The response of agitated behavior to pain management in persons with dementia

Bettina S. Husebo*, Clive Ballard, Jiska Cohen-Mansfield, Reinhard Seifert, Dag Aarsland

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

101 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)708-717
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Volume22
Issue number7
DOIs
StatePublished - Jul 2014

Funding

FundersFunder number
Universitetet i Bergen09/1568
Norges Forskningsråd189439

    Keywords

    • Aggression
    • Agitation
    • Behavioral disturbances
    • Cluster randomised trial
    • Dementia
    • Nursing home
    • Pain
    • Pain treatment

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