Rajkumar Anto P, Ballard Clive, Fossey Jane, Orrell Martin, Moniz-Cook Esme, Woods Robert T, Murray Joanna, Whitaker Rhiannon, Stafford Jane, Knapp Martin, Romeo Renee, Woodward-Carlton Barbara, Khan Zunera, Testad Ingelin, Corbett Anne
Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS foundation Trust, London, United Kingdom.
University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom.
J Am Med Dir Assoc. 2017 May 1;18(5):453.e1-453.e6. doi: 10.1016/j.jamda.2017.01.024. Epub 2017 Mar 18.
Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited.
We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629).
Baseline prevalence of pain was 35.3% (95% CI 32.3-38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18-1.85) with all-cause mortality during follow-up.
Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.
关于住在养老院的痴呆症患者疼痛的纵向病程、影响或治疗意义的知识非常有限。
我们对居住在英国伦敦和白金汉郡67家养老院的痴呆症患者进行了调查。在基线时（N = 967）和9个月后（n = 629），使用适当的工具测量疼痛、痴呆严重程度、神经精神症状、抑郁、激越和生活质量。
疼痛的基线患病率为35.3%（95%可信区间32.3 - 38.3）。在两个时间点，疼痛严重程度均与痴呆严重程度、神经精神症状、抑郁、激越和生活质量显著相关。使用镇痛药进行常规治疗可显著降低疼痛严重程度。疼痛与更多的抗精神病药物处方显著相关。疼痛与随访期间的全因死亡率显著相关（比值比1.48；95%可信区间1.18 - 1.85）。
疼痛是神经精神症状、死亡率、生活质量和抗精神病药物处方的重要决定因素。改善对疼痛的识别、监测和治疗是改善痴呆症患者健康和生活质量的当务之急。
