title: Pain and Aggression in Nursing Home Residents With Dementia: Minimum Data Set 3.0 Analysis.
abstract: BACKGROUND
  Few studies have examined the potential relationship between pain and aggressive behavioral symptoms in nursing home (NH) residents with dementia as a function of resident communicative status (ability to self-report pain).
  
  
  OBJECTIVE
  The objective of this study was to examine the relationship between pain and aggression for residents who self-reported pain and for those whose pain was measured by staff evaluation of pain-related behaviors.
  
  
  METHODS
  This is a secondary analysis of the comprehensive data collected from January to March 2012 in the national Minimum Data Set (MDS) 3.0 of NH residents, aged 65 years or older, with dementia (N = 71,227). Pain was measured using the MDS Pain Assessment Interview for residents who could communicate or by staff evaluation using the MDS Pain Behavior Scale for residents who could not communicate. The relationship between pain and aggressive behavioral symptoms was estimated from logistic regression models after controlling for covariates (functional/cognitive impairments, pain medications, comorbidities, and sociodemographic variables).
  
  
  RESULTS
  In residents who could not communicate, pain was associated with both verbal and physical aggression (verbal aggression: adjusted odds ratio [AOR] = 1.23, 95% CI [1.17, 1.29]; physical aggression: AOR = 1.20, 95% CI [1.14, 1.26]). In residents who could communicate, pain was associated with verbal aggression only (AOR = 1.12, 95% CI [1.04, 1.18]).
  
  
  CONCLUSIONS
  The relationship between pain and aggressive behavioral symptoms varies according to the communicative status of NH residents and disproportionately affects those who cannot articulate their pain. Strategies for enhancing pain management in these residents are needed to adequately treat pain and reduce aggression.
authors.affiliation: Hyochol Ahn, PhD, ARNP, ANP-BC, is Assistant Professor, Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville. Cynthia Garvan, PhD, is Research Associate, Professor, and Biostatistician, College of Nursing, University of Florida, Gainesville. Debra Lyon, PhD, RN, FAAN, is Executive Associate, Dean/Endowed Chair, and Professor, Department of Adult and Elderly Nursing, College of Nursing, University of Florida, Gainesville.
authors.forename: Hyochol
authors.initials: H
authors.lastname: Ahn
authors.forename: Cynthia
authors.initials: C
authors.lastname: Garvan
authors.forename: Debra
authors.initials: D
authors.lastname: Lyon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D003147:Communication Disorders / Q000150:complications / Q000523:psychology*; D066264:Datasets as Topic; D003704:Dementia / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010146:Pain / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D010147:Pain Measurement; D012307:Risk Factors; D057566:Self Report; D014481:United States; D014705:Verbal Behavior