Management of noncancer pain in community-dwelling persons with dementia.
OBJECTIVE
To explore the pharmacological treatment of noncancer pain in persons with dementia and identify predictors associated with insufficient analgesia.


METHODS
Cross-sectional analysis of an observational cohort study.


METHODS
Academic outpatient geriatric clinic in Chicago, Illinois.


METHODS
A total of 115 dyads, mostly African American, consisting of community-dwelling persons with dementia and their caregivers.


METHODS
Patient report of demographics, noncancer pain, function, cognition, and depression. Caregiver report of patient agitation and over-the-counter and prescription medications.


RESULTS
Sixty-two of 115 (54%) patients reported pain "on an average day." The caregivers of more than half of persons with dementia who reported pain "on an average day" did not report analgesic use. The majority of caregivers who reported analgesic use reported that patients took a World Health Organization Class I medication. No patients had been prescribed a Class III (strong opioid) drug. Fifty-three of 115 (46%) patients had potentially insufficient analgesia. In the logistic regression, insufficient analgesia was associated with greater age, Mini-Mental State Examination score of less than 10, and impairment in daily functioning. Insufficient analgesia was 1.07 times as likely (95% confidence interval (CI) = 1.01-1.14) for each additional year of age, 3.0 times as likely (95% CI = 1.05-9.10) if the subject had advanced dementia, and 2.5 times as likely (95% CI = 1.01-6.25) if the patient had any impairment in activities of daily living.


CONCLUSIONS
In this convenience sample from a geriatric clinic, many persons with dementia and noncancer pain were not receiving pharmacological treatment. Those at greatest risk for insufficient analgesia were older, had moderate to severe dementia, and experienced impairments in activities of daily living.
Shega
Joseph W
JW
Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois 60611, USA. j-shega@northwestern.edu
Hougham
Gavin W
GW
Stocking
Carol B
CB
Cox-Hayley
Deon
D
Sachs
Greg A
GA
D000203:Activities of Daily Living; D001741:Black or African American; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D017028:Caregivers; D002641:Chicago; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications* / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010146:Pain / Q000145:classification / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000700:Analgesics