Practice Points
- •Assessment and management of pain, particularly in black males, is important as pain is associated with behavioral symptoms, functional decline, and quality of life.
- •Pain is challenging to evaluate among individuals with moderate to severe dementia although observational measures such as the PAINAD can be easily used in practice.
- •Ongoing consideration of the use and value of opioids for pain management among residents with moderate to severe dementia is needed.
Abstract
Background
This study evaluated the association between age, sex, comorbidities, cognition, and
administration of opioids with pain and the impact of all of these variables plus
function, agitation, resistiveness to care, and depression on quality of life among
residents in nursing home with severe dementia.
Design
This was a descriptive study using baseline data from the Evidence Integration Triangle
for Behavioral and Psychological Symptoms of Dementia implementation study.
Methods
Model testing was done using structural equation modeling. The sample included 553
residents from 55 nursing homes with a mean age of 83.88 (standard deviation = 10.44)
and mean Brief Interview of Mental Status of 4.30 (standard deviation = 3.50).
Results
There were significant associations showing those who were older, male, had fewer
comorbidities, better cognition, and were black were more likely to have pain. Pain,
in combination with the demographic and descriptive variables, explained 32% of the
variance in function, 75% of the variance in depression, 88% of the variance in agitation,
98% of the variance in resistiveness to care, and 92% of the variance in quality of
life. The model however did not show a good fit to the data.
Setting
The study was done in 55 nursing homes in Maryland and Pennsylvania.
Participants/Subjects
A total of 553 residents were included in the study.
Conclusions
The model did not have a good fit with the data which likely was due to the lack of
variance in outcomes. The hypothesized paths, with the exception of opioid use, were
significant.
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Article info
Publication history
Published online: August 02, 2021
Accepted:
July 4,
2021
Received in revised form:
June 17,
2021
Received:
March 20,
2021
Identification
Copyright
© 2021 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
