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Caregiver’s Perceptions of the Relationship of Pain to Behavioral and Psychiatric Symptoms in Older Community-residing Adults With Dementia

Hodgson, Nancy PhD, RN*; Gitlin, Laura N. PhD*; Winter, Laraine PhD; Hauck, Walter W. PhD

The Clinical Journal of Pain: May 2014 - Volume 30 - Issue 5 - p 421–427
doi: 10.1097/AJP.0000000000000018
Original Articles

Objectives: Pain is underrecognized and undermanaged in older adults with dementia. Because dementia patients have a diminished capacity to communicate discomfort, untreated pain may be expressed in the form of behavioral and psychiatric symptoms. The goal of the present study was to examine the relationship between pain and behavioral and psychiatric symptoms of dementia in community-residing older adults from the perspective of the family caregiver.

Materials and Methods: Dyads composed of 272 dementia patients, and their family caregivers were assessed to determine dementia patient’s mental status; family caregiver’s assessment of care recipient’s pain, functional dependence, and number of behavioral symptoms; analgesic use; and demographic information.

Results: Hierarchical multiple regression analysis controlling for age, marital status, race, functional disability, and analgesic use showed that pain explained a small but significant percent of variance in the number of behavioral symptoms (3%, P<0.001). Pain had a stronger influence on the number of behavioral and psychiatric symptoms of dementia among those with severe cognitive impairment (F 1,69=11.75, P<0.001) compared with those with low to moderate cognitive impairment (F 1,199=4.543, P=0.034.).

Discussion: The findings indicate that pain is a risk factor for behavioral symptoms in individuals with dementia and suggest that pain is a more significant predictor of behavior for individuals with severe dementia, compared with those with mild/moderate stage dementia. These results reinforce the importance of proper pain assessment and its management as part of dementia care planning.

*School of Nursing, Johns Hopkins University, Baltimore, MD

Philadelphia VA Medical Center, Philadelphia, PA

Sycamore Consulting LLC, Woodstock, GA

Supported in part by funds from the National Institute on Aging and the National Institute on Nursing Research (RO1 AG22254). The authors declare no conflict of interest.

Reprints: Nancy Hodgson, PhD, RN, School of Nursing, Johns Hopkins University, 525N. Wolfe Street, Baltimore, MD 21205 (e-mail:

Received March 13, 2012

Accepted August 2, 2013

© 2014 by Lippincott Williams & Wilkins