TY - JOUR
T1 - The response of agitated behavior to pain management in persons with dementia
AU - Husebo, Bettina S.
AU - Ballard, Clive
AU - Cohen-Mansfield, Jiska
AU - Seifert, Reinhard
AU - Aarsland, Dag
N1 - Funding Information:
We thank the patients, their relatives, and nursing home staff for their willingness and motivation that made this study possible. BSH, CB, JC-M, and DA conceived the study and obtained funding. All authors contributed to the study design, carrying out the study, and wrote the manuscript. OBN and BSH contributed to the statistical analysis. The trial is registered at ClinicalTrials.gov ( NCT01021696 ) and at the Norwegian Medicines Agency (EudraCTnr: 2008-007490-20). Funding for this study was provided by Norwegian Research Counci l (Sponsor's Protocol Code: 189439) and the University of Bergen (09/1568), Norway .
PY - 2014/7
Y1 - 2014/7
N2 - Objectives: Behavioral disturbances and pain are common in nursing home (NH) patients with dementia. An association between pain and increased agitation has been suggested, and recently a significant reduction of agitation has been demonstrated by pain treatment in patients with moderate to severe dementia. We now examined which specific agitated behaviors respond to individualized pain treatment. Design: Cluster randomized clinical trial. Setting: 60 clusters (i.e., clusters defined as single independent NH units) in 18 NHs within five municipalities of Western Norway. Participants: 352 patients with moderate to severe dementia and clinically significant behavioral disturbances. Intervention: The control group received usual treatment and care. According to a predefined scheme for 8 weeks, all patients in the intervention group received individual daily pain treatment with acetaminophen, extended release morphine, buprenorphine transdermal patch, and/or pregabaline. Measurements: Cohen-Mansfield Agitation Inventory subscales and items. Results: Analyses demonstrated that Factor 3 (Verbally agitated behaviors) showed the largest significant difference (DF = 1204.0, t = -4.308, p <0.001), followed by Factor 2 (Physically non-aggressive behaviors) (DF = 1198.0, t = -2.672, p = 0.008), and Factor 1 (Aggressive behaviors) (DF = 1196.0, t=-2.093, p = 0.037) after 8 weeks, by a linear random intercept mixed model in two-way repeated-measures configuration with adjustment for heteroscedasticity. Conclusion: We found that verbal agitation behaviors such as complaining, negativism, repetitious sentences and questions, constant request for attention, and cursing or verbal aggression responded to pain treatment. In addition, restlessness and pacing were sensible to analgesics. Such behaviors should therefore lead to an assessment of pain, and pain treatment. Further studies comparing how pain treatment should be balanced against other strategies including psychotropic drugs are needed.
AB - Objectives: Behavioral disturbances and pain are common in nursing home (NH) patients with dementia. An association between pain and increased agitation has been suggested, and recently a significant reduction of agitation has been demonstrated by pain treatment in patients with moderate to severe dementia. We now examined which specific agitated behaviors respond to individualized pain treatment. Design: Cluster randomized clinical trial. Setting: 60 clusters (i.e., clusters defined as single independent NH units) in 18 NHs within five municipalities of Western Norway. Participants: 352 patients with moderate to severe dementia and clinically significant behavioral disturbances. Intervention: The control group received usual treatment and care. According to a predefined scheme for 8 weeks, all patients in the intervention group received individual daily pain treatment with acetaminophen, extended release morphine, buprenorphine transdermal patch, and/or pregabaline. Measurements: Cohen-Mansfield Agitation Inventory subscales and items. Results: Analyses demonstrated that Factor 3 (Verbally agitated behaviors) showed the largest significant difference (DF = 1204.0, t = -4.308, p <0.001), followed by Factor 2 (Physically non-aggressive behaviors) (DF = 1198.0, t = -2.672, p = 0.008), and Factor 1 (Aggressive behaviors) (DF = 1196.0, t=-2.093, p = 0.037) after 8 weeks, by a linear random intercept mixed model in two-way repeated-measures configuration with adjustment for heteroscedasticity. Conclusion: We found that verbal agitation behaviors such as complaining, negativism, repetitious sentences and questions, constant request for attention, and cursing or verbal aggression responded to pain treatment. In addition, restlessness and pacing were sensible to analgesics. Such behaviors should therefore lead to an assessment of pain, and pain treatment. Further studies comparing how pain treatment should be balanced against other strategies including psychotropic drugs are needed.
KW - Aggression
KW - Agitation
KW - Behavioral disturbances
KW - Cluster randomised trial
KW - Dementia
KW - Nursing home
KW - Pain
KW - Pain treatment
UR - http://www.scopus.com/inward/record.url?scp=84904723532&partnerID=8YFLogxK
U2 - 10.1016/j.jagp.2012.12.006
DO - 10.1016/j.jagp.2012.12.006
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AN - SCOPUS:84904723532
SN - 1064-7481
VL - 22
SP - 708
EP - 717
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
IS - 7
ER -
