Hunt Lauren J, Covinsky Kenneth E, Yaffe Kristine, Stephens Caroline E, Miao Yinghui, Boscardin W John, Smith Alex K
Department of Physiological Nursing, University of California at San Francisco, San Francisco, California.
Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
J Am Geriatr Soc. 2015 Aug;63(8):1503-11. doi: 10.1111/jgs.13536. Epub 2015 Jul 22.
To report prevalence, correlates, and medication management of pain in community-dwelling older adults with dementia.
Cross-sectional.
In-person interviews with self- or proxy respondents living in private residences or non-nursing home residential care settings.
Nationally representative sample of community-dwelling Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study 2011 wave.
Dementia status was determined using a modified previously validated algorithm. Participants were asked whether they had had bothersome and activity-limiting pain over the past month. A multivariable Poisson regression model was used to determine the relationship between bothersome pain and sociodemographic and clinical characteristics.
Of the 7,609 participants with complete data on cognitive function, 802 had dementia (67.2% aged ≥80, 65.0% female, 67.9% white, 49.7% proxy response, 32.0% lived alone, 18.8% lived in residential care); 670 (63.5%) participants with dementia experienced bothersome pain, and 347 (43.3%) had pain that limited activities. These rates were significantly higher than in a propensity score-matched cohort without dementia (54.5% bothersome pain, P < .001, 27.2% pain that limited activity, P < .001). Proxies reported slightly higher rates of pain than self-respondents, but differences were statistically significant only for activity-limiting pain (46.6% proxy vs 40.1% self, P = .03). Correlates of bothersome pain included arthritis, heart and lung disease, less than high school education, activity of daily living disability, depressive and anxiety symptoms, and low energy. Of those reporting pain, 30.3% stated that they rarely or never took any medications for pain.
Community-living older adults with dementia are at high risk of having pain. Creative interventions and programs are needed to manage pain adequately in this vulnerable population.
报告社区居住的老年痴呆症患者疼痛的患病率、相关因素及药物治疗情况。
横断面研究。
对居住在私人住宅或非养老院式居住护理机构的自我受访者或代理受访者进行面对面访谈。
2011年全国健康与老龄化趋势研究中纳入的65岁及以上社区居住医疗保险受益人的全国代表性样本。
使用经过修改的先前验证的算法确定痴呆症状态。询问参与者在过去一个月内是否有令人烦恼且限制活动的疼痛。采用多变量泊松回归模型确定令人烦恼的疼痛与社会人口统计学和临床特征之间的关系。
在7609名有完整认知功能数据的参与者中，802人患有痴呆症（67.2%年龄≥80岁，65.0%为女性，67.9%为白人，49.7%由代理回答，32.0%独自生活，18.8%居住在居住护理机构）；670名（63.5%）患有痴呆症的参与者经历了令人烦恼的疼痛，347名（43.3%）有疼痛限制活动。这些比率显著高于倾向得分匹配的无痴呆症队列（令人烦恼的疼痛为54.5%，P<.001；疼痛限制活动为27.2%，P<.001）。代理报告的疼痛发生率略高于自我受访者，但差异仅在疼痛限制活动方面具有统计学意义（代理为46.6%，自我为40.1%，P=.03）。令人烦恼的疼痛的相关因素包括关节炎、心肺疾病、高中以下学历、日常生活活动能力残疾、抑郁和焦虑症状以及精力不足。在报告疼痛的人中，30.3%表示他们很少或从未服用过任何止痛药物。
社区居住的老年痴呆症患者有很高的疼痛风险。需要有创造性的干预措施和项目来充分管理这一弱势群体的疼痛。
