. The algorithm is scalable to other variables and compatible with wearable devices and digital sensors.ConclusionWe presented a new approach to clinical data analysis using systems concepts and algorithms. We found that it is possible to quantify and visualize relationships between variables with a precision only dependent on the precision of measurements. This method should be further validated, but incipient results show great potential, especially for wearable-generated continuous data.
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Affiliation(s)
- Bettina S. Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Department of Nursing Home Medicine, Bergen, Norway
- *Correspondence: Bettina S. Husebo
| | - Maarja Vislapuu
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | | | - Manal Mustafa
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Monica Patrascu
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Complex Systems Laboratory, Department of Automatic Control and System Engineering, University Politehnica of Bucharest, Bucharest, Romania
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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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Agit A, Balci C, Yavuz BB, Cankurtaran E, Kuyumcu ME, Halil M, Arıogul S, Cankurtaran M. An Iceberg Phenomenon in Dementia: Pain. J Geriatr Psychiatry Neurol 2018; 31:186-193. [PMID: 29966466 DOI: 10.1177/0891988718785765] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pain is one of the most frequent symptoms in older adults. It severely impairs quality of life, increases delirium risk, and may lead to progression of dementia. Assessment of pain performed by taking anamnesis from the patient is not reliable in patients with dementia due to cooperation and communication problems. The aim of this study was to assess pain and its consequences in patients with dementia. METHODS Seventy-five nursing home residents with dementia were enrolled. After comprehensive geriatric assessment, presence of pain was asked to patients, and Pain Assessment in Advanced Dementia (PAINAD), Discomfort Scale for Dementia of the Alzheimer's Type (DS-DAT), Pain Assessment for the Dementing Elderly (PADE), Wong-Baker Faces Pain Rating Scale, and Numeric Rating Scale tests were performed. RESULTS Mean age was 81.1 (7.0), and 46.7% (n = 35) were female. Thirty-two percent of the patients were at early stage, 24% at moderate stage, and 44% at severe stage. Although the number of patients declaring pain was lower in moderate and severe stage, scores of PADE, PAINAD, and DS-DAT were significantly higher in severe stage showing the presence of pain ( P < .001). Furthermore, scores of PADE, PAINAD, and DS-DAT were negatively correlated with comprehensive geriatric assessment test scores. CONCLUSION These results demonstrate that pain is not rare in patients with dementia, but they are not usually capable of expressing it, especially in the severe stage. Therefore, objective pain assessment scales developed for patients with dementia should be routinely used and management of pain should be done regarding the association of pain with other geriatric syndromes.
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Affiliation(s)
- Abdullah Agit
- 1 Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balci
- 2 Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Yavuz
- 2 Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Eylem Cankurtaran
- 3 Department of Psychiatry, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Emin Kuyumcu
- 2 Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Halil
- 2 Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Servet Arıogul
- 2 Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- 2 Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Petyaeva A, Kajander M, Lawrence V, Clifton L, Thomas AJ, Ballard C, Leroi I, Briggs M, Closs J, Dening T, Nunez KM, Testad I, Romeo R, Johar I, Corbett A. Feasibility of a staff training and support programme to improve pain assessment and management in people with dementia living in care homes. Int J Geriatr Psychiatry 2018; 33:221-231. [PMID: 28474837 DOI: 10.1002/gps.4727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study was to establish the feasibility and initial effectiveness of training and support intervention for care staff to improve pain management in people with dementia living in care homes (PAIN-Dem). METHODS PAIN-Dem training was delivered to care staff from three care homes in South London, followed by intervention support and resources to encourage improved pain management by staff over 4 weeks. Feasibility was assessed through fidelity to intervention materials and qualitative approaches. Focus group discussions with staff explored the use of the PAIN-Dem intervention, and interviews were held with six residents and family carers. Pain was assessed in all residents at baseline, 3 and 4 weeks, and goal attainment scaling was assessed at 4 weeks. RESULTS Delivery of training was a key driver for success and feasibility of the PAIN-Dem intervention. Improvements in pain management behaviour and staff confidence were seen in homes where training was delivered in a care home setting across the care team with good manager buy-in. Family involvement in pain management was highlighted as an area for improvement. Goal attainment in residents was significantly improved across the cohort, although no significant change in pain was seen. CONCLUSIONS This study shows good initial feasibility of the PAIN-Dem intervention and provides valuable insight into training and support paradigms that deliver successful learning and behaviour change. There is a need for a larger trial of PAIN-Dem to establish its impact on resident pain and quantifiable staff behaviour measures. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anya Petyaeva
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Martine Kajander
- Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lei Clifton
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Alan J Thomas
- Institute for Neuroscience, Newcastle University, Newcastle, UK
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.,Exeter University Medical School, University of Exeter, Exeter, UK
| | - Iracema Leroi
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Michelle Briggs
- Centre for Pain Research, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Jose Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Tom Dening
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Ingelin Testad
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.,Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway
| | - Renee Romeo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iskandar Johar
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.,Exeter University Medical School, University of Exeter, Exeter, UK
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Corbett A, Nunez KM, Smeaton E, Testad I, Thomas AJ, Closs SJ, Briggs M, Clifton L, Gjestsen MT, Lawrence V. The landscape of pain management in people with dementia living in care homes: a mixed methods study. Int J Geriatr Psychiatry 2016; 31:1354-1370. [PMID: 26898542 DOI: 10.1002/gps.4445] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/26/2015] [Accepted: 01/20/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study is to explore the current landscape of pain management in people with dementia living in care home settings. Pain is extremely common in this patient group, yet there is very limited guidance for healthcare professionals. METHODS Triangulation of stakeholder consultation and quality review of pain management guidance were performed. A review of existing pain management guidance was conducted using published quality criteria adapted for the field. Three focus group discussions were held with care home staff and two focus group discussions and an online survey with family carers. Data were subjected to thematic analysis to identify themes and sub-themes. Outcomes were reviewed by an expert panel, which gave recommendations. RESULTS Fifteen existing guidelines were identified, of which three were designed for use in dementia and none were tailored for care home settings. Thematic analysis revealed six major themes in current pain management in dementia: importance of person-centredness, current lack of pain awareness in staff, communication as a core element, disparities in staff responsibility and confidence, the need for consistency of care and current lack of staff training. In addition to the needs for practice, the expert panel identified promising pharmacological treatment candidates, which warrant clinical evaluation. CONCLUSIONS The findings of this study clearly articulate a need for an evidence-based pain management programme for care homes, which is informed by stakeholder input and based within a conceptual framework for this setting. There are novel opportunities for clinical trials of alternative analgesics for use in this patient group. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
| | | | - Emily Smeaton
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Ingelin Testad
- Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway
| | - Alan J Thomas
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - S Jose Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Michelle Briggs
- Centre for Pain Research, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Lei Clifton
- Centre for Statistics in Medicine (CSM), University of Oxford, UK
| | | | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Husebo BS, Achterberg W, Flo E. Identifying and Managing Pain in People with Alzheimer's Disease and Other Types of Dementia: A Systematic Review. CNS Drugs 2016; 30:481-97. [PMID: 27240869 PMCID: PMC4920848 DOI: 10.1007/s40263-016-0342-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Pain in patients with Alzheimer's disease is a complex issue; these patients suffer from the common causes of acute and chronic pain, and some also have neuropathic or nociceptive pain. Whatever the mechanism of pain in these patients, their pain will require careful assessment and management, to insure the correct type and level of analgesia is given. The objective of this systematic review was the identification of studies that have investigated the efficacy of different analgesics on pain intensity or pain-related behavior during nursing home stay and at the end of life. METHODS A search using pain, pain treatment, and dementia MESH terms and keywords was conducted (October 15, 2015) in MEDLINE, EMBASE, PsychINFO, CINAHL, and Cochrane libraries. RESULTS Our search yielded 3138 unique hits, published between 1990 and October 2015. We read titles and abstracts, identified 124 papers for full-text evaluation, and included 12 papers to reflect and synthesize the following questions: (1) Which pain assessment tools for people with dementia are responsive to change in pain intensity scores? (2) Which analgesics are efficacy-tested by controlled trials including people with dementia living in nursing homes, including at the end of life? (3) Which outcome measures have been used to identify pain, pain behavior, and/or treatment efficacy in people with dementia? CONCLUSION Despite increased use of analgesics, pain is still prevalent in people with dementia. Validated pain tools are available but not implemented and not fully tested on responsiveness to treatment. Official guidelines for pain assessment and treatment addressing people with dementia living in a nursing home are lacking. The efficacy of analgesic drug use on pain or neuropsychiatric behavior related to dementia has been hardly investigated.
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Affiliation(s)
- Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
- Section for Nursing Home Medicine, Municipality of Bergen, Bergen, Norway.
| | - Wilco 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, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth Flo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
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Husebo BS, Flo E, Aarsland D, Selbaek G, Testad I, Gulla C, Aasmul I, Ballard C. COSMOS--improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial. Implement Sci 2015; 10:131. [PMID: 26374231 PMCID: PMC4572450 DOI: 10.1186/s13012-015-0310-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home patients have complex mental and physical health problems, disabilities and social needs, combined with widespread prescription of psychotropic drugs. Preservation of their quality of life is an important goal. This can only be achieved within nursing homes that offer competent clinical conditions of treatment and care. COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety (COSMOS) is an effectiveness-implementation hybrid trial that combines and implements organization of activities evidence-based interventions to improve staff competence and thereby the patients' quality of life, mental health and safety. The aim of this paper is to describe the development, content and implementation process of the COSMOS trial. METHODS/DESIGN COSMOS includes a 2-month pilot study with 128 participants distributed among nine Norwegian nursing homes, and a 4-month multicenter, cluster randomized effectiveness-implementation clinical hybrid trial with follow-up at month 9, including 571 patients from 67 nursing home units (one unit defined as one cluster). Clusters are randomized to COSMOS intervention or current best practice (control group). The intervention group will receive a 2-day education program including written guidelines, repeated theoretical and practical training (credited education of caregivers, physicians and nursing home managers), case discussions and role play. The 1-day midway evaluation, information and interviews of nursing staff and a telephone hotline all support the implementation process. Outcome measures include quality of life in late-stage dementia, neuropsychiatric symptoms, activities of daily living, pain, depression, sleep, medication, cost-utility analysis, hospital admission and mortality. DISCUSSION Despite complex medical and psychosocial challenges, nursing home patients are often treated by staff possessing low level skills, lacking education and in facilities with a high staff turnover. Implementation of a research-based multicomponent intervention may improve staff's knowledge and competence and consequently the quality of life of nursing home patients in general and people with dementia in particular. TRIAL REGISTRATION ClinicalTrials.gov NCT02238652.
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Affiliation(s)
- Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly - and Nursing Home Medicine, University of Bergen, Kalfarveien 31, N-5020, Bergen, Norway.
- Centre for Elderly and Nursing Home Medicine, Stavanger University Hospital, Stavanger, Norway.
| | - Elisabeth Flo
- Department of Global Public Health and Primary Care, Centre for Elderly - and Nursing Home Medicine, University of Bergen, Kalfarveien 31, N-5020, Bergen, Norway.
| | - Dag Aarsland
- Centre for Elderly and Nursing Home Medicine, Stavanger University Hospital, Stavanger, Norway.
- Karolinska Institutet (KI), Department of Neurobiology, Care Sciences and Society, KI-Alzheimer Disease Research Center, Stockholm, Sweden.
| | - Geir Selbaek
- Norwegian National Advisory Unit of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway.
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ingelin Testad
- Centre for Elderly and Nursing Home Medicine, Stavanger University Hospital, Stavanger, Norway.
| | - Christine Gulla
- Department of Global Public Health and Primary Care, Centre for Elderly - and Nursing Home Medicine, University of Bergen, Kalfarveien 31, N-5020, Bergen, Norway.
| | - Irene Aasmul
- Department of Global Public Health and Primary Care, Centre for Elderly - and Nursing Home Medicine, University of Bergen, Kalfarveien 31, N-5020, Bergen, Norway.
| | - Clive Ballard
- Centre for Elderly and Nursing Home Medicine, Stavanger University Hospital, Stavanger, Norway.
- The Wolfson Wing & Hodgkin Building Guys Campus, Kings College, London, SE1 1UL, UK.
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Flo E, Gulla C, Husebo BS. Effective pain management in patients with dementia: benefits beyond pain? Drugs Aging 2015; 31:863-71. [PMID: 25373921 DOI: 10.1007/s40266-014-0222-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This current opinion aims to provide a literature overview of the associations between pain and neuropsychiatric symptoms and the efficacy of pain management for both pain and neuropsychiatric symptoms in patients with dementia. In addition, international guidelines and recommendations for pain management have been collated, and important developing research areas are highlighted. Pain is, in general, under-recognized and undertreated in people with dementia and may therefore trigger or exacerbate neuropsychiatric symptoms. While there is an abundance of pain assessment instruments intended for people with dementia, few have been adequately tested for their feasibility, reliability and validity. In patients with dementia, vocalizations, facial expressions and body movements may be the only valid expressions of pain. Further, pain has been related to the neuropsychiatric symptoms of agitation, aggression, mood syndrome and sleep problems. Unfortunately, health personnel may misinterpret these symptoms as neuropsychiatric symptoms of dementia. A differential assessment of dementia, its presenting neuropsychiatric symptoms and the potential presence of pain is crucial to provide the correct treatment. To achieve this, use of pain assessment tools that are responsive to change and are validated for use in patients with dementia is a prerequisite. To date, there have been few studies, with inconsistent findings on the association between pain and neuropsychiatric symptoms. To ensure a better differential assessment of pain and neuropsychiatric symptoms, and consequently more accurate treatment for patients with dementia, studies with adequate statistical power and high-quality study designs, including randomized controlled trials, are needed.
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Affiliation(s)
- Elisabeth Flo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Pbox 7800, 5020, Bergen, Norway,
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11
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van Dalen-Kok AH, Pieper MJC, de Waal MWM, Lukas A, Husebo BS, Achterberg WP. Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis. BMC Geriatr 2015; 15:49. [PMID: 25928621 PMCID: PMC4409739 DOI: 10.1186/s12877-015-0048-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/01/2015] [Indexed: 12/24/2022] Open
Abstract
Background Pain, neuropsychiatric symptoms (NPS) and functional impairment are prevalent in patients with dementia and pain is hypothesized to be causal in both neuropsychiatric symptoms (NPS) and functional impairment. As the exact nature of the associations is unknown, this review examines the strength of associations between pain and NPS, and pain and physical function in patients with dementia. Special attention is paid to the description of measurement instruments and the methods used to detect pain, NPS and physical function. Methods A systematic search was made in the databases of PubMed (Medline), Embase, Cochrane, Cinahl, PsychINFO, and Web of Science. Studies were included that described associations between pain and NPS and/or physical function in patients with moderate to severe dementia. Results The search yielded 22 articles describing 18 studies, including two longitudinal studies. Most evidence was found for the association between pain and depression, followed by the association between pain and agitation/aggression. The longitudinal studies reported no direct effects between pain and NPS but some indirect effects, e.g. pain through depression. Although some association was established between pain and NPS, and pain and physical function, the strength of associations was relatively weak. Interestingly, only three studies used an observer rating scale for pain-related behaviour. Conclusions Available evidence does not support strong associations between pain, NPS and physical function. This might be due to inadequate use or lack of rating scales to detect pain-related behaviour. These results show that the relationship between pain and NPS, as well as with physical function, is complicated and warrants additional longitudinal evaluation. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0048-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annelore H van Dalen-Kok
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands.
| | - Marjoleine J C Pieper
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands. .,Department of General Practice & Elderly Care Medicine, VU University Medical Centre Amsterdam, van der Boechorststraat 7, Amsterdam, BT, 1081, The Netherlands.
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands.
| | - Albert Lukas
- Malteser Hospital Bonn/Rhein-Sieg, Centre of Geriatric Medicine, Academic Hospital University of Bonn, Von-Hompesch-Straße 1, Bonn, 53123, Germany.
| | - Bettina S Husebo
- Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway. .,Stavanger University Hospital, Bergen, Norway.
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Hippocratespad 21 Post zone V0-P, PO Box 9600, Leiden, RC, 2300, The Netherlands.
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