title: Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XI: Dementia.
abstract: OBJECTIVE : To present the 11th in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributions to pain and disability in older adults with CLBP. This article focuses on dementia.
  
  
  
  A modified Delphi technique was used to develop an algorithm for an approach to treatment for older adults living with CLBP and dementia. A panel of content experts on pain and cognition in older adults developed the algorithm through an iterative process. Though developed using resources available within Veterans Health Administration (VHA) facilities, the algorithm is applicable across all health care settings. A case taken from the clinical practice of one of the contributors demonstrates application of the algorithm.
  
  
  
  We present an evidence-based algorithm and biopsychosocial rationale to guide providers evaluating CLBP in older adults who may have dementia. The algorithm considers both subtle and overt signs of dementia, dementia screening tools to use in practice, referrals to appropriate providers for a complete a workup for dementia, and clinical considerations for persons with dementia who report pain and/or exhibit pain behaviors. A case of an older adult with CLBP and dementia is presented that highlights how an approach that considers the impact of dementia on verbal and nonverbal pain behaviors may lead to more appropriate and successful pain management.
  
  
  
  Comprehensive pain evaluation for older adults in general and for those with CLBP in particular requires both a medical and a biopsychosocial approach that includes assessment of cognitive function. A positive screen for dementia may help explain why reported pain severity does not improve with usual or standard-of-care pain management interventions. Pain reporting in a person with dementia does not always necessitate pain treatment. Pain reporting in a person with dementia who also displays signs of pain-associated suffering requires concerted pain management efforts targeted to improving function while avoiding harm in these vulnerable patients.Key Words. Dementia; Chronic Pain; Low Back Pain; Lumbar; Primary Care.
authors.affiliation: Division of Geriatric Medicine.
authors.forename: Rollin
authors.initials: R
authors.lastname: Wright
authors.affiliation: Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Monica
authors.initials: M
authors.lastname: Malec
authors.affiliation: VITAS Healthcare, Miami, Florida.|University of Central Florida, Orlando, Florida.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Shega
authors.affiliation: Division of Geriatric Medicine.
authors.forename: Eric
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.|Yale School of Medicine New Haven, Connecticut.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kulas
authors.affiliation: Department of Psychiatry.
authors.forename: Lisa
authors.initials: L
authors.lastname: Morrow
authors.affiliation: Department of Occupational Therapy, School of Health and Rehabilitation Sciences.
authors.forename: Juleen
authors.initials: J
authors.lastname: Rodakowski
authors.affiliation: US Department of Veterans Affairs, National Pharmacy Benefits Management Services, Hines, Illinois.|Departments of Psychiatry.|Behavioral Sciences, Northwestern University, Chicago, Illinois.
authors.forename: Todd
authors.initials: T
authors.lastname: Semla
authors.affiliation: Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.|Division of Geriatric Medicine.|Yale School of Medicine New Haven, Connecticut.|Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000369:Aged, 80 and over; D059350:Chronic Pain / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003697:Delphi Technique; D003704:Dementia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D016896:Treatment Outcome