National Meeting 2008

3008 — Self-reported Pain in Persons with Dementia Predicts Subsequent Decreased Psychosocial Functioning

Chandler JF (University of Alabama) , Snow AL (Tuscaloosa VAMC and University of Alabama), Balasubramanyam V (Houston COE), Kunik ME (Houston COE), Steele AB (Houston COE), Davila JA (Houston COE), Morgan RO (Houston COE)

The purpose of this study is to investigate whether simple self-report pain assessments can predict changes in psychosocial functioning in community-dwelling persons with dementia.

Newly diagnosed, nonaggressive dementia patients were identified through VA Administrative Databases and primary care physicians. Exclusion criteria were 1) current nursing home residence; or 2) having a caregiver less than 8 hours per week. Participants and their caregivers were assessed monthly for 24 months. The independent variables were three self-reported pain items from the Philadelphia Geriatric Center Pain Intensity Scale (worst pain in the past week, pain intensity now, interference with daily activities due to pain). The dependent variables included: Agitation (Cohen-Mansfield Agitation Inventory), Hamilton Rating Scale for Depression, Psychosis (Neuropsychiatric Inventory), Caregiver Burden (Burden Index), Caregiver Relationship (Mutuality Scale) and Environmental Quality (Pleasant Events Scale). Models used an auto-regressive General Linear Model with Generalized Estimating Equations (GEE) parameter estimation and assuming a first order auto-regressive error structure. Controlling for participant age, race, sex, and baseline DRS score, self-reported pain was modeled as an independent variable predicting level of change in each of the dependent measures at the subsequent assessment visit (four months later), controlling for the level of the dependent measure at the previous assessment visit.

Increases in depression were predicted by higher levels of “worst pain” (p < .01) and “pain now” (p < .01) four months earlier. A similar predictive pattern was seen for agitation (p < .02). Decreases in the frequency of pleasant events were predicted by higher levels of “pain now” (p < .02) and “pain activity interference” (p < .01) four months earlier. None of the other psychosocial dependent variables were significantly predicted by self-reported pain.

This is the first known longitudinal study of self-reported pain and psychosocial factors in persons with dementia. Self-reported pain is predictive of depression, agitation, and decreases in participation in pleasant events.

Self-reported pain assessment is the most efficient and economic way of tracking pain. Despite previous indications that such reports are flawed in this population, this study finds that such reports are a potentially important clinical tool for detecting persons at risk for subsequent negative psychosocial developments.