The impact of dementia on the pain experience

Farrell, Michael J.; Katz, Benny; Helme, Robert D.

doi:10.1016/0304-3959(96)03041-2

Cited by 123 publications

(81 citation statements)

References 53 publications

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“…43 GPs perceive people with dementia as being more difficult to manage and less amenable to improvements in quality of life, compared with patients who have heart disease and diabetes; 44 this may result in the undertreatment and less aggressive management of medical conditions. 45 How far this reflects GPs' judgements that aggressive treatment is inappropriate, given the prognosis of a patient with dementia, or caution about exposing patients to sideeffects of preventative drugs, is unclear. This could lead to higher numbers of those with dementia being exception reported.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The poorer quality of vascular care for those living in care homes is consistent with research on the monitoring of chronic diseases and appropriate drug treatment. 17 Previous research has identified a reduced ability to recall and communicate symptoms or adverse effects, 45 decreased decisionmaking capacity, and treatment adherence 52 as potential challenges in addressing health needs in those with dementia. QOF targets may be more difficult to complete in those with dementia, which may explain poor performance on indicators that require greater compliance from patients (for example, retinal screening); however, this is not the case for all indicators (for example, physical examination for peripheral pulses), suggesting that poor quality cannot be explained by patient-level factors alone.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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BackgroundVascular diseases contribute to the causation and progression of clinical dementia. AimTo evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. Design and settingObservational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. MethodA total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. ResultsLevel of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. ConclusionThe quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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“…11 Chart reviews of clinical visits, follow-up phone calls by radiology nursing, and neuropsychological testing were performed. Exclusion criteria included the following: [12][13][14] This criterion has been applied to other studies of pain in patients with dementia. 15 All patients had radiographic evidence of a compression fracture, including marrow edema on an MR image or radiopharmaceutical uptake on a bone scan.…”

Section: Selection Criteriamentioning

confidence: 99%

Percutaneous Vertebroplasty for Painful Compression Fractures in a Small Cohort of Patients with a Decreased Expectation-Related Placebo Effect due to Dementia

Lehman¹,

Gray²,

Kallmes³

2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Although abundant literature has reported success with vertebroplasty for the treatment of painful compression fractures, none has accounted for a potential expectationrelated placebo effect. We report the results of vertebroplasty for painful vertebral body compression fractures in a small cohort of patients with dementia with the assumption that this patient subgroup is subjected to a decreased placebo effect.

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“…These observations are important considering that an inadequate approach of this problem can have a significant impact on the elderly individual's quality of life, leading to depression, aggressiveness, social isolation and functional impairment 9,11,12 .…”

Section: Acta Fisiatr 2006; 13(2): 75-82mentioning

confidence: 99%

“…However, it seems that, with the advanced age, there is a reduction of pain in all body segments, except in the joints 7,8 . The pain in the elderly patient is, most of the time, difficult to be recognized and consequently, often goes untreated [9][10][11][12] . The disease itself does not affect the individual's functionality 13,14 ; there is a weak correlation between health status and function (coefficient < 0.10) 14 .…”

Section: Introductionmentioning

confidence: 99%

Applicability of the Brazilian version of the McGill pain questionnaire in elderly patients with chronic pain

Santos¹,

Pereira²,

Resende³

et al. 2006

Acta Fisiátrica

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A dor crônica é uma experiência multidimensional que envolve aspectos sensório-perceptual, afetivo-motivacional e cognitivo-avaliativo que se interagem e contribuem para a resposta dolorosa final. As alterações características do processo do envelhecimento em cada um desses aspectos podem interferir na experiência da dor, dificultando a sua avaliação adequada. O uso de uma escala multidimensional como o Questionário de dor McGill (MPQ) possibilita uma avaliação mais adequada desse sintoma. Os objetivos desse estudo foram verificar a confiabilidade intra e inter examinadores da aplicação do Br-MPQ em idosos com dor crônica em decorrência de doenças ortopédicas e neurológicas.Participaram desse estudo 19 idosos com doenças ortopédicas (71,21  7,51 anos) e 19 idosos com doenças neurológicas (69,79  5,30 anos) apresentando o diagnóstico de dor crônica, encaminhados pelo serviço médico, sem alterações cognitivas. A confiabilidade geral intra e interexaminadores nos idosos com doenças ortopédicas foram 0,86 e 0,89, respectivamente, e para idosos com doenças neurológicas de 0,71 e 0,68, respectivamente (Spearman, p<0,05). Os resultados mostraram que o Br-MPQ foi de fácil aplicação (8,54  2,35 minutos) nessa amostra. O presente estudo demonstrou que o Br-MPQ pode ser mais adequado para avaliar a dor crônica em idosos, uma vez que a percepção desse sintoma está mais relacionada aos aspectos sensoriais, afetivos e cognitivo-avaliativos e não somente à intensidade. PAlAvRAs-chAve Dor crônica, idoso, questionário de dor McGill ABstRActChronic pain is a multidimensional experience that involves sensory-perceptual affective-motivational and cognitive-evaluation aspects, which interact and contribute to the ultimate painful response. The characteristic changes of the aging process on each of these aspects can interfere with the experience of pain, thus making appropriate assessment more difficult. The use of multidimensional scales, such as the McGill Pain Questionnaire (MPQ) makes more appropriate evaluations possible. The aims of this study were to assess the intra-and inter-examiner reliability of the Brazilian Version of the MPQ (Br-MPQ) and characterize the perceptions of chronic pain in elderly individuals with orthopedic and neurological diseases. The sample consisted of 19 elderly individuals (71.21  7.51 yrs) with orthopedic (G1) and 19 (69.79  5.30 yrs) with neurological diseases (G2), all with a clinical diagnosis of chronic pain but no cognitive alterations. The general intra-and inter-examiner reliability was 0.86 and 0.89 for G1, and 0.71 and 0.68 for G2, respectively (p<0.05). The results showed that the Br-MPQ was easily applied to a group of elderly individuals with chronic pain (8.54  2.35 minutes). The present study demonstrated that the Br-MPQ can be more effective to assess pain in the elderly, as the perception of this symptom is more associated to sensorial, affective, and subjective aspects than to pain intensity.

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The impact of dementia on the pain experience

Cited by 123 publications

References 53 publications

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Percutaneous Vertebroplasty for Painful Compression Fractures in a Small Cohort of Patients with a Decreased Expectation-Related Placebo Effect due to Dementia

Applicability of the Brazilian version of the McGill pain questionnaire in elderly patients with chronic pain

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