title: The response of agitated behavior to pain management in persons with dementia.
abstract: OBJECTIVE
  Behavioral disturbances and pain are common in nursing home (NH) patients with dementia. An association between pain and increased agitation has been suggested, and recently a significant reduction of agitation has been demonstrated by pain treatment in patients with moderate to severe dementia. We now examined which specific agitated behaviors respond to individualized pain treatment.
  
  
  METHODS
  Cluster randomized clinical trial.
  
  
  METHODS
  60 clusters (i.e., clusters defined as single independent NH units) in 18 NHs within five municipalities of Western Norway.
  
  
  METHODS
  352 patients with moderate to severe dementia and clinically significant behavioral disturbances.
  
  
  METHODS
  The control group received usual treatment and care. According to a predefined scheme for 8 weeks, all patients in the intervention group received individual daily pain treatment with acetaminophen, extended release morphine, buprenorphine transdermal patch, and/or pregabaline.
  
  
  METHODS
  Cohen-Mansfield Agitation Inventory subscales and items.
  
  
  RESULTS
  Analyses demonstrated that Factor 3 (Verbally agitated behaviors) showed the largest significant difference (DF = 1204.0, t = -4.308, p <0.001), followed by Factor 2 (Physically non-aggressive behaviors) (DF = 1198.0, t = -2.672, p = 0.008), and Factor 1 (Aggressive behaviors) (DF = 1196.0, t = -2.093, p = 0.037) after 8 weeks, by a linear random intercept mixed model in two-way repeated-measures configuration with adjustment for heteroscedasticity.
  
  
  CONCLUSIONS
  We found that verbal agitation behaviors such as complaining, negativism, repetitious sentences and questions, constant request for attention, and cursing or verbal aggression responded to pain treatment. In addition, restlessness and pacing were sensible to analgesics. Such behaviors should therefore lead to an assessment of pain, and pain treatment. Further studies comparing how pain treatment should be balanced against other strategies including psychotropic drugs are needed.
authors.affiliation: Department of Public Health and Primary Health Care Center for Elderly- and Nursing Home Medicine, University of Bergen, Bergen, Norway; Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway. Electronic address: Bettina.Husebo@isf.uib.no.
authors.forename: Bettina S
authors.initials: BS
authors.lastname: Husebo
authors.affiliation: Kings College, London, United Kingdom; Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Tel-Aviv University Sackler Faculty of Medicine and Herczeg Institute on Aging, Tel-Aviv, Israel; George Washington University Medical Center, Washington, DC.
authors.forename: Jiska
authors.initials: J
authors.lastname: Cohen-Mansfield
authors.affiliation: Heart Department, Haukeland University Hospital, Bergen, Norway.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Seifert
authors.affiliation: Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Karolinska Institute-Alzheimer Disease Research Center, Stockholm, Sweden; Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Dag
authors.initials: D
authors.lastname: Aarsland
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D003704:Dementia / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009664:Norway; D009735:Nursing Homes; D010146:Pain / Q000150:complications* / Q000188:drug therapy*; D059408:Pain Management; D000069583:Pregabalin; D011595:Psychomotor Agitation / Q000150:complications* / Q000188:drug therapy*; D057968:Transdermal Patch; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D003692:Delayed-Action Preparations; D000082:Acetaminophen; D002047:Buprenorphine; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D009020:Morphine
keywords: Dementia; aggression; agitation; behavioral disturbances; cluster randomised trial; nursing home; pain; pain treatment