title: Who suffers most? Dementia and pain in nursing home patients: a cross-sectional study.
abstract: OBJECTIVE
  To explore the relationship between nursing home patients with different stages of dementia and different dementia diagnoses and use of pain medication according to pain intensity.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Participants included 181 consecutive, long-term stay patients, 43 primary caregivers, 1 geriatric study nurse, and 4 physicians of a Norwegian nursing home.
  
  
  METHODS
  Admission records, prescription lists, care plans, Mini-Mental State Examination, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), International Classification of Diseases (ICD-10), cerebral computed tomography, pain diagnoses and pain locations by physicians' examinations, and pain intensity by MOBID-2 (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale), a novel staff-administered pain tool in dementia.
  
  
  RESULTS
  Patients with severe dementia do not experience less pain intensity (P = .079), numbers of pain diagnoses (P = .172), and pain locations (P = .202) compared to other stages of dementia. Severely demented patients receiving opioids demonstrated higher pain intensity (mean 4.4, SD 1.7) than nondemented patients (mean 2.9, SD 1.8), and received less pain treatment (P = .018). Pain intensity did not differ between diagnostic groups of dementia (P = .439). Patients with mixed dementia receiving opioids had more pain (mean 5.3, SD 1.5, range 4-7) than mentally healthy controls and received less pain treatment (P < .005).
  
  
  CONCLUSIONS
  Patients with severe dementia and mixed dementia are at high risk to suffer from severe pain. More research and quality improvement programs are needed to increase the knowledge in pain treatment by staff, which requires competence in both pain assessment and dementia.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. Bettina.Husebo@isf.uib.no
authors.forename: Bettina Sandgathe
authors.initials: BS
authors.lastname: Husebo
authors.forename: Liv Inger
authors.initials: LI
authors.lastname: Strand
authors.forename: Rolf
authors.initials: R
authors.lastname: Moe-Nilssen
authors.forename: Stein
authors.initials: S
authors.lastname: Borgehusebo
authors.forename: Dag
authors.initials: D
authors.lastname: Aarsland
authors.forename: Anne Elisabeth
authors.initials: AE
authors.lastname: Ljunggren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008485:Medical Audit; D009664:Norway; D009735:Nursing Homes; D010146:Pain / Q000188:drug therapy*; D012720:Severity of Illness Index
chemical_list: D000700:Analgesics