Pain Incidence, Treatment, and Associated Symptoms in Hospitalized Persons with Dementia

Boltz, Marie; Kuzmik, Ashley; Mogle, Jacqueline; Jones, Joanne Roman; Arendacs, Rachel; BeLue, Rhonda; Cacchione, Pamela Z.; Galvin, James E.

doi:10.1016/j.pmn.2020.08.002

Cited by 19 publications

(21 citation statements)

References 58 publications

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“…Based on the PAINAD scale results, a significant number of participants remained in pain throughout the study. These results are supported by those of other studies showing that PwD still remain undertreated for pain [ 45 ]. Moreover, Nowak et al [ 46 ] found low Barthel scores among institutionalized patients with cognitive impairment inappropriately treated for pain.…”

Section: Discussionsupporting

confidence: 90%

Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery

Casafont

González-García²,

Marañón-Echeverría

et al. 2022

IJERPH

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This study reports the characteristics of patients with dementia or cognitive impairment hospitalized with a proximal femur fracture requiring surgery. Methods: Multicentric descriptive longitudinal study conducted in three traumatology units, representing high-technology public hospitals across Spain. Data collection took place between August 2018 and December 2019 upon admission to hospital, discharge, one month and three months after discharge. Results: Study participants (n = 174) were mainly women (81.6%), and the mean age was 90.7± 6.3 years old. Significant statistical differences were noted in the decline of functional capacity at baseline and one month later, and after three months they had still not recovered. Malnutrition increased from baseline to the one-month follow-up. The use of physical restraints increased during hospitalization, especially bilateral bedrails and a belt in the chair/bed. After one month, 15.2% of patients had pressure ulcers. Although pain decreased, it was still present after three months. Conclusion: Hospitalization after hip surgery for elderly people with dementia or cognitive impairment negatively impacted their global health outcomes such as malnutrition and the development of pressure ulcers, falls, functional impairment and the use of physical restraints and pain management challenges. Hospitals should implement policy-makers’ strategic dementia care plans to improve their outcomes.

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Section: Discussionsupporting

confidence: 90%

Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery

Casafont

González-García²,

Marañón-Echeverría

et al. 2022

IJERPH

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“…First, impaired cognition may limit the patient's ability to self‐report pain and changes in pain since administration of analgesics, potentially leading to under‐treatment of pain. Second, behavioral expressions of pain, for example, grimacing, agitation, and screaming, may be confused with behavioral and psychiatric symptoms of ADRD, leading to undertreatment of pain 4 . Third, clinicians generally rely on patient self‐report to recognize pain and may have limited competency and training regarding pain management in patients with ADRD 41,42 .…”

Section: Discussionmentioning

confidence: 99%

Pain treatment and functional improvement in home health care: Relationship with dementia

Wang

Cato

Conwell

et al. 2021

J American Geriatrics Society

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Background Pain management is important to post‐acute functional recovery, yet older persons with Alzheimer's disease and related dementias (ADRD) are often undertreated for pain. The main objectives were (1) to examine the relationship between ADRD and analgesic use among Medicare home health care (HHC) recipients with daily interfering pain, and (2) to examine the impact of analgesic use on functional outcome in patients with and without ADRD. Methods We analyzed longitudinal data from the Outcome and Assessment Information Set, Medicare HHC claims, and HHC electronic medical records during a 60‐day HHC episode. The sample included 6048 Medicare beneficiaries ≥65 years receiving care from an HHC agency in New York in 2019 who reported daily interfering pain. Analgesic use was assessed during HHC medication reconciliation and included any analgesic, non‐opioid analgesic, and opioid. ADRD was identified from ICD‐10 codes (HHC claims) and cognitive impairment symptoms (Outcome and Assessment Information Set [OASIS]). Functional outcome was measured as change in the composite Activity of Daily Living (ADL) limitation score in the HHC episode. Results ADRD was related to a lower likelihood of using any analgesic (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.49, 0.90, p = 0.008) and opioids (OR = 0.54, 95% CI: 0.47, 0.62, p < 0.001), but not related to non‐opioid analgesic use (OR = 0.94, 95% CI: 0.74, 1.18, p = 0.58). Stratified analyses showed that any analgesic use (β = −0.43, 95% CI: −0.73, −0.13, p = 0.004) and non‐opioid analgesic use (β = −0.31, 95% CI: −0.56, −0.06, p = 0.016) were associated with greater ADL improvement in patients with ADRD, but not in patients without ADRD. Opioid use was not significantly related to ADL improvement regardless of ADRD status. Conclusions HHC patients with ADRD may be undertreated for pain, yet pain treatment is essential for functional improvement in HHC. HHC clinicians and policymakers should ensure adequate pain management for older persons with ADRD for improved functional outcomes.

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“…Our results support the usefulness of the PAINAD scale for assessing pain in patients with advanced dementia, given the correlation between the sTNF-RII and sIgA measurements and the score on the PAINAD scale. Therefore, the PAINAD scale was confirmed as a simple and feasible tool, but with remarkable precision, that allows to assess pain in people with dementia and inability to communicate and thus to mitigate the characteristic underdiagnosis and undertreatment in these patients [29,30]. However, it is necessary to persuade the health care professional who will conduct the assessment mentioned above to acquire training for its correct use [20,31].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Biomarkers of Pain in Saliva and PAINAD Scale in Elderly People with Cognitive Impairment and Inability to Communicate

Cantón-Habas

Rich-Ruiz

Moreno‐Casbas

et al. 2021

JCM

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The pain assessment in advanced dementia (PAINAD) appears to be a clinically useful tool. However, the salivary determination of tumor necrosis factor receptor type II (sTNF-RII) and secretory IgA (sIgA) as pain biomarkers is still incipient. The aim was to correlate the PAINAD score with sTNF-RII and sIgA biomarker levels in the saliva of patients with advanced dementia. In this regard, a cross-sectional study was conducted. The sample consisted of 75 elderly patients with a clinical diagnosis of dementia and a global deterioration scale (GDS) score of 5 to 7. The PAINAD scale was determined by a previously trained professional and the collection of salivary samples was performed using the passive secretion method. Human sTNF-RII and sIgA using ELISA kits. The results showed a correlation between the PAINAD scale (numeric, binary, and recoded) and sTNF-RII and sIgA (p < 0.001). No association between the sociodemographic and clinical variables and the PAINAD scale was found (p > 0.05). Between 97.3% and 96.2% of patients with pain on the PAINAD scale also showed pain based on the sTNF-RII levels; in all of them, sIgA levels did not fit the logistic models. Therefore, the correlation highlights the usefulness of this scale and confirms the usefulness of sTNF-RII and sIgA as biomarkers of pain.

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Pain Incidence, Treatment, and Associated Symptoms in Hospitalized Persons with Dementia

Cited by 19 publications

References 58 publications

Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery

Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery

Pain treatment and functional improvement in home health care: Relationship with dementia

Correlation between Biomarkers of Pain in Saliva and PAINAD Scale in Elderly People with Cognitive Impairment and Inability to Communicate

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