No differences in pain reported between older adults with and without dementia

Shega J, Andrew M, Herr K, Ersek MT, Weiner DK, Dale W. No differences in pain reported between older adults with and without dementia. Poster session presented at: American Geriatrics Society Annual Meeting; 2012 May 4; Seattle, WA.

Background: Non-cancer pain is a common experience among older persons with and without dementia. However, uncertainty remains about whether persons with mild to moderate dementia report less pain than persons with no cognitive impairment (NCI). Methods: Cross-sectional analysis of a subset of the Canadian Study of Health and Aging (1996 wave) that completed a diagnostic cognitive assessment. Non-cancer pain was measured using the 5-point verbal descriptor scale, dichotomized into "no/very mild" versus "moderate" or greater pain. Cognitive status was clinically assessed and categorized as NCI, cognitive impairment no dementia (CIND), Alzheimer's Disease (AD), and vascular dementia (VaD). Multivariable logistic regression was utilized to analyze the relationship between pain report and cognitive diagnosis controlling for covariates (demographics, comorbidity, IADL's, and depression). Results: 1,658 (96.7%) of participants that completed a diagnostic cognitive assessment had their cognitive status designated and a pain measure completed. Overall, the frequency of pain report varied with cognitive status among the four groups, (Chi-square 9.16, p = 0.02). 34.7% (263/757) of persons with NCI reported moderate or greater pain, compared to 39.1% (223/570) CIND (p = 0.11), 28.5% (73/256) AD (p = 0.08), and 40% (26/65) VaD (p = 0.42). In the fullyadjusted multivariate model, compared with persons with NCI, the odds of reporting moderate or higher pain was not significantly different among persons with CIND OR = 0.86 (0.65,1.13; p = 0.28), AD OR = 0.68 (0.44,1.04; p = 0.08), or VaD OR = 0.80 (0.36,1.80; p = 0.59). Conclusion: A noteworthy proportion of older adults with and without dementia report moderate or greater pain and did not vary with cognitive status. Given that dementia represents a consistent risk factor the under identification and undertreatment of pain, efforts to improve pain management in this vulnerable population remain a high priority for future research.