Pain Among Community-Dwelling Older Adults with Dementia: Factors Associated with Undertreatment.
OBJECTIVE
To identify factors associated with no analgesic treatment in community-dwelling older adults with mild-to-moderate dementia and moderate-to-severe pain.


METHODS
Secondary analysis of a randomized controlled trial.


METHODS
Michael E. DeBakey Veterans Affairs Medical Center.


METHODS
Two hundred and two older adults (mean age = 79.27 years).


METHODS
Guided by the Behavioral Model of Health Service Utilization, participants completed questionnaires regarding predisposing (age, gender, race, educational level, care partner relationship), enabling (income), and need (pain interference, depressive symptoms, cognitive functioning) characteristics.


RESULTS
Hierarchical logistic regression analyses revealed that participants with greater income (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.63-0.99) and greater pain interference (OR = 0.79, 95% CI = 0.63-0.99) were less likely to have no analgesic treatment. We also examined whether other factors such as depressive symptoms influenced the relationship between pain interference and pain treatment. Those with less pain interference were more likely to have no analgesic treatment (OR = 1.04, 95% CI = 1.01-1.08), but only if they had lower levels of depressive symptoms (b = -0.52, P  = 0.005).


CONCLUSIONS
The initiation of analgesic trials is complicated for individuals with dementia and comorbid pain and depressive symptomology. Future research should focus on identifying the most effective assessment and treatment procedures to best direct clinical care for this population.
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.|Menninger Department of Psychiatry and Behavioral Sciences.|VA South Central Mental Illness Research, Education and Clinical Center.
Elyse R
ER
Thakur
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.|Department of Medicine, Baylor College of Medicine, Houston, Texas.
Amber B
AB
Amspoker
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.|Department of Medicine, Baylor College of Medicine, Houston, Texas.|VA South Central Mental Illness Research, Education and Clinical Center.
Shubhada
S
Sansgiry
Alabama Research Institute on Aging and Department of Psychology, Tuscaloosa Veterans Affairs Medical Center Research & Development, The University of Alabama, Tuscaloosa, Alabama.
A Lynn
AL
Snow
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.|Menninger Department of Psychiatry and Behavioral Sciences.|VA South Central Mental Illness Research, Education and Clinical Center.
Melinda
M
Stanley
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.|Menninger Department of Psychiatry and Behavioral Sciences.
Nancy
N
Wilson
Menninger Department of Psychiatry and Behavioral Sciences.|Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Jessica
J
Freshour
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.|Menninger Department of Psychiatry and Behavioral Sciences.|VA South Central Mental Illness Research, Education and Clinical Center.
Mark E
ME
Kunik
D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology; D000700:Analgesics / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003704:Dementia / Q000523:psychology*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy*
D000700:Analgesics
Community-Dwelling; Dementia; Depression; Pain Interference; Pain Treatment