title: Health problems and correlates of pain in nursing home residents with advanced dementia.
abstract: This study describes the health problems and comorbid illnesses of nursing home (NH) residents with advanced dementia (n=123) and identifies correlates of staff-identified pain. Study participants were residents of 3 NHs in Maryland, their surrogate decision makers and their physicians. Residents' cognitive function was assessed at study enrollment, and their medical records were reviewed to identify all health problems/illnesses and use of pain medications during the 6 months before their enrollment. The most prevalent health problems were skin problems (95%), nutrition/hydration problems (85%), psychiatric/behavioral problems (85%), gastrointestinal problems (81%), and infections (80%). Sixty-three percent of residents had recognized pain, and 95% of those residents received pain medications. In a multivariate regression analysis, staff-identified pain was associated with aspiration (P=0.008), peripheral vascular disease (P=0.021), musculoskeletal disorders (P=0.032), higher cognitive function (P=0.013), and use of pain medications, including non-opiates (P=0.004) and the combination of opiates and non-opiates (P=0.001). NH residents with advanced dementia experience a complex mixture of multiple chronic and acute comorbidities. These results suggest the need for clinicians in long-term care facilities to be vigilant in assessing and treating pain, particularly as cognitive function declines in those with advanced dementia.
authors.affiliation: The Johns Hopkins Medical Institutions Baltimore, MD 21287, USA. bblack@jhmi.edu
authors.forename: Betty S
authors.initials: BS
authors.lastname: Black
authors.forename: Thomas
authors.initials: T
authors.lastname: Finucane
authors.forename: Alva
authors.initials: A
authors.lastname: Baker
authors.forename: David
authors.initials: D
authors.lastname: Loreck
authors.forename: David
authors.initials: D
authors.lastname: Blass
authors.forename: Linda
authors.initials: L
authors.lastname: Fogarty
authors.forename: Hilary
authors.initials: H
authors.lastname: Phillips
authors.forename: Linda
authors.initials: L
authors.lastname: Hovanec
authors.forename: Cynthia
authors.initials: C
authors.lastname: Steele
authors.forename: Peter V
authors.initials: PV
authors.lastname: Rabins
mesh_terms: D000369:Aged, 80 and over; D000700:Analgesics; D003071:Cognition; D015897:Comorbidity; D003704:Dementia / Q000150:complications*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D010166:Palliative Care / Q000379:methods*; D015995:Prevalence
chemical_list: D000700:Analgesics