Pain and Psychological Well-Being Among People with Dementia in Long-Term Care

Abstract

Objective To examine the relationship between self-reported pain and psychological well-being of people with dementia (PWD) living in residential long-term care as indicated by displays of observed emotional expression over the daytime period. Design Secondary analysis using repeated measures of self-report and observational data. Setting and subjects A total of 177 PWD were included from 17 nursing homes and six assisted living facilities in Michigan and Pennsylvania. Methods Negative emotional expression was used as an indicator of reduced psychological well-being. Pain was assessed through PWD's response to a question about presence of pain obtained at each observation. Cognitive impairment was assessed using the Mini-Mental Status Examination (MMSE). Linear mixed models were used that accounted for correlation of negative emotional expression measurements over time for each participant and between participants within the same facility. Results Among 171 participants who were able to express their pain, 44% of PWD reported pain once or more during the daytime period. Severity of cognitive impairment was related to expression of negative emotion. PWD with pain displayed more negative emotional expression than PWD without pain. Conclusions Routine pain assessment is feasible among PWD with moderate to severe dementia and positive report of pain is associated with greater observed negative emotional expression, an indicator of reduced psychological well-being. Improving pain management holds potential for enhancing psychological well-being among PWD living in residential long-term care.

Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study

“…This study shows that it is possible to detect which persons with dementia are at risk for a lower QOL across different QOL domains; therefore, it seems possible to target interventions to improve QOL. Interventions such as group cognitive stimulation therapy (GCST) [66], integrated emotion-oriented care [67], emotional adaptation [68], improving pain management [23] and research on the effect of organization of LTCF [69], and the effect of an outdoor space such as a garden [70], show promise with regard to the aim of improving QOL in persons with dementia.…”

“…Although some studies confirm a relationship between pain and a lower psychological wellbeing in dementia, the exact relationship between pain and the various domains and the effect on QOL remains unclear [20,21,22,23]. In addition, although chronic diseases can have an impact on QOL, information is lacking on their relationship with QOL in persons with dementia [24,25].…”

Psychosocial interventions for pain management in older adults with dementia: A systematic review of randomized controlled trials

“…Studies show that pain is one of the most common problems in people with dementia, affecting approximately half of nursing home residents with dementia (Lee, McConnell, Knafl, & Algase, 2015;Van Kooten, Smalbrugge, van der Wouden, Stek, & Hertogh, 2017) and up to 57.3% of people with dementia living in the community (Barry, Parsons, Passmore, & Hughes, 2016). Such high rates of pain in people with dementia is known to be closely associated with the presentation of neuropsychiatric symptoms and reduced sleep quality and poor quality of life (Hodgson, Gitlin, & Jin, 2014;Rajkumar et al, 2017).…”