Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications

Anto P. Rajkumar; Clive Ballard; Jane Fossey; Martin Orrell; Esme Moniz-Cook; Robert T. Woods; Joanna Murray; Rhiannon Whitaker; Jane Stafford; Martin Knapp; Renee Romeo; Barbara Woodward-Carlton; Zunera Khan; Ingelin Testad; Anne Corbett

doi:10.1016/j.jamda.2017.01.024

Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications

Anto P. Rajkumar, Clive Ballard, Jane Fossey, Martin Orrell, Esme Moniz-Cook, Robert T. Woods, Joanna Murray, Rhiannon Whitaker, Jane Stafford, Martin Knapp, Renee Romeo, Barbara Woodward-Carlton, Zunera Khan, Ingelin Testad, Anne Corbett

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Abstract

Introduction: Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited.

Methods: We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629).

Results: Baseline prevalence of pain was 35.3% (95% CI 32.3–38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18–1.85) with all-cause mortality during follow-up.

Conclusions: Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.

Original language	English
Pages (from-to)	453.e1-453.e6
Journal	Journal Of The American Medical Directors Association
Volume	18
Issue number	5
Early online date	18 Mar 2017
DOIs	https://doi.org/10.1016/j.jamda.2017.01.024
Publication status	Published - May 2017

Keywords

Pain
dementia
analgesics
quality of life
mortality
depression

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Epidemiology of Pain in_RAJKUMAR_Publishedonline18March2017_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 427 KBLicence: CC BY-NC-ND

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Rajkumar, A. P., Ballard, C., Fossey, J., Orrell, M., Moniz-Cook, E., Woods, R. T., Murray, J., Whitaker, R., Stafford, J., Knapp, M., Romeo, R., Woodward-Carlton, B., Khan, Z., Testad, I., & Corbett, A. (2017). Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications. Journal Of The American Medical Directors Association, 18(5), 453.e1-453.e6. https://doi.org/10.1016/j.jamda.2017.01.024

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abstract = "Introduction: Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited. Methods: We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629). Results: Baseline prevalence of pain was 35.3% (95% CI 32.3–38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18–1.85) with all-cause mortality during follow-up. Conclusions: Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.",

keywords = "Pain, dementia, analgesics, quality of life, mortality, depression",

author = "Rajkumar, {Anto P.} and Clive Ballard and Jane Fossey and Martin Orrell and Esme Moniz-Cook and Woods, {Robert T.} and Joanna Murray and Rhiannon Whitaker and Jane Stafford and Martin Knapp and Renee Romeo and Barbara Woodward-Carlton and Zunera Khan and Ingelin Testad and Anne Corbett",

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Rajkumar, AP, Ballard, C, Fossey, J, Orrell, M, Moniz-Cook, E, Woods, RT, Murray, J, Whitaker, R, Stafford, J, Knapp, M, Romeo, R, Woodward-Carlton, B, Khan, Z, Testad, I & Corbett, A 2017, 'Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications', Journal Of The American Medical Directors Association, vol. 18, no. 5, pp. 453.e1-453.e6. https://doi.org/10.1016/j.jamda.2017.01.024

TY - JOUR

T1 - Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications

AU - Rajkumar, Anto P.

AU - Ballard, Clive

AU - Fossey, Jane

AU - Orrell, Martin

AU - Moniz-Cook, Esme

AU - Woods, Robert T.

AU - Murray, Joanna

AU - Whitaker, Rhiannon

AU - Stafford, Jane

AU - Knapp, Martin

AU - Romeo, Renee

AU - Woodward-Carlton, Barbara

AU - Khan, Zunera

AU - Testad, Ingelin

AU - Corbett, Anne

PY - 2017/5

Y1 - 2017/5

N2 - Introduction: Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited. Methods: We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629). Results: Baseline prevalence of pain was 35.3% (95% CI 32.3–38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18–1.85) with all-cause mortality during follow-up. Conclusions: Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.

AB - Introduction: Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited. Methods: We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629). Results: Baseline prevalence of pain was 35.3% (95% CI 32.3–38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18–1.85) with all-cause mortality during follow-up. Conclusions: Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.

KW - Pain

KW - dementia

KW - analgesics

KW - quality of life

KW - mortality

KW - depression

U2 - 10.1016/j.jamda.2017.01.024

DO - 10.1016/j.jamda.2017.01.024

M3 - Article

SN - 1525-8610

VL - 18

SP - 453.e1-453.e6

JO - Journal Of The American Medical Directors Association

JF - Journal Of The American Medical Directors Association

IS - 5

ER -

Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications

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Keywords

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