Pain in nursing home residents and correlation with neuropsychiatric disorders.

BACKGROUND

Pain is a common problem in older age and strongly interacts with neuropsychiatric disorders. In this paper we studied the prevalence of pain and the connection between pain and neuropsychiatric comorbidities among older nursing home residents.

OBJECTIVE

To determine if data provided in 2004 National Nursing Home Survey supports connection between pain and neuropsychiatric comorbidities among older nursing home residents.

SETTING

Medical university.

DESIGN

Retrospective study of published reports

METHODS

We used the results of the 2004 National Nursing Home Survey (NNHS) to determine the rates and correlations of pain parameters with the main neurodegenerative and psychiatric diagnoses in residents over 65 years of age including Alzheimer's and Picks dementia, schizophrenia, depression, bipolar disease, anxiety, and obsessive-compulsive disorder.

RESULTS

Pain was reported by 22% of residents over 65 years of age. Patients with anxiety or depression had the highest prevalence of pain, 29.4% and 24.4%, respectively. Patients with dementia had the lowest rate of reported pain, 14.5%. All neurodegenerative and psychiatric diagnoses had significant correlations (P = 0.000) with pain rate, however, only anxiety (r = 0.056) and depression (r=0.025) positively correlated with the presence of pain. There were clear differences in the highest levels of reported pain in different neurodegenerative and psychiatric groups. We created the Disease-Specific Pain Intensity Scale (DSPI Scale) which can be calculated for each diagnostic entity. The DSPI was highest in patients with obsessive-compulsive disorder (721) and lowest in patients with bipolar disease (358). The average value of this scale in nursing home residents who reported pain in the last 7 days was 488.

LIMITATIONS

The overwhelming majority of patients had chronic somatic diseases that were not included in the analysis and could skew the results. In addition, pain perception could be affected by prescribed medications which were not taken into consideration. Moreover, neurodegenerative and psychiatric disorders could interact among each other and overlapped cases were not regarded in our research. Finally, the new instrument created for evaluating the spectrum of highest pain intensities in a group of patients with a specific diagnosis requires validation. It is a unidimentional scale that does not incorporate the length of time a person has experienced pain, an important parameter in pain chronicity.

CONCLUSION

It is important when assessing pain to consider the patient's neuropsychiatric status and especially communication abilities. The information above helps understand the variances in pain parameters in neuropsychiatric patients and may ultimately lead to better pain management in these difficult patients.