Pain Treatments for Nursing Home Residents with Advanced Dementia and Substantial Impaired Communication: A Cross-Sectional Analysis at Baseline of a Cluster Randomized Controlled Trial.
OBJECTIVE
This is a cross-sectional analysis at baseline of a cluster randomized controlled trial to identify factors associated with the use of pharmacological and nonpharmacological pain treatments by nursing home residents with dementia and impaired communication.


METHODS
One hundred thirty-four residents with dementia and impaired communication were recruited. Nine of them were excluded because data on their pain treatments were missing, resulting in 125 for analysis. Hierarchical generalized estimating equations analyses controlling for the clustering effect of nursing homes were used to identify factors associated with the use of pharmacological and nonpharmacological pain treatments.


RESULTS
Although all participants had a confirmed pain condition, only 23 (18.4%) and 45 (36%) had received pharmacological or nonpharmacological pain treatments, respectively. Participants with a higher ability to communicate ( P  = 0.031) and fewer pain locations were found to be more likely to receive pain medications, with the impact of communication ability being greater among participants with better cognitive status than among those with poor cognitive status. Participants who had been living in the home longer and who were more dependent were less likely to receive nonpharmacological treatments.


CONCLUSIONS
Suboptimal pain management was common among this population. Severe impairment in the ability to communicate is a major reason for the underuse of pain medications. Staff may become desensitized and fail to perceive subtle changes in the residents' behavior as indicative of pain, leading to the underadministering of nonpharmacological treatments. To improve this situation, it is suggested that observational pain assessments be systematically carried out in nursing homes.
Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
Justina Yat Wa
JYW
Liu
The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
Doris Y P
DYP
Leung
D000368:Aged; D000369:Aged, 80 and over; D003147:Communication Disorders / Q000209:etiology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D059408:Pain Management / Q000379:methods*
Administration; Communication Impairment; Dementia; Pain Treatment; Prescription