title: The Quality of Pain Treatment in Community-Dwelling Persons with Dementia.
abstract: OBJECTIVE
  Despite pervasive and debilitating pain among elders, it is underassessed and undertreated; and cognitive impairment can add challenges. We assessed the quality of pain care for community-dwelling elderly patients with dementia.
  
  
  METHODS
  We phone interviewed 203 Veterans Affairs primary care outpatients with dementia and pain and reviewed medical records to score 15 quality indicators of pain assessment and management.
  
  
  RESULTS
  Pain assessment was documented for 98%, and a standard pain scale was used for 94%. Modified pain scales were rarely used. Though 70% self-reported pain of 'quite bad' or worse, charts documented no pain in 64%. When pain was identified, treatment was offered to 80%; but only 59% had a follow-up assessment within 6 months. Nonpharmacological interventions were underused.
  
  
  CONCLUSIONS
  Community-dwelling elders with dementia are underdiagnosed and undertreated for pain.
authors.affiliation: Baylor College of Medicine, Houston, Tex., USA.
authors.forename: Jiwen
authors.initials: J
authors.lastname: Li
authors.affiliation: University of Alabama, Tuscaloosa, Ala., USA; Tuscaloosa VA Medical Center, Tuscaloosa, Ala., USA.
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Tex., USA; Baylor College of Medicine, Houston, Tex., USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Tex., USA; Baylor College of Medicine, Houston, Tex., USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, Tex., USA.
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Stanley
authors.affiliation: The University of Texas School of Public Health-Houston, Houston, Tex., USA.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Tex., USA; Baylor College of Medicine, Houston, Tex., USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, Tex., USA.
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Tex., USA; Baylor College of Medicine, Houston, Tex., USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, Tex., USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
keywords: Dementia; Pain management; Quality indicators, health care; Veterans