Polypharmacy and excessive polypharmacy are common among nursing home residents in Europe. Determinants of polypharmacy status include not only comorbidity but also specific symptoms, age, functional, and cognitive status.

The etiology of behavioral and psychiatric symptoms is generally considered to be multifactorial, and these symptoms often indicate a need for care or assistance, which may include the presence of uncontrolled pain. The aim of this cross-sectional study was to assess the association of pain with behavioral and psychiatric symptoms in a population of nursing home (NH) residents with cognitive impairment in Europe. Data are from the SHELTER project, which contains information on NH residents in 8 countries. Pain was defined as any type of physical pain or discomfort in any part of the body in the 3 days before the assessment. The mean age of 2822 cognitively impaired residents entering the study was 84.1 (standard deviation 9.1)years, and 2110 (74.8%) were women. Of the total sample, 538 residents (19.1%) presented with pain. After adjusting for potential confounders, pain was significantly and positively associated with socially inappropriate behavior (odds ratio [OR] 1.37; 95% confidence interval [CI] 1.04-1.80), resistance to care (OR 1.41; 95% CI 1.08-1.83), abnormal thought process (OR 1.48; 95% CI 1.16-1.90), and delusions (OR 1.48; 95% CI 1.07-2.03). A borderline inverse association was observed with wandering (OR 0.74; 95% CI 0.55-1.00). In conclusion, this cross-sectional study provides evidence from a large sample of frail elderly showing an association between pain and behavioral and psychiatric symptoms. Treatment models that put together assessment and treatment of pain and evaluate their effect on behavioral and psychiatric symptoms are needed.

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Few studies have assessed the impact of pain on physical function among old-old subjects. The aim of the present observational study was to evaluate the association between presence of daily pain and incident disability in elderly subjects aged 80 years or older living in the community. We used data from the "Invecchiamento e Longevità nel Sirente" (ilSIRENTE) project, a two-year longitudinal study enrolling subjects aged 80 years or older. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day over the seven days preceding the baseline assessment. Disability in performing activities of daily living (ADLs) was defined as the need of assistance in one or more of the following ADLs: eating, dressing, transferring, mobility in bed, personal hygiene, and toileting. The mean age of 204 subjects participating to this study was 84.3 years (standard deviation [SD]: 3.8), and 135 (SD: 66.1%) were women. Of the total sample, 103 subjects (50.4%) presented with daily pain. After a two-year follow-up, 25 of 103 (24.2%) participants with daily pain and 14 of 101 (13.9%) without daily pain developed disability. After adjusting for potential confounders, presence of daily pain was associated with an increased risk of disability, but this association did not reach statistical significance (hazard ratio [HR]: 1.87; 95% confidence interval [CI]: 0.92-4.26). The risk of disability increased with pain severity. Compared with subjects without daily pain, the risk of incident disability was higher for participants with mild pain (HR: 1.35; 95% CI: 0.65-3.28) and significantly higher for those with moderate to severe pain (HR: 6.94; 95% CI: 2.00-23.01). In conclusion, among very old subjects living in the community, moderate to severe daily pain is associated with a significant increased risk of disability, irrespective of potential confounders.