Pain Management and Behavioral Outcomes in Patients With Dementia
Pain Management and Behavioral Outcomes in Patients With Dementia
Dementia illness often co-exists with painful medical conditions associated with aging (e.g.,
 degenerative joint disease, osteoarthritis, skin ulcers, back pain, headaches, cancer, or
 angina). While the standard practice is pain assessment for all patients, the elderly with
 dementia have special needs for assessment, management, and evaluation. When they are unable
 to verbalize pain, objective measurement of their discomfort are possible manifestations of
 pain. No research relates systemic pain treatment with reduction of negative problematic
 behaviors in patient dementia.
Background:

 Dementia illness often co-exists with painful medical conditions associated with aging (e.g.,
 degenerative joint disease, osteoarthritis, skin ulcers, back pain, headaches, cancer, or
 angina). While the standard practice is pain assessment for all patients, the elderly with
 dementia have special needs for assessment, management, and evaluation. When they are unable
 to verbalize pain, objective measurement of their discomfort are possible manifestations of
 pain. No research relates systemic pain treatment with reduction of negative problematic
 behaviors in patient dementia.

 Objectives:

 The objectives of this research are (1) to elucidate the relationships between pain,
 discomfort, and agitation; and (2) to determine the influence that pain management has on
 decreasing the outcomes of discomfort, agitation, and confusion in nursing home residents.

 Methods:

 This study used a randomized, double-blind, placebo-controlled, cross-over design. Each
 treatment arm lasted two weeks. The crossover point occurred without washout. One arm was
 acetaminophen 650 mg qid and placebo qid PRN. The other arm was placebo qid and acetaminophen
 650 mg qid PRN. Sites involved in the study included the Jewish Home for the Aged in San
 Francisco; Golden Gate Healthcare Center in San Francisco; Palo Alto VA Health Care System;
 Nursing Home Care Unit at Livermore. Patients were included who: are > 55 years; have severe
 dementia; have a documented painful condition not requiring opiates or a current medication
 regimen; unable to report pain consistently or reliably; be present and accept treatment for
 study duration; have > 1 episode of agitation per day. Patients with schizophrenia or severe
 Parkinson�s are excluded. A research assistant (blind to treatment arm) tested each patient
 for discomfort, agitation, and confusion at baseline and two times per day on two days of the
 week for four weeks. Nurses rated patients for agitation each shift. Instruments included the
 Cohen-Mansfield Agitation Inventory, the Discomfort Scale, and the Confusion Assessment
 Method. Repeated measures analyses examined effect of treatment on the three behaviors
 (agitation, confusion, and discomfort).

 Status:

 The study is complete. Final report was submitted to HSR&D in August 2001.
Inclusion Criteria:

 Patients must be: 55 years old and older, nursing home residents, a diagnosed painful that
 would respond to tylenol, documented agitated behavior, a dementia diagnosis or a
 functional impairment severe enough to rate a 7 on the Global Deterioration Scale, be
 unable to report pain. Patients must have been residents in the nursing home for at least 1
 month with a plan to stay at least 2 months.

 Exclusion Criteria: