Uncontrolled Pain Associated with Risk of Behavioral Symptoms and Depression in Dementia
It is important to identify risk factors that precipitate behavioral and psychological symptoms of dementia (BPSD) before starting any suggested pharmacological treatment. In a study in the October issue of JAMDA, the authors found that uncontrolled pain was associated with elevated risk for depressive and behavioral symptoms in dementia, underscoring the importance of pain assessment and control among long-term care facility residents with dementia, including Alzheimer’s disease.
In Uncontrolled Pain and Risk for Depression and Behavioral Symptoms in Residents with Dementia, the authors conducted a retrospective cohort study of a 5% Medicare sample linked to the Minimum Data Set 3.0. They found that residents with uncontrolled pain had a higher risk for developing depression and behavioral symptoms than those with controlled pain. These symptoms included psychotic (delusions or hallucinations) or disruptive behaviors (rejection of care or physical, verbal, or other aggressive behaviors). Residents with uncontrolled pain were more likely to be younger (50-64 years old), female, White, receive prescription pain medication, and have five or more comorbidities.
“Associations between pain and depression and behavioral symptoms are well documented among older adults with intact cognition, but less well documented among those with cognitive impairment,” the authors observed. Their study, they said, explored the association between uncontrolled pain and depression or BPSD by dementia severity and the use of pain treatment and management at baseline. They concluded, “Our finding is analogous to results from published randomized clinical trials showing that pain treatment is associated with decreased pain and subsequent risk for agitation in patients with moderate to severe dementia.”
This study was conducted by researchers at several institutions, including the Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL; United States “Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL; Department of Neurology and McKnight Brain Institute, University of Florida, Gainesville, FL; and the Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, FL.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.