The relationship between pain and disruptive behaviors in nursing home resident with dementia

Abstract

BackgroundNursing 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.MethodsThis 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.ResultsResidents 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]).ConclusionsThe 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.

Pain and agitation in dementia: a review of the literature

“…They also discovered that there was a decrease in aberrant motor behaviours (includes wandering which was identified as a sign for agitation) within the treatment group, thus suggesting a link between wandering and pain. This is contradicted by Ahn and Horgas (2013) and Miu and Chan (2014) who found no statistical significance between pain and wandering.…”

“…They state that due to direct observation of the participants recall bias was kept to a minimum improving the validity of the results. However they did not use a specific tool to measure agitation, unlike Ahn and Horgas (2013) who used the Cohen-Mansfield Agitation Inventory scale(CMAI).. Both Ahn and Horgas (2013) and Miu and Chan (2014), however, recognise that other factors could contribute to disruptive behaviours.…”

“…However they did not use a specific tool to measure agitation, unlike Ahn and Horgas (2013) who used the Cohen-Mansfield Agitation Inventory scale(CMAI).. Both Ahn and Horgas (2013) and Miu and Chan (2014), however, recognise that other factors could contribute to disruptive behaviours. This needs to be considered when assessing patients to ensure a correct diagnosis is carried out.…”

“…The use of validated dementia specific pain assessment tools such as those identified in these studies incorporate observation skills of signs of pain. o The pain assessment obtained by Ahn and Horgas (2013) and Ahn et al (2015) was from the generic MDS assessments. However, this tool incorporated aspects of observations for signs of distress, including wandering.…”

“…Disruptive behaviours, such as agitation and aggression, are problematic because they are related to injuries and hospitalisation (Kunik et al 2010). Ahn and Horgas (2013) states that it is important to manage and treat the possible causes of agitated behaviour, to reduce the distress or residents, family and staff It has been highlighted that 30-60% of residents that have late stage dementia suffer from daily pain (Achterberg et al 2010;Sandvik et al 2014 andvan Dalen-Kok et al 2015). Research suggests that this could be due to losing the ability to express pain through communication (Horgas et al 2009).…”