Pain in Dementia: Prevalence and Association With Neuropsychiatric Behaviors

Atee, Mustafa; Morris, Thomas; Macfarlane, Stephen; Cunningham, Colm

doi:10.1016/j.jpainsymman.2020.10.011

Cited by 48 publications

(46 citation statements)

References 81 publications

(79 reference statements)

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“…In the study of Lin et al, it was demonstrated that 49.07% of the elderly had experienced pain during the last year (23). Also, in the study of Atee et al, on 479 elderly people with dementia, it was shown that the prevalence of pain was 65.6% in this group (30), which is consistent with the results of prevalence of high pain in elderly with dementia.…”

Section: Discussionsupporting

confidence: 59%

Association Between Pain with Disability in the Elderly with Dementia

Hatefi

Nouri

2021

Arch Neurosci

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Background: Elderly is one of the most important and critical periods of life, and paying attention to the issues and problems of this period is very important. Objectives: The present study was performed to investigate the relationship between pain and disability in the elderly with dementia in 2021. Methods: In the present cross-sectional descriptive study, 120 elderly people with dementia were included. The instruments used in the four sections were the demographic profile form, the P-APS pain observation tool, and Stanford Disability Questionnaire questions. the researcher identified the elderly with dementia by available sampling method and if the elderly with dementia were eligible and written informed consent was obtained from the elderly and their primary caregivers, the questionnaires were completed. Conditions of pain and disability were described by descriptive tests, and then the relationship between pain and the degree of disability in patients was analyzed by statistical analysis using SPSS16 software. Results: The results showed mean (SD) pain score was 14.45 (4.23), disability score was 12.75 (3.09), and fall score was 37 (30.8%). According to pain score status classification, 4 (3.3%) of the elderly had no pain, 8 (6.7%) had mild pain, 27 (22.5%) had moderate pain, and 81 (67.5%) had severe pain. There is a significant relationship between pain status and disability in the elderly with dementia. By increase in pain, the patients had more disability (P = 0.000, F = 79.971). Conclusions: As the pain increased, the disability of the elderly with dementia decreased. For this reason, preventive interventions are explained in this field.

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Section: Discussionsupporting

confidence: 59%

Association Between Pain with Disability in the Elderly with Dementia

Hatefi

Nouri

2021

Arch Neurosci

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“…Of those, 5 studies demonstrated significant reductions in agitation and only one study used NPI as a measure of change (42). There are various triggers for BPSD such as staff practises, pain, discomfort, environmental stressors or over stimulation, and thus applying tailored multimodal interventions is the best practise approach (8,43).…”

Section: Discussionmentioning

confidence: 99%

“…BPSD is an umbrella term for a diverse range of neuropsychiatric (non-cognitive) symptoms that are either instigated by unmet needs (e.g., pain) or linked to psychiatric symptoms (e.g., hallucinations) (43,44). As such, it is difficult to untangle the impact of the programs unless we specifically focus on individual symptoms or subsyndromes.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia

Macfarlane

Atee

Morris³

et al. 2021

Front. Psychiatry

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Background/Objective: People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviours and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies. This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centred care interventions delivered by national multidisciplinary dementia-specific behaviour support programs.Methods: A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version “NPI-Q” was administered for DBMAS referrals whereas the nursing home version “NPI-NH” was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen's effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters.Results: A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect.Conclusions: Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.

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“…The contention that BPSD represent a reaction to either unmet needs (e.g., pain), 2 or change in the environment (e.g., over‐ or under‐stimulation), 3 is relatively easy to support in most cases. 1 We accept that stress may arise when the environment places demands upon an individual that require an adaptive response.…”

Section: Bpsd—unmet Reactive And/or Organic?mentioning

confidence: 99%

When responsive and reactive meet organic? Treatment implications of language use in the era of #BanBPSD

Macfarlane

Atee

Morris³

et al. 2021

Int J Geriat Psychiatry

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Key points The aetiopathogenesis of behaviours and psychological symptoms of dementia (BPSD) is often subjective, complex and multifaceted, produced by an array of contributing factors, including biomedical, psychological, environmental and/or social factors Alongside other contributing factors, organic aetiology of BPSD should be considered when devising therapeutic management plans Although considered last resort, time‐limited antipsychotic treatment (≤3 months) may have a vital adjunct role in managing intractable, refractory, distressing and/or life‐threatening BPSD, such as delusions and hallucinations; but only after person‐centred psychosocial interventions are exhausted and fail to deliver any therapeutic response If prescribed, careful monitoring of therapeutic responses and adverse effects of antipsychotics with de‐prescribing plans should be a top priority, as these agents have limited efficacies and serious adverse outcomes (e.g., mortality)

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Pain in Dementia: Prevalence and Association With Neuropsychiatric Behaviors

Cited by 48 publications

References 81 publications

Association Between Pain with Disability in the Elderly with Dementia

Association Between Pain with Disability in the Elderly with Dementia

Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia

When responsive and reactive meet organic? Treatment implications of language use in the era of #BanBPSD

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