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

Authors Nowak T, Neumann-Podczaska A, Deskur-Śmielecka E, Styszyński A, Wieczorowska-Tobis K

Received 16 November 2017

Accepted for publication 29 March 2018

Published 25 May 2018 Volume 2018:13 Pages 1045—1051


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Richard Walker

Tomasz Nowak,1 Agnieszka Neumann-Podczaska,2 Ewa Deskur-Śmielecka,1 Arkadiusz Styszyński,1 Katarzyna Wieczorowska-Tobis1

1Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland; 2Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznań, Poland

Introduction: In 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 methods: The 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.
Results: Analgesics 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.
Conclusion: Our 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.

Keywords: pain, analgesics, nursing home residents, older individuals, Abbey Pain Scale, CMAI

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