Parmelee P A, Smith B, Katz I R
Polisher Research Institute, Philadelphia Geriatric Center, PA 19141.
J Am Geriatr Soc. 1993 May;41(5):517-22. doi: 10.1111/j.1532-5415.1993.tb01888.x.
To examine the association between self-reported pain and cognitive impairment among frail elderly institution residents.
A cross-sectional correlational study.
A large urban nursing home and congregate apartment complex housing predominantly Jewish elderly.
Seven hundred fifty-eight elderly institution residents (30% in the nursing home, 70% in congregate apartments). The sample was 70% female and averaged 83.3 years of age.
Respondent self-reports tapped pain intensity, number of localized pain complaints, cognitive status, and disability in performance of activities of daily living. Attending physicians or physician assistants rated respondents' health status.
Pain intensity and number of localized pain complaints bore small but significant negative relationships to cognitive impairment. Pain was positively associated with physician-rated ill health and functional disability. The association between pain and cognitive status remained significant even when controlled statistically for effects of physical health and functional disability. Item-by-item examination of localized pain complaints indicated that markedly cognitively impaired individuals were less likely to report pain in the back and joints. However, examination of possible physical causes of reported pain revealed no differences between pain reports of cognitively impaired versus intact individuals in either the presence or the absence of a likely physical cause.
These data provide no evidence for the "masking" of pain complaints by cognitive impairment. They suggest instead that, although cognitively impaired elderly may slightly underreport experienced pain, their self-reports are generally no less valid that those of cognitively intact individuals. Limitations of the research are acknowledged and implications for treatment of cognitively impaired institution residents are discussed.
研究体弱的老年机构居住者自我报告的疼痛与认知障碍之间的关联。
一项横断面相关性研究。
一个大型城市养老院和主要居住着犹太老年人的集合式公寓楼。
758名老年机构居住者（30%在养老院，70%在集合式公寓）。样本中70%为女性，平均年龄83.3岁。
通过受访者自我报告来了解疼痛强度、局部疼痛主诉的数量、认知状态以及日常生活活动表现中的残疾情况。主治医生或医生助理对受访者的健康状况进行评分。
疼痛强度和局部疼痛主诉的数量与认知障碍呈小而显著的负相关。疼痛与医生评定的健康不佳和功能残疾呈正相关。即使在对身体健康和功能残疾的影响进行统计学控制后，疼痛与认知状态之间的关联仍然显著。对局部疼痛主诉进行逐项检查表明，认知明显受损的个体报告背部和关节疼痛的可能性较小。然而，对报告疼痛的可能身体原因进行检查发现，认知受损个体与认知未受损个体的疼痛报告在是否存在可能的身体原因方面没有差异。
这些数据没有为认知障碍“掩盖”疼痛主诉提供证据。相反，它们表明，尽管认知受损的老年人可能会稍微少报所经历的疼痛，但他们的自我报告通常与认知未受损个体的报告同样有效。承认了该研究的局限性，并讨论了对认知受损机构居住者治疗的影响。
