Abstract
Objectives
Limited cohort studies have assessed the association between uncontrolled pain and
risk for behavioral and psychological symptoms of dementia (BPSDs). We conducted a
longitudinal cohort study to examine whether associations exist between uncontrolled
pain and risk for 2 common BPSDs—depression and behavioral symptoms—among long-term
care (LTC) residents with Alzheimer disease and related dementia (ADRD).
Design
This retrospective cohort study analyzed quarterly data from the 5% Medicare sample
linked to Minimum Data Set (MDS) 3.0 between January 1, 2011, and December 31, 2015.
Setting and Participants
LTC residents aged 50 years or older with ADRD who had chronic pain and at least 2
quarterly MDS 3.0 assessments.
Methods
LTC residents were followed up quarterly from first observed quarterly MDS 3.0 until
first outcome event or last observed quarterly MDS 3.0. Uncontrolled pain was defined
as numerical rating scale >4, verbal descriptor scale of moderate or severe pain,
or ≥1 pain indicators on the Checklist of Nonverbal Pain Indicators. Depression was
defined as ≥10 on the Patient Health Questionnaire 9; behavioral symptoms were defined
as the presence of psychotic (delusions or hallucinations) or disruptive behaviors
(rejection of care, or physical, verbal, or other aggressive behaviors). Generalized
linear models (GLMs) with marginal structural modeling (MSM) stabilized weights were
used to examine uncontrolled pain and outcome risk.
Results
The incidence rate of depression and behavioral symptoms during follow-up was 9.4
and 23.1 per 100 resident-years, respectively. Results from the MSM-GLMs showed that
LTC residents with uncontrolled pain had a higher risk than those with controlled
pain for developing depression [hazard ratio 1.67, 95% confidence interval (CI) 1.54–1.81]
and behavioral symptoms (hazard ratio 1.28, 95% CI 1.19–1.37).
Conclusions and Implications
Uncontrolled pain was associated with elevated risk for depressive and behavioral
symptoms in dementia, underscoring the importance of pain assessment and control among
LTC residents with ADRD.
Keywords
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Article info
Publication history
Published online: June 02, 2021
Footnotes
This project was funded by the National Institute on Aging (Mentored Research Scientist Award K01AG054764, Dr. Wei).
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
