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. 2021 Oct;22(10):2079-2086.e5.
doi: 10.1016/j.jamda.2021.05.010. Epub 2021 Jun 3.

Uncontrolled Pain and Risk for Depression and Behavioral Symptoms in Residents With Dementia

Yu-Jung Jenny Wei  1 , Cheng Chen  2 , Roger B Fillingim  3 , Steven T DeKosky  4 , Siegfried Schmidt  5 , Marco Pahor  6 , Laurence Solberg  7 , Almut G Winterstein  8
Affiliations

Uncontrolled Pain and Risk for Depression and Behavioral Symptoms in Residents With Dementia

Yu-Jung Jenny Wei et al. J Am Med Dir Assoc. 2021 Oct.

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: ADRD; Uncontrolled pain; behavioral symptoms; depression; nursing home.

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Conflict of interest statement

Disclosure of interest: The authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1. Flow chart of the retrospective cohort study samples for depression and for behavioral symptom outcomes.
ADRD represents Alzheimer disease and related dementia; and MDS, Minimum Data Set.
See this image and copyright information in PMC

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