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Kobayashi T, Igusa T, Uchida H, Tsuchiya K, Akiba T, Takahashi T, Taguchi M, Okada C, Yabuki H, Kanazawa Y, Kikuchi S, Hirao K. Reliability of the Two-dimensional Mood Scale for self-reported mood assessment by older adults with dementia. Geriatr Nurs 2024; 58:459-465. [PMID: 38941790 DOI: 10.1016/j.gerinurse.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
The purpose of this study was to evaluate the reliability of the Two-dimensional Mood Scale (TDMS) for mood assessment among older adults with dementia. The study included 100 elderly patients with dementia admitted to two hospitals. For each mood state measured by the TDMS, the intraclass correlation coefficient of agreement (ICCagreement) was calculated to evaluate test-retest reliability. Scores corresponding to the minimal detectable change (MDC) in each mood state at the individual level (MDCind) was also calculated to evaluate measurement error, while McDonald's omega was calculated to evaluate internal consistency. The TDMS ICC was 0.54 for vitality, 0.74 for stability, 0.70 for pleasure, and 0.55 for arousal. The MDCind was 6.89 for vitality, 5.88 for stability, 9.96 for pleasure, and 4.11 for arousal. McDonald's omega ranged from 0.60 to 0.84. The TDMS has generally acceptable reliability for the self-assessment of mood states by older adults with dementia.
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Affiliation(s)
- Takuya Kobayashi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Takumi Igusa
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Hiroyuki Uchida
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan; Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Takanari Akiba
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Tsuyoshi Takahashi
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Maya Taguchi
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Chihiro Okada
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Hasumi Yabuki
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Yukina Kanazawa
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Senichiro Kikuchi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan.
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Iversen WL, Cowan RL, Atalla S, Englehart SS, Gure TR, Moss KO, Ryan CM, Scharre DW, Wright KD, Monroe TB. Treating the most vulnerable: A discursive review of experimental pain in Alzheimer's disease. Nurs Open 2021; 9:942-949. [PMID: 34165251 PMCID: PMC8859087 DOI: 10.1002/nop2.922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
AIM The purpose of this manuscript is to summarize research on how experimental pain is experienced by adults with Alzheimer's disease (AD) and to translate results into implications for nurses. DESIGN This discursive review synthesizes the results of three previous research studies exploring experimental pain in adults with AD. METHODS Using a series of fictional clinical vignettes, the authors discuss how the results from three previous papers using acute experimental pain can potentially be translated into clinical practice. The authors also introduce the reader to the concept of research-related psychophysics using introductory definitions and concepts with the impetus to encourage other nurses to consider this research methodology. RESULTS Pain characteristics in AD that differ from cognitively intact controls must be explored to properly address pain in this population. Nurses are well positioned to address these issues in order to provide a high quality of care to adults with AD.
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Affiliation(s)
- Wm Larkin Iversen
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Ronald L Cowan
- Department of Psychiatry, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sebastian Atalla
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Sydney S Englehart
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Tanya R Gure
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Karen O Moss
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Claire M Ryan
- Vanderbilt Department of Psychiatry and Behavioral Sciences, Nashville, TN, USA
| | - Douglas W Scharre
- Department of Neurology, Division of Cognitive Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kathy D Wright
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Todd B Monroe
- The Ohio State University College of Nursing, The Ohio State University, Columbus, OH, USA
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Factors Affecting Participation in Physical Therapy During Posttraumatic Amnesia. Arch Phys Med Rehabil 2020; 102:378-385. [PMID: 32745545 DOI: 10.1016/j.apmr.2020.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the effect of agitation, cognitive impairment, fatigue, and pain on physical therapy participation and outcomes during posttraumatic amnesia (PTA) after traumatic brain injury (TBI). DESIGN Prospective longitudinal study. SETTING Inpatient rehabilitation hospital. PARTICIPANTS Participants (N=77) with moderate-to-severe TBI who were deemed to be experiencing PTA using the Westmead Post-Traumatic Amnesia Scale. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Pittsburgh Rehabilitation Participation Scale and time in therapy (min) were recorded twice daily after routine physical therapy sessions during PTA. The FIM-motor (select items related to physical therapy) score rated on admission and after emergence from PTA was used to calculate FIM-motor change. RESULTS Agitation was associated with lower participation in therapy. The presence of agitation and pain both predicted lower FIM-motor change at emergence from PTA. Higher levels of cognitive impairment and fatigue were also associated with lower participation and less time in therapy. CONCLUSIONS The presence of agitation, fatigue, pain, and cognitive impairment impede rehabilitation success during PTA. This study strengthens the case for implementing environmental and behavioral recommendations, such as conducting therapy earlier in the day within a familiar space (ie, on the ward) and tailoring session duration to patient needs. This is with the aim of minimizing fatigue, agitation, and pain, while promoting cognitive recovery and arousal during PTA to maximize physical gains. Further research is warranted to examine the factors associated with rehabilitation success across other therapeutic disciplines.
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Boon JT, Maxwell CA. Policy Opportunities to Support Family Caregivers Managing Pain in People with Dementia. Pain Manag Nurs 2020; 22:8-10. [PMID: 32690469 DOI: 10.1016/j.pmn.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey T Boon
- Vanderbilt University Medical Center, Nashville, TN, USA
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Lee SJ, Park MS, Choi YR, Chang SO. Concept Development of Identification of Discomfort for Nursing Home Patients With Advanced Dementia. Int J Nurs Knowl 2020; 32:274-285. [PMID: 31957245 DOI: 10.1111/2047-3095.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/31/2019] [Accepted: 01/09/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study is to clarify the concept of discomfort identification by concept development in the nursing home. METHODS The Schwartz-Barcott and Kim's hybrid model was used. FINDINGS The identification of discomfort can be explained as an interactive and confirmative process of sympathetically responding to patients with dementia's problem behavior expressions that communicate unmet needs. CONCLUSIONS The identification of discomfort has the potential to improve the detection of multidimensional discomfort related to nursing diagnosis as a holistic and patient-centered approach. IMPLICATION FOR NURSING PRACTICE The findings could help nursing home nurses have a better understanding of identification of discomfort and can improve nurses and interdisciplinary caregivers' knowledge for developing appropriate comfort caring activities.
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Affiliation(s)
- Su Jung Lee
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Min Sun Park
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Young-Rim Choi
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Sung Ok Chang
- Korea University College of Nursing, Seoul, Republic of Korea
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The Differentiation Between Pain and Discomfort: A Concept Analysis of Discomfort. Pain Manag Nurs 2019; 20:556-562. [DOI: 10.1016/j.pmn.2019.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 02/11/2019] [Accepted: 05/17/2019] [Indexed: 12/22/2022]
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Nowak T, Neumann-Podczaska A, Deskur-Śmielecka E, Styszyński A, Wieczorowska-Tobis K. Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia. Clin Interv Aging 2018; 13:1045-1051. [PMID: 29872283 PMCID: PMC5973322 DOI: 10.2147/cia.s157246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction In patients with dementia, observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare, and as a consequence pain is frequently underdiagnosed and undertreated in these types of subjects. Thus, the aim of the study was to assess analgesic treatment in nursing home residents with cognitive impairment and to delineate the relationship between pain and behavioral and psychological symptoms of dementia. Patients and methods The research was conducted in 2 nursing home facilities in Wielkopolska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen-Mansfield Agitation Inventory (CMAI). Thereafter, medical files related to drug prescriptions were analyzed. Results Analgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment and 7 individuals (7%) - as when needed pain treatment. A relationship was found between the APS and CMAI (r=0.45, p<0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p<0.001), and despite having a higher APS (p=0.001), this did not correlate with higher analgesia. Conclusion Our study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. In order to reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management are essential.
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Affiliation(s)
- Tomasz Nowak
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Ewa Deskur-Śmielecka
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Arkadiusz Styszyński
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Katarzyna Wieczorowska-Tobis
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
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Abstract
Pain in aging adults is a global health problem requiring a proactive and consistent assessment approach. Pain assessment is critical to detecting pain and developing a collaborative and adaptive pain management plan. Getting health providers to assess and measure pain even in older adults who are communicative and can self-report remains a challenge. Self-report is the best method for identifying pain. Using a validated pain assessment scale is key to evaluate pain intensity. This article discusses techniques to obtain self-report and describe appropriate self-report pain tools for a focused pain assessment and reassessment in adults in later life.
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Affiliation(s)
- Staja Q Booker
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, USA
| | - Keela A Herr
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, USA.
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Schaub C, Morin D, von Gunten A. L’agitation chez les personnes atteintes de démence : examen de la portée des connaissances et mise en perspective du phénomène selon la théorie du confort et le concept de l’attachement. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.125.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sources of Discomfort in Persons with Dementia: Scale and Initial Results. Behav Neurol 2015; 2015:732832. [PMID: 26180375 PMCID: PMC4491380 DOI: 10.1155/2015/732832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/20/2015] [Accepted: 06/07/2015] [Indexed: 12/03/2022] Open
Abstract
The Sources of Discomfort Scale (SODS) assesses discomfort manifestations based on source of discomfort, thus making it both distinct from and complementary to pain assessments for persons with dementia. Sources were categorized as pertaining to physical discomfort, to body position, and to environmental sources. Body position sources of discomfort were related to poor functional status and to pain. The SODS scores were not related to cognitive functioning, and sources of discomfort other than those pertaining to body position were not correlated with pain. This paper demonstrates a direct and enhanced method to detect the manifestations of discomfort separately from pain indicators in a population with advanced dementia. The determination of the source of discomfort has direct implications for intervention.
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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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Woodward MC. Pharmacological Treatment of Challenging Neuropsychiatric Symptoms of Dementia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2005.tb00348.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pieper MJ, van Dalen-Kok AH, Francke AL, van der Steen JT, Scherder EJ, Husebø BS, Achterberg WP. Interventions targeting pain or behaviour in dementia: a systematic review. Ageing Res Rev 2013; 12:1042-55. [PMID: 23727161 DOI: 10.1016/j.arr.2013.05.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Both pain and challenging behaviour are highly prevalent in dementia, and multiple studies show that some of these behaviours may be correlated. Pain, especially in non-communicative patients, can cause challenging behaviour, and treatment of pain therefore may have an effect on behaviour. This review aims to provide a comprehensive overview of the current state of evidence regarding the effectiveness of interventions targeting pain on the outcome behaviour, and interventions targeting behaviour on pain, in dementia. METHOD PubMed (MEDLINE), EMBASE, COCHRANE, CINAHL, PsychINFO and Web of Science were searched systematically. Studies were included if they focused on an intervention targeting a reduction in the person's distress, pain, and/or behaviour, and included adults with a main diagnosis of dementia. RESULTS Of a total of 893 potentially relevant publications that were identified, 16 publications met the inclusion criteria and were eligible for further analysis; 6 studies focused on a pain intervention targeting behaviour, 1 study focused on a behavioural intervention targeting pain, and 9 studies focused on an intervention targeting both pain and behaviour. CONCLUSION Available evidence suggests that (pain) interventions targeting behaviour, and (behavioural) interventions targeting pain are effective in reducing pain and behavioural symptoms in dementia.
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Ahn H, Horgas A. The relationship between pain and disruptive behaviors in nursing home residents with dementia. BMC Geriatr 2013; 13:14. [PMID: 23399452 PMCID: PMC3573898 DOI: 10.1186/1471-2318-13-14] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 02/05/2013] [Indexed: 11/23/2022] Open
Abstract
Background Nursing home residents with dementia gradually lose the ability to process information so that they are less likely to express pain in typical ways. These residents may express pain through disruptive behaviors because they cannot appropriately verbalize their pain experience. The objective of this study was to investigate the effect of pain on disruptive behaviors in nursing home residents with dementia. Methods This is a secondary analysis of the Minimum Data Set (MDS 2.0) assessment data on long-term care from the state of Florida. The data used in this study were the first comprehensive assessment data from NH residents with dementia aged 65 and older (N = 56,577) in Medicare- or Medicaid-certified nursing homes between January 1, 2009 and December 31, 2009. Variables examined were pain, wandering, aggression, agitation, cognitive impairment, activities of daily living impairments, and demographic characteristics. Ordinal logistic regression was used to evaluate the effect of pain on disruptive behaviors. Results Residents with more severe pain are less likely to display wandering behaviors (OR = .77, 95% CI for OR = [0.73, 0.81]), but more likely to display aggressive and agitated behaviors (OR = 1.04, 95% CI for OR = [1.01, 1.08]; OR = 1.17, 95% CI for OR = [1.13, 1.20]). Conclusions The relationship between pain and disruptive behaviors depends on the type of behaviors. Pain is positively correlated with disruptive behaviors that do not involve locomotion (e.g., aggression and agitation), but negatively related to disruptive behaviors that are accompanied by locomotion (e.g., wandering). These findings indicate that effective pain management may help to reduce aggression and agitation, and to promote mobility in persons with dementia.
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Affiliation(s)
- Hyochol Ahn
- Department of Adult and Elderly Nursing, College of Nursing, University of Florida, Gainesville, FL 32610-0197, USA.
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Jensen-Dahm C, Vogel A, Waldorff FB, Waldemar G. Discrepancy Between Self- and Proxy-Rated Pain in Alzheimer's Disease: Results from the Danish Alzheimer Intervention Study. J Am Geriatr Soc 2012; 60:1274-8. [DOI: 10.1111/j.1532-5415.2012.04036.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christina Jensen-Dahm
- Memory Disorders Research Group; Department of Neurology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | - Asmus Vogel
- Memory Disorders Research Group; Department of Neurology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
| | | | - Gunhild Waldemar
- Memory Disorders Research Group; Department of Neurology; Rigshospitalet, Copenhagen University Hospital; Copenhagen; Denmark
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Johnson R, Taylor C. Can playing pre-recorded music at mealtimes reduce the symptoms of agitation for people with dementia? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.12.700] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Clare Taylor
- Occupational Therapy, Bournemouth University, UK
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Little KG, Wilks SE. Psychometric evaluation of a proposed Alzheimer's aggression scale. Am J Alzheimers Dis Other Demen 2011; 26:373-80. [PMID: 21737406 PMCID: PMC10845433 DOI: 10.1177/1533317511414553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The purpose of this study was to evaluate a popular measure of Alzheimer's disease (AD) memory and behavior problems and to determine whether its aggressive behavior items coalesced empirically as a subscale to form a psychometrically viable AD aggression measure for clinicians. Data from self-report questionnaires were examined from 419 informal AD caregivers in the southern United States. Principal axis factoring revealed a unidimensional solution with robust item loadings on the single factor. Three forms of reliability analysis indicated moderately strong internal consistency on this proposed measure. Evidence of convergent validity analysis was suggested via the measure's significant correlations to theoretically linked constructs. The proposed measure emerged as a reliable and valid tool for health care practitioners for the appraisal of problematic AD aggression behaviors from the caregiver perspective.
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Affiliation(s)
- Kristina G. Little
- LSU School of Social Work, Louisiana State University, Baton Rouge, LA, USA
| | - Scott E. Wilks
- LSU School of Social Work, Louisiana State University, Baton Rouge, LA, USA
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Ersek M, Polissar N, Neradilek MB. Development of a composite pain measure for persons with advanced dementia: exploratory analyses in self-reporting nursing home residents. J Pain Symptom Manage 2011; 41:566-79. [PMID: 21094018 PMCID: PMC3062661 DOI: 10.1016/j.jpainsymman.2010.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 06/08/2010] [Accepted: 06/09/2010] [Indexed: 12/01/2022]
Abstract
CONTEXT Experts agree that pain assessment in noncommunicative persons requires data from sources that do not rely on self-report, including proxy reports, health history, and observation of pain behaviors. However, there is little empirical evidence to guide clinicians in weighting or combining these sources to best approximate the person's experience. OBJECTIVES The aim of this exploratory study was to identify a combination of observer-dependent pain indicators that would be significantly more predictive of self-reported pain intensity than any single indicator. Because self-reported pain is usually viewed as the criterion measure for pain, self-reported usual and worst pains were the dependent variables. METHODS The sample consisted of 326 residents (mean age: 83.2 years; 69% female) living in one of 24 nursing homes. Independent variables did not rely on self-report: surrogate reports from certified nursing assistants (CNAs) using the Iowa Pain Thermometer (IPT), Checklist of Nonverbal Pain Indicators (CNPI), Cornell Scale for Depression in Dementia (CSDD), Pittsburgh Agitation Scale (PAS), number of painful diagnoses, and Minimum Data Set (MDS) pain variables. RESULTS In univariate analyses, the CNA IPT scores were correlated most highly with self-reported pain. The final multivariate model for self-reported usual pain included CNA IPT, CSDD, PAS, and education; this model accounted for only 14% of the variance. The more extensive of the two final models for worst pain included MDS pain frequency, CSDD, CNA IPT, CNPI, and age (R(2)=0.14). CONCLUSION Additional research is needed to develop a predictive pain model for nonverbal persons.
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Affiliation(s)
- Mary Ersek
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104-6096, USA.
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Nygaard HA. Pain in People with Dementia and Impaired Verbal Communication. J Pain Palliat Care Pharmacother 2010. [DOI: 10.3109/15360288.2010.526687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pain in the Older Adult: An Imperative Across All Health Care Settings. Pain Manag Nurs 2010; 11:S1-10. [DOI: 10.1016/j.pmn.2010.03.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 10/29/2009] [Accepted: 02/14/2010] [Indexed: 11/23/2022]
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Lemay M, Landreville P. Review: verbal agitation in dementia: the role of discomfort. Am J Alzheimers Dis Other Demen 2010; 25:193-201. [PMID: 20142626 PMCID: PMC10845377 DOI: 10.1177/1533317509356687] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Verbal agitation (VA) is a disturbing and commonly observed behavioral symptom in people with dementia. Although several different variables contribute to VA, it seems that discomfort plays an important role. The overall objective of this article is to review the relationship between VA and discomfort among people with dementia. Specifically, this article discusses the place of discomfort within the conceptualizations of VA, empirical support for the association between discomfort and VA, and practical implications of this relationship in the assessment and treatment of VA. This article contributes to a better understanding of VA and provides recommendations for prevention and effective intervention.
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Ersek M, Herr K, Neradilek MB, Buck HG, Black B. Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments. PAIN MEDICINE (MALDEN, MASS.) 2010; 11:395-404. [PMID: 20088854 PMCID: PMC2866060 DOI: 10.1111/j.1526-4637.2009.00787.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia. DESIGN In a cross-sectional descriptive study nursing home (NH) residents were videotaped at rest and during a structured movement procedure. Following one training session and one practice session, two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools. SETTING Fourteen NHs in Western Washington State participating in a randomized controlled trial of an intervention to enhance pain assessment and management. PARTICIPANTS Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment. MEASURES Checklist of Nonverbal Pain Indicators (CNPI) and the Pain Assessment in Advanced Dementia (PAINAD), demographic and pain-related data (Minimum Data Set), nursing assistant reports of participants' usual pain intensity, and Pittsburgh Agitation Scale. RESULTS Internal consistency for both tools was good except for the CNPI at rest for one rater. Inter-rater reliability for pain presence was fair (K = 0.25 for CNPI with movement; K = 0.31 for PAINAD at rest) to moderate (K = 0.43 for CNPI at rest; K = 0.54 for PAINAD with movement). There were significant differences in mean CNPI and PAINAD scores at rest and during movement, providing support for construct validity. However, both tools demonstrated marked floor effects, particularly when participants were at rest. CONCLUSIONS Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD, findings from the current study indicate that these measures warrant further study with clinical users, should be used cautiously both in research and clinical settings and only as part of a comprehensive approach to pain assessment.
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Affiliation(s)
- Mary Ersek
- School of Nursing, University of Pennsylvania, Room 329, 418 Curie Bld, Philadelphia, PA 19104-6096, USA.
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Ball VL, Hudson S, Davila J, Morgan R, Walder A, Graham DP, Snow AL, Kunik ME. Post-traumatic stress disorder and prediction of aggression in persons with dementia. Int J Geriatr Psychiatry 2009; 24:1285-90. [PMID: 19382286 DOI: 10.1002/gps.2258] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This prospective cohort study evaluated the potential of increased aggression in patients with dementia who had a preexisting diagnosis of post-traumatic stress disorder (PTSD) compared with those without a diagnosis of PTSD. METHODS Patients more than 60 years of age with newly diagnosed dementia between 2001 and 2004 were identified from the Michael E. DeBakey Veterans Affairs (VA) Medical Center in Houston, TX. Among these patients, we identified patients with a preexisting diagnosis of PTSD. The proportions of patients who became aggressive within 2 years of enrollment were compared in patients with and without PTSD. Fisher's exact tests were used to compare differences in the number of PTSD patients with and without aggression. RESULTS A total of 215 patients were identified with newly diagnosed dementia. Ten were found to have a diagnosis of PTSD, and 205 did not. Eighty-four (41%) of the 205 were found to be aggressive. Among the 10 patients with a diagnosis of PTSD, 4 (40%) were aggressive. CONCLUSION There was no evidence to support an increased risk of aggression in patients with a coexisting diagnosis of dementia and PTSD.
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Affiliation(s)
- Valdesha L Ball
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
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Van Der Steen JT, Pasman HRW, Ribbe MW, Van Der Wal G, Onwuteaka-Philipsen BD. Discomfort in dementia patients dying from pneumonia and its relief by antibiotics. ACTA ACUST UNITED AC 2009; 41:143-51. [PMID: 19065450 DOI: 10.1080/00365540802616726] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dementia patients frequently die after a pneumonia or prolonged intake problems. Maintaining comfort is a goal of palliative care in end-stage dementia. To compare discomfort in dementia patients dying after a pneumonia with patients dying after intake problems, and to assess associations with treatment, we combined 2 Dutch prospective studies. We selected 559 pneumonia patients and 166 patients with intake problems who had no pneumonia. Discomfort was observed with the Discomfort Scale - Dementia of Alzheimer Type (DS-DAT). Linear regression was performed with the dependent DS-DAT levels shortly before death in 314 patients who died within 2 weeks. Compared with discomfort in patients with intake problems, unadjusted and adjusted discomfort in patients with pneumonia was higher both at t 0 and before death. In adjusted analyses, antibiotic treatment (mostly oral) was associated with less discomfort before death (beta -1.1, CI -2.2 - -0.03), while invasive rehydration (received by only 8 patients) was associated with more discomfort (beta 3.5, CI 0.6 - 6.3). Death from pneumonia may cause great suffering in dementia patients. If confirmed in a study with different case mix and treatments, antibiotics may be used to decrease discomfort even when death is imminent.
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Affiliation(s)
- Jenny T Van Der Steen
- Departments of Public and OccupationalHealth, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Hadjistavropoulos T, Marchildon GP, Fine PG, Herr K, Palley HA, Kaasalainen S, Béland F. Transforming long-term care pain management in north america: the policy-clinical interface. PAIN MEDICINE 2009; 10:506-20. [PMID: 19254336 DOI: 10.1111/j.1526-4637.2009.00566.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. OBJECTIVE Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. METHODS We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. RESULTS AND CONCLUSIONS We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.
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Affiliation(s)
- Thomas Hadjistavropoulos
- Department of Psychology & Centre on Aging and Health, University of Regina, Regina, SK, Canada.
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Levels of Personhood: A Model for Dementia Care. Geriatr Nurs 2008; 29:324-32. [DOI: 10.1016/j.gerinurse.2007.11.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/05/2007] [Accepted: 11/11/2007] [Indexed: 11/19/2022]
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Pelletier IC, Landreville P. Discomfort and agitation in older adults with dementia. BMC Geriatr 2007; 7:27. [PMID: 18034903 PMCID: PMC2213647 DOI: 10.1186/1471-2318-7-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 11/22/2007] [Indexed: 11/23/2022] Open
Abstract
Background A majority of patients with dementia present behavioral and psychological symptoms, such as agitation, which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization. Although internal factors, such as discomfort, may be associated with agitation in patients with dementia, little research has examined this question. The goal of this study is to document the relationship between discomfort and agitation (including agitation subtypes) in older adults suffering from dementia. Methods This correlational study used a cross-sectional design. Registered nurses (RNs) provided data on forty-nine residents from three long-term facilities. Discomfort, agitation, level of disability in performing activities of daily living (ADL), and severity of dementia were measured by RNs who were well acquainted with the residents, using the Discomfort Scale for patients with Dementia of the Alzheimer Type, the Cohen-Mansfield Agitation Inventory, the ADL subscale of the Functional Autonomy Measurement System, and the Functional Assessment Staging, respectively. RNs were given two weeks to complete and return all scales (i.e., the Cohen-Mansfield Agitation Inventory was completed at the end of the two weeks and all other scales were answered during this period). Other descriptive variables were obtained from the residents' medical file or care plan. Results Hierarchical multiple regression analyses controlling for residents' characteristics (sex, severity of dementia, and disability) show that discomfort explains a significant share of the variance in overall agitation (28%, p < 0.001), non aggressive physical behavior (18%, p < 0.01) and verbally agitated behavior (30%, p < 0.001). No significant relationship is observed between discomfort and aggressive behavior but the power to detect this specific relationship was low. Conclusion Our findings provide further evidence of the association between discomfort and agitation in persons with dementia and reveal that this association is particularly strong for verbally agitated behavior and non aggressive physical behavior.
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Landreville P, Casault L, Julien E, Dicaire L, Verreault R, Lévesque L. Structure factorielle de l'Inventaire d'agitation de Cohen-Mansfield. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY-REVUE EUROPEENNE DE PSYCHOLOGIE APPLIQUEE 2007. [DOI: 10.1016/j.erap.2005.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cervo FA, Raggi RP, Bright-Long LE, Wright WK, Rows G, Torres AE, Levy RB, Komaroff E. Use of the certified nursing assistant pain assessment tool (CPAT) in nursing home residents with dementia. Am J Alzheimers Dis Other Demen 2007; 22:112-9. [PMID: 17545138 PMCID: PMC10846100 DOI: 10.1177/1533317506298907] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to develop a pain assessment tool utilized by certified nursing assistant (CNA) direct-care providers for nursing home residents with dementia and to examine the impact of such a tool on their function, behavior, or medication use. In the first phase, 41 items from an observational pain assessment tool were correlated with an objective pain "gold standard"; 12 statistically significant items were retained and used in the CNA pain assessment tool. Symmetry analysis was then conducted to determine if this resulted in any significant change in resident function, behavior, or medication use. This failed to detect significant change in these characteristics. A pain assessment tool utilized by CNA direct-care providers can be developed for use in nursing home residents with dementia. Further study is required to determine whether the use of such a tool will improve their function or quality of life.
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Affiliation(s)
- Frank A Cervo
- Long Island State Veterans Home, Stony Brook, New York 11790, USA.
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Stevenson KM, Brown RL, Dahl JL, Ward SE, Brown MS. The Discomfort Behavior Scale: a measure of discomfort in the cognitively impaired based on the Minimum Data Set 2.0. Res Nurs Health 2007; 29:576-87. [PMID: 17131282 DOI: 10.1002/nur.20168] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Because persons with cognitive impairment often cannot self-report pain, it is imperative to develop instruments that use observable indicators. The purpose of this study was to develop and test the psychometric properties of the Discomfort Behavior Scale (DBS), which is comprised of 17 items from the Minimum Data Set (MDS). MDS data from 29,120 cognitively impaired nursing home residents were used for psychometric testing. Factor analyses of the DBS indicated that it reflects a single discomfort dimension. The items are tau equivalent, allowing unity weighting and simple summation to create scale scores, and the internal consistency was good. The DBS has potential to be useful in studies of efforts to improve pain management in cognitively impaired residents of nursing homes.
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Affiliation(s)
- Karen M Stevenson
- American Alliance of Cancer Pain Initiatives, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Berger JT. Suffering in Advanced Dementia: Diagnostic and Treatment Challenges and Questions about Palliative Sedation. THE JOURNAL OF CLINICAL ETHICS 2006. [DOI: 10.1086/jce200617414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
In long-term care settings, behavioral disturbances are exhibited more often by those residents with some level of cognitive impairment. The extent to which pain influences dysfunctional behaviors, and the extent to which pain manifests itself as dysfunctional behaviors, has not been empirically studied. The purpose of our study was to investigate the relationship between pain and behavioral disturbances among long-term care residents suffering from varying levels of dementia. A cross-sectional study of 277 long-term care residents aged 60 and older was conducted to (1) determine the influence of pain on the number, intensity, frequency, and duration of dysfunctional behaviors; (2) investigate the differences between residents with varying levels of dementia who were suffering from acute pain in the intensity, frequency, and duration of 19 behavioral categories; and (3) investigate the differences between residents with varying levels of dementia who were suffering from chronic pain in the intensity, frequency, and duration of 19 behavioral categories. Results suggest that pain influenced behavioral disturbances among those with severe dementia more often than those with moderate or mild dementia, and residents with chronic pain who have severe dementia exhibit significantly more dysfunctional behaviors than those with earlier-stage dementia. These findings support the utility of comprehensive behavioral analysis involving clinical ratings of intensity, frequency, and duration of dysfunctional behaviors, with the assessment of the resident's level of dementia. Moreover, our results imply that pain and other forms of physical suffering must be adequately treated in order to reduce behavioral disturbances and improve quality of life.
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Affiliation(s)
- Daisha J Cipher
- University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth 2006; 16:258-65. [PMID: 16490089 DOI: 10.1111/j.1460-9592.2005.01773.x] [Citation(s) in RCA: 277] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Difficulty with pain assessment in individuals who cannot self-report their pain poses a significant barrier to effective pain management. However, available assessment tools lack consistent reliability as pain measures in children with cognitive impairment (CI). This study evaluated the validity and reliability of the revised and individualized Face Legs Activity Cry and Consolability (FLACC) behavioral pain assessment tool in children with CI. METHODS Children with CI scheduled for elective surgery were studied. The FLACC was revised to include specific descriptors and parent-identified, unique behaviors for individual children. The child's ability to self-report pain was evaluated. Postoperatively, two nurses scored pain using the revised FLACC scale before and after analgesic administration, and, children self-reported a pain score, if able. Observations were videotaped and later viewed by experienced nurses blinded to analgesic administration. RESULTS Eighty observations were recorded in 52 children aged 4-19 years. Twenty-one parents added individualized pain behaviors to the revised FLACC. Interrater reliability was supported by excellent intraclass correlation coefficients (ICC, ranging from 0.76 to 0.90) and adequate kappa statistics (0.44-0.57). Criterion validity was supported by the correlations between FLACC, parent, and child scores (rho = 0.65-0.87; P < 0.001). Construct validity was demonstrated by the decrease in FLACC scores following analgesic administration (6.1 +/- 2.6 vs 1.9 +/- 2.7; P < 0.001). CONCLUSIONS Findings support the reliability and validity of the FLACC as a measure of pain in children with CI.
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Affiliation(s)
- Shobha Malviya
- Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, Ann Arbor, MI 48109-0211, USA.
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Abstract
AIM The aim of this paper is to clarify the concept of agitation in dementia through analysing definitions, critical attributes, components, boundaries, antecedents and consequences of agitation. BACKGROUND The concept of agitation is not well defined. In addition, there exists much confusion about the characteristics and boundaries of agitation, as well as the distinction between agitation and related concepts. Recently developed theoretical models for agitation in dementia require new interpretation and conceptualization of agitation. METHODS Morse's method of critical appraisal of the literature was used. In addition, some parts of Rodgers' evolutionary method were employed. Data were selected using six electronic databases and the key words 'agitation', 'agitated', 'dementia', 'demented' and 'Alzheimer'. The analysis included 86 empirical or theoretical papers and one book. RESULTS A transition from the observer's perspective to the patient's perspective in the interpretation of agitation was found. Five critical attributes of agitation in dementia were identified: excessive, inappropriate, repetitive, non-specific and observable. Patient factors, interpersonal factors, environmental factors and restraint were identified as precipitating antecedents. Mediating antecedents included discomfort, unmet need and misinterpretation. Consequences of agitation were identified at the levels of patient, caregiver and others. CONCLUSIONS This transition in perspectives has important implications as it can change health providers' attitudes and responses to agitation and lead to patient-focused and individualized care. Researchers and clinicians are encouraged to avoid labelling agitated behaviour as 'disturbing behaviour'.
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Affiliation(s)
- Eun-Hi Kong
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-6106, USA.
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Abstract
Posttraumatic agitation is a challenging problem for acute and rehabilitation staff, persons with traumatic brain injury, and their families. Specific variables for evaluation and care remain elusive. Clinical trials have not yielded a strong foundation for evidence-based practice in this arena. This review seeks to evaluate the present literature (with a focus on the decade 1995-2005) and employ previous clinical experience to deliver a review of the topic. We will discuss definitions, pathophysiology, evaluation techniques, and treatment regimens. A recommended approach to the evaluation and treatment of the person with posttraumatic agitation will be presented. The authors hope that this review will spur discussion and assist in facilitating clinical care paradigms and research programs.
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Affiliation(s)
- Lisa A Lombard
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Williams CS, Zimmerman S, Sloane PD, Reed PS. Characteristics Associated With Pain in Long-Term Care Residents With Dementia. THE GERONTOLOGIST 2005; 45 Spec No 1:68-73. [PMID: 16230752 DOI: 10.1093/geront/45.suppl_1.68] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article describes the prevalence, assessment, and treatment of pain, as well as characteristics associated with pain, in 331 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 21% of residents had pain, and pain was more commonly reported in for-profit facilities, and for those receiving professional assessment and treatment.
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Affiliation(s)
- Christianna S Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
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Abstract
OBJECTIVE The Geriatric Level of Dysfunction Scale (GLDS) was developed to assess the intensity, frequency, and duration of 19 behavioral disturbance categories that can potentially interfere with long-term care. DESIGN Secondary analysis of data collected from residents in long-term care facilities. PARTICIPANTS Participants were 399 adults aged 60 and older residing in one of 16 long-term care facilities. RESULTS The GLDS items were analyzed for reliability, content validity, and convergent and discriminant validity. The GLDS items were significantly correlated with items from the Geriatric Multidimensional Pain and Illness Inventory, Geriatric Depression Scale, Neurobehavioral Cognitive Status Examination, and the Psychosocial Resistance to Activities of Daily Living Index. CONCLUSIONS The GLDS is evidenced to be a reliable and valid assessment tool for assessing dysfunctional behaviors of residents in long-term care facilities. Its brevity and clearly defined assessment criteria are assets to the administering clinician. Research on the utility of the GLDS as a treatment outcome instrument in long-term care is warranted. The potential for psychologists, physicians, social workers, and registered nurses to administer the GLDS in long-term care settings is discussed.
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Affiliation(s)
- P Andrew Clifford
- Mind-Body Wellness Institute, Senior Connections of Dallas, Dallas, TX, USA
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Shega JW, Hougham GW, Stocking CB, Cox-Hayley D, Sachs GA. Factors Associated with Self- and Caregiver Report of Pain among Community-Dwelling Persons with Dementia. J Palliat Med 2005; 8:567-75. [PMID: 15992198 DOI: 10.1089/jpm.2005.8.567] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Among cognitively intact patients, self- and caregiver report of patient pain has been associated with worse psychological health for both the patient and caregiver. Little existing research examines factors associated with patient self-report of pain and caregiver report of patient pain among community-dwelling persons with dementia. OBJECTIVE To identify patient and caregiver factors associated with self- and caregiver report of patient pain among community-dwelling persons with dementia. DESIGN Cross-sectional analysis of a longitudinal study using structured interviews with dementia patients and their family caregivers. SETTING AND SUBJECTS Urban outpatient geriatrics clinics affiliated with a university hospital. Dyads composed of dementia patients and their family caregivers were approached prior to routine clinic visits to participate in the study. MEASUREMENTS Relevant patient measurements included self-report of pain; cognitive, functional, and comorbidity assessments; a screen for depression; and demographic information. Relevant caregiver measurements included their report of patient pain and agitation, screens for depression and strain, and demographic information. RESULTS Of 115 dyads, 37 patients (32%) and 57 caregivers (53%) reported the patient to be in pain. No patient or caregiver factors were significantly associated with patient self-report of pain. In the univariate analysis, caregiver reports of patient pain were associated with the patient not being depressed (p = .036), caregiver reports of patient agitation (p = .038), higher level of education in the caregiver (p = .029), and caregiver depression (p = .019). In multivariate logistic regression analyses, caregiver depression and patient agitation remained significantly associated with caregiver report of patient pain. CONCLUSIONS In community-dwelling persons with dementia, self-report of pain was not associated with any other variables measured, suggesting that pain should be assessed through direct self-report and treated accordingly. Caregiver report of patient pain was associated with both caregiver report of patient agitation and caregiver depression. These findings suggest that clinicians may need to routinely assess patient pain, patient agitation, and caregiver depression. More research is needed to understand the relationship between these conditions.
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Affiliation(s)
- Joseph W Shega
- The University of Chicago, Department of Medicine, Section of Geriatrics, Chicago, Illinois 60637, USA.
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Buffum MD, Sands L, Miaskowski C, Brod M, Washburn A. A clinical trial of the effectiveness of regularly scheduled versus as-needed administration of acetaminophen in the management of discomfort in older adults with dementia. J Am Geriatr Soc 2005; 52:1093-7. [PMID: 15209646 DOI: 10.1111/j.1532-5415.2004.52305.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine in a sample of nursing home patients with dementia and a painful condition whether the regularly scheduled administration of acetaminophen (650 mg four times a day (qid)) was more or less effective than as-needed (prn) administration of acetaminophen in reducing discomfort. DESIGN Double-blind, double-dummy, placebo-controlled, crossover study. One arm consisted of 650 mg of acetaminophen administered qid with placebo prn; the other arm consisted of placebo administered qid with acetaminophen prn. SETTING Two community and one Veterans Affairs nursing homes in the San Francisco Bay area. PARTICIPANTS Thirty-nine nursing home patients with a mean+/-standard deviation Mini-Mental State Examination score of 4.3+/-5, a mean Global Deterioration Scale score of 5.7+/-0.4, and a mean Discomfort Scale score of 10.7+/-6.8. Approximately 84% had degenerative joint disease. RESULTS Mean Discomfort Scale scores of 7.4+/-3.7 during the prn arm and 7.2+/-2.1 during the qid arm (t=0.249, nonsignificant) were within the range previously shown to indicate substantial discomfort. No significant differences in discomfort scores were found between the trial arms after controlling for baseline discomfort and prn use of acetaminophen. CONCLUSION Although this trial was negative in terms of the analgesic effects of acetaminophen, the findings have important implications for clinical practice. Prn administration of acetaminophen is sometimes the standard of care for pain management in nursing homes or is offered as an intervention to assess effectiveness. Findings from this study suggest that a 2,600-mg/d dose of acetaminophen is inadequate for elderly nursing home patients with degenerative joint disease, fractures, or back pain who have significant discomfort.
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Affiliation(s)
- Martha D Buffum
- Veterans Affairs Medical Center, San Francisco, California 94121, USA.
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Taylor LJ, Harris J, Epps CD, Herr K. Psychometric Evaluation of Selected Pain Intensity Scales for Use with Cognitively Impaired and Cognitively Intact Older Adults. Rehabil Nurs 2005; 30:55-61. [PMID: 15789697 DOI: 10.1002/j.2048-7940.2005.tb00360.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to determine the reliability and validity of selected pain intensity scales such as the Faces Pain Scale (FPS), the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) to assess pain in cognitively impaired older adults. A descriptive correlational design was used, and a convenience sample of 66 volunteers age 60 and older residing in assisted living facilities in the South was recruited for this study. The sample included 22 (33%) men and 44 (67%) women, with a mean age of 76. Ninety-eight percent (65) of the sample comprised Caucasian participants, with the exception of 1 African-American man. Seventy percent (47) completed high school and/or college. The mean Mini Mental State Exam (MMSE) score was 16, with a range of 1 to 29. Eighty-five percent scored 24 or lower, indicating some degree of cognitive impairment. The remaining 15% were cognitively intact. All but one participant could use each scale to rate their pain. Concurrent validity of the VDS, NRS, and IPT was supported with Spearman rank correlation coefficients ranging from .78 to .86 in the cognitively impaired group. The FPS, however, demonstrated weak correlations with other scales when used with the impaired group, ranging from .48 to .53. In the cognitively intact group, strong correlations ranging from .96 to .97 were found among all of the scales. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from .67 to .85) and unacceptable for most scales in the cognitively impaired group (correlations ranged from .26 to .67). When asked about scale preference, both the cognitively impaired and the intact groups preferred the IPT and the VDS. This study revealed that cognitive impairment did not inhibit participants' ability to use a variety of pain intensity scales, but the stability issue must be considered.
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Affiliation(s)
- Laurie Jowers Taylor
- Graduate program, Department of Nursing, State University of West Georgia, Carrollton, GA, USA
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Cabayé-Borgès Da Silva G, Iahns P, Mabriez JC. [Deficiencies in treating pain of elderly people suffering from a severe cognitive impairment]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2005; 17:87-93. [PMID: 15835218 DOI: 10.3917/spub.051.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The objective of this study was to verify if the provision of care aimed at reducing pain was identical between elderly people suffering from a server cognitive distortion and other elderly people. The sample, taken from a two-tiered survey, was composed of 352 elderly people living in 34 retirement homes or other similar establishments housing the elderly. We categorised the residents into 2 groups: Group I was comprised of those who had a complete loss of physical autonomy, and Group II contained all of the others. Within these two groups, we compared four types of medicine of which the prescription was given at the request of the patient following a complaint, and four types of medicine prescribed as a result of the analysis of biological tests and screening and not as a result of a complaint from the patient. The results showed that the elderly people having a severe cognitive impairment received significantly less medication aimed at reducing pain than the other elderly people. This difference is not recognised when the medication is prescribed as a result of a need noted due to a biological check-up and analysis.
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Affiliation(s)
- G Cabayé-Borgès Da Silva
- Médecin conseil, échelon local du service médical du Var, 42, rue Emile-Ollivier, BP 1405, F-83056 Toulon cedex, France
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Shega JW, Hougham GW, Stocking CB, Cox-Hayley D, Sachs GA. Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 2004; 28:585-92. [PMID: 15589083 DOI: 10.1016/j.jpainsymman.2004.04.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2004] [Indexed: 10/26/2022]
Abstract
To better understand the pain experience of persons with dementia and to describe what factors are related to congruence of pain reports within patient-caregiver dyads, a cohort study enrolled patient-caregiver dyads at a primary care geriatrics clinic. Thirty-two percent of persons with dementia self-report pain "right now." Of these, 65% report slight/mild pain, 27% moderate pain, and 8% severe pain or greater. Fifty-two percent of caregivers report their care recipients with dementia are in some pain "right now." Of these, 52% report slight/mild pain, 30% moderate, and 18% severe pain or greater. Fifty-nine percent of dyads agree on the presence or absence of patient pain. In multivariate analysis of dyadic congruence of pain reports by patient and caregiver factors, only patient factors predicted congruence. The odds of congruence of pain reports increase 3.7 (1.2-12.3) if the patient is male and decrease 0.938 (0.93-0.99) as the patient becomes more agitated. These findings suggest that community-dwelling persons with dementia report less pain than those in the nursing home and caregivers do a fair job of predicting patient pain.
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Affiliation(s)
- Joseph W Shega
- Section of Geriatrics, Department of Medicine, The University of Chicago, Chicago, Illinois 60637, USA
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Diwan S, Hougham GW, Sachs GA. Strain Experienced by Caregivers of Dementia Patients Receiving Palliative Care: Findings from the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. J Palliat Med 2004; 7:797-807. [PMID: 15684847 DOI: 10.1089/jpm.2004.7.797] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Programs that provide palliative care to individuals with dementia, which is a progressive terminal illness, are likely to encounter different issues (e.g., management of problem behaviors, caregiver strain extending over years) from those typically addressed by hospice programs. Little research is available on palliative care for individuals with dementia who live in the community. OBJECTIVE This study examines predictors of types of strain experienced by caregivers of community-dwelling patients with dementia enrolled in a unique demonstration program titled Palliative Excellence in Alzheimer Care Efforts (PEACE), which moved palliative care "upstream," integrating palliative care into the primary care of patients with dementia. DESIGN Data were collected through structured, face-to-face interviews with 150 community-dwelling, predominantly African American patient-caregiver dyads who were enrolled in the PEACE program. MEASUREMENTS Established measures, including the Caregiver Strain Index, the Revised Memory and Behavior Problems Checklist, and the Katz Index of Activities of Daily Living, were used in addition to other measures assessing caregiver, patient, and situational characteristics. RESULTS Factor analysis of the Caregiver Strain Index revealed three dimensions of strain (role, personal, and emotional) related to caregiving. Using a stress process model, regression analyses examined stressors and resources related to patient, caregiver, and support system characteristics in predicting these three dimensions of strain among caregivers. Patient problem behaviors predicted all types of caregiver strain. Perceived lack of support from the health care team predicted personal and emotional strain, whereas higher income, surprisingly, predicted role strain. Patient functional limitations predicted personal and role strain. CONCLUSIONS Findings suggest that effective palliative care programs for patients with dementia need to understand and address the various sources and types of caregiver strain; provide adequate support to caregivers for the management of problem behaviors; provide counseling to help cope with the emotional reactions to the cognitive and behavioral changes associated with dementia progression; facilitate communication with the health care team; and broker access to community and other resources for assistance with functional limitations. Further research examining changes in strain over time will provide useful insights on the delivery of care and services for patients with dementia and their families in a palliative care framework.
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Affiliation(s)
- Sadhna Diwan
- Center for Health Administration Studies, School of Social Service Administration, University of Chicago, Chicago, Illinois, USA.
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Mentes JC, Teer J, Cadogan MP. The pain experience of cognitively impaired nursing home residents: perceptions of family members and certified nursing assistants. Pain Manag Nurs 2004; 5:118-25. [PMID: 15359223 DOI: 10.1016/j.pmn.2004.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pain in cognitively impaired nursing home (NH) elders is difficult to detect. We report the results of the qualitative interview portion of a larger study that characterized the pain experience of cognitively impaired NH residents. Interviews were conducted with 16 family members or friends and 11 certified nursing assistants (CNAs) of 20 cognitively impaired NH residents experiencing pain. Analysis of the interviews yielded themes in family and CNA perceptions of pain in cognitively impaired NH residents. Family members and CNAs concurred that knowing the resident's usual behavior and daily habits was essential to being able to detect pain in cognitively impaired NH residents. Although a majority of family members reported that their relative was "stoic" about pain expression prior to NH placement, personal care information and historical information were perceived as helpful by nursing staff members. CNAs used facial and eye cues to detect pain and pain relief in their assigned residents. In addition, CNAs reported specific pain management strategies for their residents. Major themes related to pain detection in cognitively impaired NH residents identified in this investigation include: (a) knowing the resident; (b) importance of family input about previous pain behaviors in knowing the resident; (c) CNA reliance on face and eye cues for pain detection, particularly with residents who were nonverbal; and (d) the prevalence of pain with caregiving activities. Information from multiple sources can improve pain management strategies for cognitively impaired NH residents.
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Gruber-Baldini AL, Boustani M, Sloane PD, Zimmerman S. Behavioral Symptoms in Residential Care/Assisted Living Facilities: Prevalence, Risk Factors, and Medication Management. J Am Geriatr Soc 2004; 52:1610-7. [PMID: 15450035 DOI: 10.1111/j.1532-5415.2004.52451.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the prevalence, correlates, and medication management of behavioral symptoms in elderly people living in residential care/assisted living (RC/AL) facilities. DESIGN Cross-sectional study. SETTINGS A stratified random sample of 193 RC/AL facilities in four states (Florida, Maryland, New Jersey, North Carolina). PARTICIPANTS A total of 2,078 RC/AL residents aged 65 and older. MEASUREMENT Behavioral symptoms were classified using a modified version of the Cohen-Mansfield Agitation Inventory. Additional items on resistance to care were also examined. RESULTS Approximately one-third (34%) of RC/AL residents exhibited one or more behavioral symptoms at least once a week. Thirteen percent exhibited aggressive behavioral symptoms, 20% demonstrated physically nonaggressive behavioral symptoms, 22% expressed verbal behavioral symptoms, and 13% resisted taking medications or activities of daily living care. Behavioral symptoms were associated with the presence of depression, psychosis, dementia, cognitive impairment, and functional dependency, and these relationships persisted across subtypes of behavioral symptoms. Overall, behavioral symptoms were more prevalent in smaller facilities. More than 50% of RC/AL residents were taking a psychotropic medication, and two-thirds had some mental health problem indicator (dementia, depression, psychosis, or other psychiatric illness). CONCLUSION Integrating mental health services within the process of care in RC/AL is needed to manage and accommodate the high prevalence of behavioral symptoms in this evolving long-term setting.
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Affiliation(s)
- Ann L Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Cornali C, Franzoni S, Riello R, Ghianda D, Frisoni GB, Trabucchi M. Effect of High Climate Temperature on the Behavioral and Psychological Symptoms of Dementia. J Am Med Dir Assoc 2004. [DOI: 10.1016/s1525-8610(04)70109-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manfredi PL, Breuer B, Wallenstein S, Stegmann M, Bottomley G, Libow L. Opioid treatment for agitation in patients with advanced dementia. Int J Geriatr Psychiatry 2003; 18:700-5. [PMID: 12891637 DOI: 10.1002/gps.906] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Some patients with advanced dementia cannot convey the experience of pain verbally and may react to pain with aggressive and agitated behaviors. We hypothesized that unrecognized pain could contribute to agitation and that low dose opioid therapy might reduce agitation by reducing pain. We therefore attempted to determine the effect of opioids on agitation in demented patients. METHODS We administered placebo for 4 weeks and a long-acting opioid for another 4 weeks to nursing home patients with advanced dementia and severe agitation despite treatment with psychotropic drugs. Patients and study nurses did not know if the medication administered was placebo or opioid. We measured the Cohen-Mansfield Agitation Inventory (CMAI) score at baseline and every two weeks. RESULTS Among 47 patients who entered the study, 25 completed the two phases. The median age for the 25 patients was 85.5 years. Analyses of the data of these 25 patients and of the patients <85 years-old showed no significant differences in agitation level between the placebo and opioid phases. However, among the 13 patients who completed the study and were > or =85 years old, the agitation level at the end of the opioid phase was significantly lower than at the end of the placebo phase (mean change in CMAI score: -6.4; 95% confidence interval (CI): -10.96, -1.8). The decrease in agitation in the patients > or =85 years old persisted after adjusting for sedation. The results remained unchanged when we expanded the analyses to include four > or =85 patients who dropped out of the study after the second week of the opioid phase. CONCLUSION Low dose, long-acting opioids can lessen agitation that is difficult to control in very old (> or =85) patients with advanced dementia.
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Taylor LJ, Herr K. Pain intensity assessment: a comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired African American older adults. Pain Manag Nurs 2003; 4:87-95. [PMID: 12836153 DOI: 10.1016/s1524-9042(02)54210-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale (FPS), the Verbal Description Scale, the Numeric Rating Scale, and the Iowa Pain Thermometer to assess pain in cognitively impaired minority older adults. A descriptive correlational design was used, and a convenience sample of 57 volunteers age 58 and older residing in the South was recruited for this study. The sample consisted of 8 males and 49 females with a mean age of 76. Fifty-nine percent of the sample completed an 11th grade education or less, and 59% completed high school or college. Seventy-seven percent (n = 44) of the sample scored 24 or less on the mental status exam, indicating some degree of cognitive impairment. The remaining 23% (n = 13) were cognitively intact. All of the participants were able to use each of the scales to rate their pain. Concurrent validity of the scales was supported with Spearman rank correlation coefficients ranging from.74 to.83 in the cognitively impaired group and.81 to.96 in the cognitively intact group. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from.73 to.83) and to a lesser degree in the cognitively impaired group (correlations ranged from.52 to.79). When asked about scale preference, both the cognitively impaired and the intact group indicated a preference for the FPS. Findings from this study suggest that cognitive impairment did not inhibit older minority participants' ability to use a variety of pain intensity scales. Additionally, options should be provided that address individual needs of older adults considering specific cognitive level and disability, education, gender, ethnicity, and cultural influences concerning perceptions of the various pain intensity scales.
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Affiliation(s)
- Laurie Jowers Taylor
- Department of Nursing, State University of West Georgia, 1600 Maple Street, Carrollton, GA 30118, USA.
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