Pain interference and depressive symptoms in communicative people with Alzheimer's disease: a pilot study

Wang, Jinjiao; Dietrich, Mary S.; Simmons, Sandra F.; Cowan, Ronald L.; Monroe, Todd B.

doi:10.1080/13607863.2017.1318258

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…First, when compared with patients with intact cognition, patients with ADRD, particularly those who are noncommunicative, are less capable of recognizing pain (Corbett et al, 2012) and less likely to report pain owing to their potentially higher pain tolerance (Monroe et al, 2016). Although ADRD impairs one's cognitive function (Corbett et al, 2012), many with mild to moderate ADRD and relatively reserved cognitive function retain the ability to reliably report pain (Herr, 2011;Wang et al, 2017). Clinicians working with persons with ADRD should therefore try to obtain self-report data of pain early in the course of care and to ensure that both verbal and behavioral signs of pain are correctly noted and documented (Monroe & Mion, 2012).…”

Section: Discussionmentioning

confidence: 99%

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

Wang

Monroe

Simning

et al. 2021

Pain Management Nursing

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Background: Pain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD). Aims: Examine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population. Design: Analysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data. Settings/Participants: 6,153 patients 65 years receiving care from a nonprofit HH agency in 2017. Methods: Study outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission. Results: Patients with ADRD (n ¼ 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] ¼ 1.35, p ¼ .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD. Conclusions: HH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.

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Section: Discussionmentioning

confidence: 99%

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

Wang

Monroe

Simning

et al. 2021

Pain Management Nursing

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“…The procedures proposed in this protocol are similar to those used in our completed and ongoing study of thermal pain processing in dementia (Anderson et al, 2017;Cowan et al, 2017;Monroe et al, 2015Monroe et al, , 2017Monroe et al, , 2018Wang, Dietrich, Simmons, Cowan, & Monroe, 2018). The principal investigators lead neuroimaging research programs focused on pain, ageing and dementia and psychiatric neuroimaging.…”

Section: Discussionmentioning

confidence: 99%

Determining the impact of age and sex on the psychophysical and neurophysiological response to thermal pain across the adult lifespan

Atalla

Cowan

Anderson

et al. 2021

Journal of Advanced Nursing

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Aims Determine sex‐ and age‐associated psychophysical and neurophysiological differences in the processing of pain across the adult lifespan. Design Preliminary, exploratory, cross‐sectional study. Methods Using psychophysics (to measure intensity and unpleasantness) and functional magnetic resonance imaging blood oxygenation level dependent methods (to measure stimulus‐evoked brain activation), we will examine sex‐ and age‐associated differences in thermal pain processing and their underlying neurophysiology in a broad range of healthy adults (ages 30–89). We will acquire resting state functional connectivity data for secondary analyses exploring whether resting state connectivity predicts psychophysical and neurophysiological responses to thermal pain. To examine the effects of altered blood flow, we will acquire resting‐state arterial spin labeling magnetic resonance imaging data to quantify resting cerebral blood flow. We will interpret findings in the context of a proposed neural model of pain, ageing, and sex. Study funding was received in June of 2014. Ethical approval was obtained from the Vanderbilt University IRB prior to study initiation. Conclusion Exploring the biological reasons for age‐ and sex‐associated differences in pain processing will increase our understanding of pain in older adults. The paucity of neurobiological evidence to support best practice pain management in older adults places these individuals at risk for poor pain management. Impact Poorly treated pain in older adults is a critical public health problem associated with a poor quality of life and increased healthcare costs. Understanding how age and sex have an impact on central processing of pain across the lifespan is a critical step toward improving personalized pain medicine.

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“…1 Older persons with Alzheimer's disease and related dementias (ADRD) are often hospitalized (0.37-1.26/person-year), 2 and 36%-70% of them experience pain during acute and post-acute care. [3][4][5][6] If not appropriately identified and treated, pain can worsen the neuropsychiatric symptoms of ADRD (e.g., aggression, agitation, and depression), 4,7,8 fasten cognitive and physical decline, 9,10 decrease quality of life, 11 and lead to repeated hospitalizations 12 and even death. 13 Therefore, it is important to effectively assess and treat pain among older persons with ADRD during hospitalization and in the post-acute care period.…”

Section: Introductionmentioning

confidence: 99%

Pain treatment and functional improvement in home health care: Relationship with dementia

Wang

Cato

Conwell

et al. 2021

J American Geriatrics Society

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Background Pain management is important to post‐acute functional recovery, yet older persons with Alzheimer's disease and related dementias (ADRD) are often undertreated for pain. The main objectives were (1) to examine the relationship between ADRD and analgesic use among Medicare home health care (HHC) recipients with daily interfering pain, and (2) to examine the impact of analgesic use on functional outcome in patients with and without ADRD. Methods We analyzed longitudinal data from the Outcome and Assessment Information Set, Medicare HHC claims, and HHC electronic medical records during a 60‐day HHC episode. The sample included 6048 Medicare beneficiaries ≥65 years receiving care from an HHC agency in New York in 2019 who reported daily interfering pain. Analgesic use was assessed during HHC medication reconciliation and included any analgesic, non‐opioid analgesic, and opioid. ADRD was identified from ICD‐10 codes (HHC claims) and cognitive impairment symptoms (Outcome and Assessment Information Set [OASIS]). Functional outcome was measured as change in the composite Activity of Daily Living (ADL) limitation score in the HHC episode. Results ADRD was related to a lower likelihood of using any analgesic (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.49, 0.90, p = 0.008) and opioids (OR = 0.54, 95% CI: 0.47, 0.62, p < 0.001), but not related to non‐opioid analgesic use (OR = 0.94, 95% CI: 0.74, 1.18, p = 0.58). Stratified analyses showed that any analgesic use (β = −0.43, 95% CI: −0.73, −0.13, p = 0.004) and non‐opioid analgesic use (β = −0.31, 95% CI: −0.56, −0.06, p = 0.016) were associated with greater ADL improvement in patients with ADRD, but not in patients without ADRD. Opioid use was not significantly related to ADL improvement regardless of ADRD status. Conclusions HHC patients with ADRD may be undertreated for pain, yet pain treatment is essential for functional improvement in HHC. HHC clinicians and policymakers should ensure adequate pain management for older persons with ADRD for improved functional outcomes.

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Pain interference and depressive symptoms in communicative people with Alzheimer's disease: a pilot study

Cited by 7 publications

References 38 publications

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

Determining the impact of age and sex on the psychophysical and neurophysiological response to thermal pain across the adult lifespan

Pain treatment and functional improvement in home health care: Relationship with dementia

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