Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia

Abstract

IntroductionIn 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 methodsThe 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.ResultsAnalgesics 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.ConclusionOur 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.

Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

“…Although no differences were observed between groups in terms of total ESAS scale score, significant differences were observed between different symptoms. Pain is one of the most studied symptoms in residents with dementia institutionalized in nursing homes [11,12,[21][22][23]. As our results highlighted, this symptom is usually one of the most prevalent in advanced stages and at the end of life [11].…”

“…As our results highlighted, this symptom is usually one of the most prevalent in advanced stages and at the end of life [11]. Despite this, there is great difficulty in assessing pain in dementia patients because nonverbal signs of pain can be misinterpreted as neuropsychiatric or behavioral symptoms [11,21,23]. Smedbäck et al [11] pointed out the need to develop specific scales for patients with dementia to help assess this and other symptoms.…”

“…In terms of the drugs used, contrary to the initial hypothesis, although more pain was reported in patients without dementia than in patients with dementia, no differences were observed in analgesic consumption. This absence of differences may indicate that pain is underevaluated and undertreated in nursing homes [23,33,34]. However, it is difficult to know if patients are receiving enough analgesia, even in nondementia patients [23].…”

“…This absence of differences may indicate that pain is underevaluated and undertreated in nursing homes [23,33,34]. However, it is difficult to know if patients are receiving enough analgesia, even in nondementia patients [23]. In a study carried out in Polish nursing homes, only 30% of residents with moderate or severe cognitive impairment were treated with analgesics.…”

“…In a study carried out in Polish nursing homes, only 30% of residents with moderate or severe cognitive impairment were treated with analgesics. Most of them received medication from the first step of the analgesic scale, and only a few received opioids even if they experienced moderate pain [23].…”