Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications.
BACKGROUND
Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited.


METHODS
We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629).


RESULTS
Baseline prevalence of pain was 35.3% (95% CI 32.3-38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18-1.85) with all-cause mortality during follow-up.


CONCLUSIONS
Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.
Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS foundation Trust, London, United Kingdom.
Anto P
AP
Rajkumar
University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom.
Clive
C
Ballard
Psychological Services, Oxford Health NHS Foundation Trust, Fulbrook Center, Oxford, United Kingdom.
Jane
J
Fossey
Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom.
Martin
M
Orrell
Institute of Rehabilitation, Dementia Applied Research Center, University of Hull, Hull, United Kingdom.
Esme
E
Moniz-Cook
Dementia Services Development Center, Wales, Institute of Medical and Social Care Research, Bangor University, Bangor, United Kingdom.
Robert T
RT
Woods
Section of Mental Health and Aging, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
Joanna
J
Murray
Whitaker Research Ltd, Bangor, United Kingdom.
Rhiannon
R
Whitaker
Psychological Services, Oxford Health NHS Foundation Trust, The Fulbrook Center, Oxford, United Kingdom.
Jane
J
Stafford
London School of Economics and Political Science, London, United Kingdom.
Martin
M
Knapp
Section of Mental Health and Aging, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
Renee
R
Romeo
Alzheimer Society, Devon House, London, United Kingdom.
Barbara
B
Woodward-Carlton
Wolfson Center for Age-Related Diseases, King's College London, London, United Kingdom.
Zunera
Z
Khan
Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
Ingelin
I
Testad
University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom. Electronic address: a.m.j.corbett@exeter.ac.uk.
Anne
A
Corbett
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D003704:Dementia; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D011788:Quality of Life
D000700:Analgesics
Pain; analgesics; dementia; depression; mortality; quality of life