Impact of Pain and Neuropsychiatric Symptoms on Activities in Nursing Home Residents (COSMOS Trial)

Objective: This study aims to identify whether pain and dementia -related behavior are associated with different types of activities in nursing home residents, controlled for dementia severity. Design: Cross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety). Setting and Participants: A total of 723 patients from 33 Norwegian nursing homes with 67 units (clusters). Participants aged >= 65 years, with a life expectancy of >6 months, and with valid data on activity were eligible for inclusion. Methods: Activity was operationalized in time (hours per week) and type (cognitive, social, physical, and no activity). Cognitive function was assessed using the Mini -Mental State Examination (MMSE), pain with the Mobilization -Observation -Behavior -Intensity -Dementia -2 Pain Scale (MOBID-2), and behavior with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for effect modification. Results: A total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain score was associated with less time spent on activity in participants with severe dementia (estimate 0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P = .039). Apathy (OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P =.042; lack of inhibition OR, 0.894; P = .034). Conclusion and Implications: Pain and dementia -related behavior may influence the participation in activities in the nursing home. There is an urgent need to investigate what type of activity stimulates people in different stages of dementia.