Original Article| Volume 23, ISSUE 1, P55-61, February 2022

The Relationship Between Pain, Function, Behavioral, and Psychological Symptoms of Dementia and Quality of Life

Published:August 02, 2021DOI:

      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.



      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.


      This was a descriptive study using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia implementation study.


      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).


      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.


      The study was done in 55 nursing homes in Maryland and Pennsylvania.


      A total of 553 residents were included in the study.


      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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