Outcomes of pain in frail older adults with dementia.
OBJECTIVE
To describe the outcomes of pain in cognitively impaired older adults in a Program of All-inclusive Care for older people (PACE) setting and to determine whether pain and psychotropic drug use, behavioral disturbances, hospital, nursing facility, and emergency department use, or mortality increases with the level of pain reported.


METHODS
Retrospective review of an observational cohort of patients with dementia.


METHODS
A first-generation PACE program located in Portland, Oregon. Patients with the diagnosis of dementia had been assessed for pain in a prior study.


METHODS
One hundred fifty-four cognitively impaired subjects.


METHODS
Standardized pain assessments were administered to cognitively impaired subjects between June and October 1998. After the pain assessment, information about mortality and healthcare use, including use of medication, was collected and analyzed. Subjects who reported moderate to severe pain were compared with demented subjects who reported no or mild pain.


RESULTS
There were no differences in patient characteristics (age, sex, functional limitations, disruptive behaviors, and incontinence), medications (pain and psychotropic), use (hospital, nursing home, or emergency department visit), or mortality by level of pain alone or by levels of pain and dementia together.


CONCLUSIONS
The study did not demonstrate that a single point-in-time measurement of pain in demented persons was associated with an increased rate of behavioral problems, narcotic use, or hospital or emergency department use over the following year. Prospective studies are needed that measure pain over time to determine more accurately the relationship between pain and negative outcomes in dementia.
Brummel-Smith
Kenneth
K
Providence Center on Aging, Portland, Oregon 97230, USA. kbrummel-smith@providence.org
London
Marla R
MR
Drew
Nicholas
N
Krulewitch
Harry
H
Singer
Clifford
C
Hanson
Lynn
L
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D015331:Cohort Studies; D003704:Dementia / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010146:Pain / Q000401:mortality / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies
D000700:Analgesics; D011619:Psychotropic Drugs