The relationship between pain and disruptive behaviors in nursing home resident with dementia

BMC Geriatrics

Ann Horgas¹  Hyochol Ahn¹ 

[1] Department of Adult and Elderly Nursing, College of Nursing, University of Florida, Gainesville, FL, 32610-0197, USA

关键词: Nursing home;    Dementia;    Pain;    Disruptive behaviors;   

Others  :  857899
DOI  :  10.1186/1471-2318-13-14

 received in 2012-08-18, accepted in 2013-02-05,  发布年份 2013

【 摘 要 】

Background

Nursing home residents with dementia gradually lose the ability to process information so that they are less likely to express pain in typical ways. These residents may express pain through disruptive behaviors because they cannot appropriately verbalize their pain experience. The objective of this study was to investigate the effect of pain on disruptive behaviors in nursing home residents with dementia.

Methods

This is a secondary analysis of the Minimum Data Set (MDS 2.0) assessment data on long-term care from the state of Florida. The data used in this study were the first comprehensive assessment data from NH residents with dementia aged 65 and older (N = 56,577) in Medicare- or Medicaid-certified nursing homes between January 1, 2009 and December 31, 2009. Variables examined were pain, wandering, aggression, agitation, cognitive impairment, activities of daily living impairments, and demographic characteristics. Ordinal logistic regression was used to evaluate the effect of pain on disruptive behaviors.

Results

Residents with more severe pain are less likely to display wandering behaviors (OR = .77, 95% CI for OR = [0.73, 0.81]), but more likely to display aggressive and agitated behaviors (OR = 1.04, 95% CI for OR = [1.01, 1.08]; OR = 1.17, 95% CI for OR = [1.13, 1.20]).

Conclusions

The relationship between pain and disruptive behaviors depends on the type of behaviors. Pain is positively correlated with disruptive behaviors that do not involve locomotion (e.g., aggression and agitation), but negatively related to disruptive behaviors that are accompanied by locomotion (e.g., wandering). These findings indicate that effective pain management may help to reduce aggression and agitation, and to promote mobility in persons with dementia.

【 授权许可】

   
2013 Ahn and Horgas; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Horgas A, Elliott AF, Marsiske M: Pain assessment in persons with dementia: Relationship between self-report and behavioral observation. J Am Geriatr Soc 2009, 57(1):126-132.
• [2]Cohen-Mansfield J: The adequacy of the minimum data set assessment of pain in cognitively impaired nursing home residents. J Pain Symptom Manage 2004, 27(4):343-351.
• [3]Burfield AH, Wan TT, Sole ML, Cooper JW: Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care. Clin Interv Aging 2012, 7:207-223.
• [4]Kovach CR, Noonan PE, Schlidt AM, Reynolds S, Wells T: The serial trial intervention: an innovative approach to meeting needs of individuals with dementia. J Gerontol Nurs 2006, 32(4):18-25.
• [5]Pieper MJ, Achterberg WP, Francke AL, van der Steen JT, Scherder EJ, Kovach CR: The implementation of the serial trial intervention for pain and challenging behaviour in advanced dementia patients (STA OP!): a clustered randomized controlled trial. BMC Geriatr 2011, 11(1):12. BioMed Central Full Text
• [6]Aalten P, van Valen E, de Vugt ME, Lousberg R, Jolles J, Verhey FR: Awareness and behavioral problems in dementia patients: a prospective study. Int Psychogeriatr 2006, 18(1):3-17.
• [7]Aud MA: Dangerous wandering: elopements of older adults with dementia from long-term care facilities. Am J Alzheimers Dis Other Demen 2004, 19(6):361-368.
• [8]Sink KM, Covinsky KE, Newcomer R, Yaffe K: Ethnic differences in the prevalence and pattern of dementia-related behaviors. J Am Geriatr Soc 2004, 52(8):1277-1283.
• [9]Kunik ME, Walgama JP, Snow AL, Davila JA, Schulz PE, Steele AB, Morgan RO: Documentation, assessment, and treatment of aggression in patients with newly diagnosed dementia. Alzheimer Dis Assoc Disord 2007, 21(2):115-121.
• [10]Kunik ME, Snow AL, Davila JA, McNeese T, Steele AB, Balasubramanyam V, Doody R, Schulz PE, Kalavar JS, Walder A, Morgan RO: Consequences of aggressive behavior in patients with dementia. J Neuropsychiatry Clin Neurosci 2010, 22(1):40-47.
• [11]Norton MJ, Allen RS, Snow AL, Hardin JM, Burgio LD: Predictors of need-driven behaviors in nursing home residents with dementia and associated certified nursing assistant burden. Aging Ment Health 2010, 14(3):303-309.
• [12]2011 Alzheimer’s Disease facts and figures http://www.alz.org/downloads/Facts_Figures_2011.pdf webcite
• [13]Hersch EC, Falzgraf S: Management of the behavioral and psychological symptoms of dementia. Clin Interv Aging 2007, 2(4):611-621.
• [14]Algase DL, Beck C, Kolanowski A, Whall A, Berent S, Richards K, Beattie E: Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. Am J Alzheimers Dis Other Demen 1996, 11(6):10-19.
• [15]Burgio LD, Park NS, Hardin JM, Sun F: A longitudinal examination of agitation and resident characteristics in the nursing home. Gerontologist 2007, 47(5):642-649.
• [16]Cohen-Mansfield J, Libin A: Verbal and physical non-aggressive agitated behaviors in elderly persons with dementia: Robustness of syndromes. J Psychiatr Res 2005, 39(3):325-332.
• [17]Reynolds KS, Hanson LC, DeVellis RF, Henderson M, Steinhauser KE: Disparities in pain management between cognitively intact and cognitively impaired nursing home residents. J Pain Symptom Manage 2008, 35(4):388-396.
• [18]Shega JW, Ersek M, Herr K, Paice JA, Rockwood K, Weiner DK, Dale W: The multidimensional experience of noncancer pain: Does cognitive status matter? Pain Medicine 2010, 11(11):1680-1687.
• [19]Long Term Care Minimum Data Set 3.0 http://www.resdac.org/cms-data/files/mds-3.0 webcite
• [20]Lum TY, Lin W-C, Kane RL: Use of proxy respondents and accuracy of minimum data set assessments of activities of daily living. J Gerontol A Biol Sci Med Sci 2005, 60(5):654-659.
• [21]Won A, Lapane KL, Vallow S, Schein J, Morris JN, Lipsitz LA: Long-term effects of analgesics in a population of elderly nursing home residents with persistent nonmalignant pain. J Gerontol A Biol Sci Med Sci 2006, 61(2):165-169.
• [22]Lee FP, Leppa C, Schepp K: Using the minimum data set to determine predictors of terminal restlessness among nursing home residents. J Nurs Res 2006, 14(4):286-296.
• [23]Carpenter GI, Hastie CL, Morris JN, Fries BE, Ankri J: Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment. BMC Geriatr 2006, 6:1-8. BioMed Central Full Text
• [24]Fries BE, Simon SE, Morris JN, Flodstrom C, Flodstrom C, Bookstein FL: Pain in U.S. Nursing homes: validating a pain scale for the minimum data set. Gerontologist 2001, 41(2):173-179.
• [25]Burrows AB, Morris JN, Simon SE, Hirdes JP, Phillips C: Development of an minimum data set-based depression rating scale for use in nursing homes. Age Ageing 2000, 29:165-172.
• [26]Perlman CM, Hirdes JP: The aggressive behavior scale: a new scale to measure aggression based on the minimum data Set. J Am Geriatr Soc 2008, 56(12):2298-2303.
• [27]Gerritsen DL, Achterberg WP, Steverink N, Pot AM, Frijters DH, Ribbe MW: The MDS challenging behavior profile for long-term care. Aging Ment Health 2008, 12(1):116-123.
• [28]Stevenson KM, Brown RL, Dahl JL, Ward SE, Brown MS: The discomfort behavior scale: a measure of discomfort in the cognitively impaired based on the minimum data Set 2.0. Res Nurs Health 2006, 29(6):576-587.
• [29]Hartmaier SL, Sloane PD, Guess HA, Koch GG: The MDS cognition scale: a valid instrument for identifying and staging nursing home residents with dementia using the minimum data set. J Am Geriatr Soc 1994, 42(11):1212-1213.
• [30]Achterberg W, Pot AM, Kerkstra A, Ooms M, Muller M, Ribbe M: The effect of depression on social engagement in newly admitted Dutch nursing home residents. Gerontologist 2003, 43(2):213-218.
• [31]Sgadari A, Morris JN, Fries BE, Ljunggren G, Jonsson PV, DuPaquier JN, Schroll M: Efforts to establish the reliability of the resident assessment instrument. Age Ageing 1997, 26(Suppl 2):27-30.
• [32]Williams BC, Li Y, Fries BE, Warren RL: Predicting patient scores between the functional independence measure and the minimum data set: Development and performance of a FIM-MDS “crosswalk”. Arch Phys Med Rehabil 1997, 78(1):48-54.
• [33]Frederiksen K, Tariot P, De Jonghe E: Minimum Data Set Plus (MDS+) scores compared with scores from five rating scales. J Am Geriatr Soc 1996, 44(3):305-309.
• [34]Hirdes JP, Smith TF, Rabinowitz T, Yamauchi K, Perez E, Telegdi NC, Prendergast P, Morris JN, Ikegami N, Phillips CD, Fries BE: The resident assessment instrument-mental health (RAI-MH): inter-rater reliability and convergent validity. J Behav Health Serv Res 2002, 29(4):419-432.
• [35]Hirdes JP, Frijters DH, Teare GF: The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people. J Am Geriatr Soc 2003, 51(1):96-100.
• [36]Casten R, Lawton MP, Parmelee PA, Kleban MH: Psychometric characteristics of the minimum data set I: confirmatory factor analysis. J Am Geriatr Soc 1998, 46(6):726-735.
• [37]Lawton MP, Casten R, Parmelee PA, Haitsma KV, Corn J, Kleban MH: Psychometric characteristics of the minimum data Set II: validity. J Am Geriatr Soc 1998, 46(6):736-744.
• [38]Morris JN, Fries BE, Mehr DR, Hawes C, Phillips C, Mor V, Lipsitz LA: MDS cognitive performance scale. J Gerontol A Biol Sci Med Sci 1994, 49(4):174-182.
• [39]Bula CJ, Wietlisbach V: Use of the cognitive performance scale (CPS) to detect cognitive impairment in the acute care setting: Concurrent and predictive validity. Brain Res Bull 2009, 80(4–5):173-178.
• [40]Hartmaier SL, Sloane PD, Guess HA, Koch GG, Mitchell CM, Phillips CD: Validation of the minimum data Set cognitive performance scale: agreement with the mini-mental state examination. J Gerontol A Biol Sci Med Sci 1995, 50A(2):128-133.
• [41]McConnell ES, Pieper CF, Sloane RJ, Branch LG: Effects of cognitive performance on change in physical function in long-stay nursing home residents. J Gerontol A Biol Sci Med Sci 2002, 57(12):778-784.
• [42]Morris JN, Fries BE, Morris SA: Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci 1999, 54(11):546-553.
• [43]Hawes C, Morris JN, Phillips CD, Mor V, Fries BE, Nonemaker S: Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). Gerontologist 1995, 35(2):172-178.
• [44]Pollock BG, Mulsant BH, Rosen J, Sweet RA, Mazumdar S, Bharucha A, Marin R, Jacob NJ, Huber KA, Kastango KB, Chew ML: Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. Am J Psychiatry 2002, 159(3):460-465.
• [45]Villanueva MR, Smith TL, Erickson JS, Lee AC, Singer CM: Pain Assessment for the Dementing Elderly (PADE): Reliability and validity of a new measure. J Am Med Dir Assoc 2003, 4(1):1-8.
• [46]Buffum MD, Miaskowski C, Sands L, Brod M: A pilot study of the relationship between discomfort and agitation in patients with dementia. Geriatr Nur (Lond) 2001, 22(2):80-85.
• [47]Manfredi PL, Breuer B, Wallenstein S, Stegmann M, Bottomley G, Libow L: Opioid treatment for agitation in patients with advanced dementia. Int J Geriatr Psychiatry 2003, 18(8):700-705.
• [48]Kiely DK, Morris JN, Algase DL: Resident characteristics associated with wandering in nursing homes. Int J Geriatr Psychiatry 2000, 15(11):1013-1020.
• [49]Bartels SJ, Horn SD, Smout RJ, Dums AR, Flaherty E, Jones JK, Monane M, Taler GA, Voss AC: Agitation and depression in frail nursing home elderly patients with dementia: treatment characteristics and service use. Am J Geriatr Psychiatry 2003, 11(2):231-238.