Self-reported pain in persons with dementia predicts subsequent decreased psychosocial functioning.
OBJECTIVE
Pain self-report is the assessment gold standard in cognitively intact populations but has been discouraged in persons with dementia because of significant evidence that pain intensity is often underreported by persons with dementia. However, most community-dwelling persons with dementia are cared for in primary care settings where a more in depth pain assessment is unlikely. Therefore, it is vital to know the clinical predictive value of self-report pain assessment in this population. Psychosocial functioning is a meaningful focus for clinical prediction, because psychosocial constructs are integrally related to quality of life, physical functioning, and one's ability to function in the presence of pain. The purpose of this study was to investigate the degree to which answers to simple self-report pain questions can predict changes in psychosocial functioning 4 months later in community-dwelling older adults with dementia.


METHODS
Longitudinal. Patients and caregivers were assessed every 4 months for 24 months.


METHODS
Veterans Affairs Medical Center, Houston, TX.


METHODS
One hundred seventy-one patients over age 60 years diagnosed with dementia in the previous year and with no previous aggression were recruited from Veterans Administration clinics.


METHODS
Pain, agitation, depression, involvement in pleasant events, caregiver burden, psychosis, and patient/caregiver relationship quality (mutuality).


RESULTS
Pain scores at each time period were predictive of increased agitation and depression and decreased pleasant event frequency 4 months later.


CONCLUSIONS
Our results suggest that persons with dementia who affirmatively respond to pain questions are at higher risk for developing negative psychosocial states.
Snow
A Lynn
AL
Department of Psychology, Center for Mental Health and Aging, University of Alabama, Tuscaloosa, AL 35487-0315, USA. LSNOW@bama.ua.edu
Chandler
Joseph F
JF
Kunik
Mark E
ME
Davila
Jessica A
JA
Balasubramanyam
Valli
V
Steele
Avila B
AB
Morgan
Robert O
RO
D000368:Aged; D017028:Caregivers / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis; D003704:Dementia / Q000150:complications / Q000523:psychology*; D003863:Depression / Q000175:diagnosis; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010146:Pain / Q000150:complications / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods*; D011595:Psychomotor Agitation / Q000175:diagnosis; D012647:Self-Assessment