Who suffers most? Dementia and pain in nursing home patients: A cross-sectional study

Objectives: To explore the relationship between nursing home patients with different stages of dementia and different dementia diagnoses and use of pain medication according to pain intensity. Design: Cross-sectional study. Setting and Participants: Participants included 181 consecutive, long-term stay patients, 43 primary caregivers, 1 geriatric study nurse, and 4 physicians of a Norwegian nursing home. Measurements: Admission records, prescription lists, care plans, Mini-Mental State Examination, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), International Classification of Diseases (ICD-10), cerebral computed tomography, pain diagnoses and pain locations by physicians' examinations, and pain intensity by MOBID-2 (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale), a novel staff-administered pain tool in dementia. Results: Patients with severe dementia do not experience less pain intensity (P = .079), numbers of pain diagnoses (P = .172), and pain locations (P = .202) compared to other stages of dementia. Severely demented patients receiving opioids demonstrated higher pain intensity (mean 4.4, SD 1.7) than nondemented patients (mean 2.9, SD 1.8), and received less pain treatment (P = .018). Pain intensity did not differ between diagnostic groups of dementia (P = .439). Patients with mixed dementia receiving opioids had more pain (mean 5.3, SD 1.5, range 4-7) than mentally healthy controls and received less pain treatment (P < .005). Conclusion: Patients with severe dementia and mixed dementia are at high risk to suffer from severe pain. More research and quality improvement programs are needed to increase the knowledge in pain treatment by staff, which requires competence in both pain assessment and dementia.