Department of Psychology, Center for Mental Health and Aging, University of Alabama, Tuscaloosa, AL 35487-0315, USA.
Am J Geriatr Psychiatry. 2009 Oct;17(10):873-80. doi: 10.1097/JGP.0b013e3181ad4f73.
Pain self-report is the assessment gold standard in cognitively intact populations but has been discouraged in persons with dementia because of significant evidence that pain intensity is often underreported by persons with dementia. However, most community-dwelling persons with dementia are cared for in primary care settings where a more in depth pain assessment is unlikely. Therefore, it is vital to know the clinical predictive value of self-report pain assessment in this population. Psychosocial functioning is a meaningful focus for clinical prediction, because psychosocial constructs are integrally related to quality of life, physical functioning, and one's ability to function in the presence of pain. The purpose of this study was to investigate the degree to which answers to simple self-report pain questions can predict changes in psychosocial functioning 4 months later in community-dwelling older adults with dementia.
Longitudinal. Patients and caregivers were assessed every 4 months for 24 months.
Veterans Affairs Medical Center, Houston, TX.
One hundred seventy-one patients over age 60 years diagnosed with dementia in the previous year and with no previous aggression were recruited from Veterans Administration clinics.
Pain, agitation, depression, involvement in pleasant events, caregiver burden, psychosis, and patient/caregiver relationship quality (mutuality).
Pain scores at each time period were predictive of increased agitation and depression and decreased pleasant event frequency 4 months later.
Our results suggest that persons with dementia who affirmatively respond to pain questions are at higher risk for developing negative psychosocial states.
在认知功能正常的人群中，自我报告疼痛是评估的金标准，但由于有大量证据表明痴呆患者往往会低估疼痛强度，因此不鼓励痴呆患者进行自我报告疼痛评估。然而，大多数居住在社区的痴呆患者在初级保健环境中接受护理，在这些环境中，不太可能进行更深入的疼痛评估。因此，了解该人群自我报告疼痛评估的临床预测价值至关重要。心理社会功能是临床预测的一个有意义的重点，因为心理社会结构与生活质量、身体功能以及一个人在疼痛存在的情况下的功能能力密切相关。本研究的目的是调查在 24 个月的时间内，社区居住的老年痴呆症患者对简单的自我报告疼痛问题的回答在多大程度上可以预测 4 个月后心理社会功能的变化。
纵向研究。患者和护理人员每 4 个月评估一次，共评估 24 个月。
德克萨斯州休斯顿退伍军人事务医疗中心。
从退伍军人管理局诊所招募了 171 名年龄在 60 岁以上、去年被诊断为痴呆且以前没有发生过攻击行为的患者。
疼痛、激越、抑郁、参与愉快事件、照顾者负担、精神病和患者/照顾者关系质量（相互性）。
每个时间点的疼痛评分均与 4 个月后激越和抑郁的增加以及愉快事件频率的降低有关。
我们的结果表明，积极回应疼痛问题的痴呆患者发生负面心理社会状态的风险更高。
