Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA.
J Am Med Dir Assoc. 2021 Oct;22(10):2079-2086.e5. doi: 10.1016/j.jamda.2021.05.010. Epub 2021 Jun 3.
Limited cohort studies have assessed the association between uncontrolled pain and risk for behavioral and psychological symptoms of dementia (BPSDs). We conducted a longitudinal cohort study to examine whether associations exist between uncontrolled pain and risk for 2 common BPSDs-depression and behavioral symptoms-among long-term care (LTC) residents with Alzheimer disease and related dementia (ADRD).
This retrospective cohort study analyzed quarterly data from the 5% Medicare sample linked to Minimum Data Set (MDS) 3.0 between January 1, 2011, and December 31, 2015.
LTC residents aged 50 years or older with ADRD who had chronic pain and at least 2 quarterly MDS 3.0 assessments.
LTC residents were followed up quarterly from first observed quarterly MDS 3.0 until first outcome event or last observed quarterly MDS 3.0. Uncontrolled pain was defined as numerical rating scale >4, verbal descriptor scale of moderate or severe pain, or ≥1 pain indicators on the Checklist of Nonverbal Pain Indicators. Depression was defined as ≥10 on the Patient Health Questionnaire 9; behavioral symptoms were defined as the presence of psychotic (delusions or hallucinations) or disruptive behaviors (rejection of care, or physical, verbal, or other aggressive behaviors). Generalized linear models (GLMs) with marginal structural modeling (MSM) stabilized weights were used to examine uncontrolled pain and outcome risk.
The incidence rate of depression and behavioral symptoms during follow-up was 9.4 and 23.1 per 100 resident-years, respectively. Results from the MSM-GLMs showed that LTC residents with uncontrolled pain had a higher risk than those with controlled pain for developing depression [hazard ratio 1.67, 95% confidence interval (CI) 1.54-1.81] and behavioral symptoms (hazard ratio 1.28, 95% CI 1.19-1.37).
Uncontrolled pain was associated with elevated risk for depressive and behavioral symptoms in dementia, underscoring the importance of pain assessment and control among LTC residents with ADRD.
有限的队列研究评估了未控制的疼痛与痴呆的行为和心理症状（BPSD）风险之间的关联。我们进行了一项纵向队列研究，以检验未控制的疼痛与长期护理（LTC）居民中阿尔茨海默病和相关痴呆（ADRD）中 2 种常见的 BPSD（抑郁和行为症状）之间的风险是否存在关联。
这项回顾性队列研究分析了 2011 年 1 月 1 日至 2015 年 12 月 31 日期间，从 5%的医疗保险样本中与最低数据集（MDS）3.0 链接的每季度数据。
年龄在 50 岁或以上、患有 ADRD 且有慢性疼痛并至少有 2 次季度 MDS 3.0 评估的 LTC 居民。
从首次观察到的季度 MDS 3.0 到首次出现结果事件或最后一次观察到的季度 MDS 3.0，LTC 居民每季度接受一次随访。未控制的疼痛定义为数字评分量表>4、口头描述量表中度或重度疼痛或非语言疼痛指标清单上的≥1 个疼痛指标。抑郁定义为患者健康问卷 9 上的≥10；行为症状定义为存在精神病（妄想或幻觉）或破坏性行为（拒绝护理或身体、言语或其他攻击性行为）。使用广义线性模型（GLMs）与边缘结构建模（MSM）稳定权重来检查未控制的疼痛和结果风险。
随访期间抑郁和行为症状的发生率分别为每 100 名居民年 9.4 和 23.1 例。MSM-GLMs 的结果表明，与有控制疼痛的居民相比，未控制疼痛的 LTC 居民发生抑郁的风险更高[风险比 1.67，95%置信区间（CI）1.54-1.81]和行为症状（风险比 1.28，95%CI 1.19-1.37）。
未控制的疼痛与痴呆症中抑郁和行为症状的风险升高有关，这突显了在患有 ADRD 的 LTC 居民中进行疼痛评估和控制的重要性。
