Effect of acetaminophen on behavior, well-being, and psychotropic medication use in nursing home residents with moderate-to-severe dementia.
OBJECTIVE
To evaluate the effect of regularly scheduled administration of analgesic medication on behavior, emotional well-being, and use of as-needed psychotropic medications in nursing home residents with moderate-to-severe dementia.


METHODS
Randomized, double-blind, placebo-controlled, crossover trial.


METHODS
Nursing-home based.


METHODS
Twenty-five nursing home residents with moderate-to-severe dementia.


METHODS
Participants received 4 weeks of acetaminophen (3,000 mg/d) and 4 weeks of placebo.


METHODS
Behavior and emotional well-being were assessed using Dementia Care Mapping, an observational method that quantifies time spent in behaviors across 26 domains (e.g., social interaction, unattended distress) and assesses emotional state while behaviors are being observed. Agitation was measured using the Cohen-Mansfield Agitation Inventory. As-needed psychotropic medication use was aggregated from medication logs.


RESULTS
Participants spent more time in social interaction, engaged with media, talking to themselves, engaged in work-like activity, and experiencing unattended distress when they received acetaminophen than they did when they received placebo. Participants also spent less time in their rooms, less time removed from the nursing home unit, and less time performing personal care activities when they received acetaminophen. There were no effects on agitation, emotional well-being, or as-needed psychotropic medication use.


CONCLUSIONS
Untreated pain inhibits activity in nursing home residents with moderate-to-severe dementia. Pain treatment in this group may facilitate engagement with the environment.
Chibnall
John T
JT
Department of Psychiatry, School of Medicine, Saint Louis University, St. Louis, Missouri 63104, USA. chibnajt@slu.edu
Tait
Raymond C
RC
Harman
Bonnie
B
Luebbert
Rebecca A
RA
D000082:Acetaminophen / Q000008:administration & dosage* / Q000009:adverse effects; D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000342:Affective Symptoms / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D018592:Cross-Over Studies; D015161:Dementia, Multi-Infarct / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D015140:Dementia, Vascular / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D008923:Missouri; D009483:Neuropsychological Tests; D009735:Nursing Homes; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D011619:Psychotropic Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome
D000700:Analgesics; D011619:Psychotropic Drugs; D000082:Acetaminophen