Management of noncancer pain in community-dwelling persons with dementia

OBJECTIVES: To explore the pharmacological treatment of noncancer pain in persons with dementia and identify predictors associated with insufficient analgesia. DESIGN: Cross-sectional analysis of an observational cohort study. SETTING: Academic outpatient geriatric clinic in Chicago, Illinois. PARTICIPANTS: A total of 115 dyads, mostly African American, consisting of community-dwelling persons with dementia and their caregivers. MEASUREMENTS: Patient report of demographics, noncancer pain, function, cognition, and depression. Caregiver report of patient agitation and over-the-counter and prescription medications. RESULTS: Sixty-two of 115 (54%) patients reported pain "on an average day." The caregivers of more than half of persons with dementia who reported pain "on an average day" did not report analgesic use. The majority of caregivers who reported analgesic use reported that patients took a World Health Organization Class I medication. No patients had been prescribed a Class III (strong opioid) drug. Fifty-three of 115 (46%) patients had potentially insufficient analgesia. In the logistic regression, insufficient analgesia was associated with greater age, Mini-Mental State Examination score of less than 10, and impairment in daily functioning. Insufficient analgesia was 1.07 times as likely (95% confidence interval (CI) = 1.01-1.14) for each additional year of age, 3.0 times as likely (95% CI = 1.05-9.10) if the subject had advanced dementia, and 2.5 times as likely (95% CI 1.01-6.25) if the patient had any impairment in activities of daily living. CONCLUSION: In this convenience sample from a geriatric clinic, many persons with dementia and noncancer pain were not receiving pharmacological treatment. Those at greatest risk for insufficient analgesia were older, had moderate to severe dementia, and experienced impairments in activities of daily living.