Health problems and correlates of pain in nursing home residents with advanced dementia

This study describes the health problems and comorbid illnesses of nursing home (NH) residents with advanced dementia (n = 123) and identifies correlates of staff-identified pain. Study participants were residents of 3 NHs in Maryland, their surrogate decision makers and their physicians. Residents' cognitive function was assessed at study enrollment, and their medical records were reviewed to identify all health problems/illnesses and use of pain medications during the 6 months before their enrollment. The most prevalent health problems were skin problems (95%), nutrition/hydration problems (85%), psychiatric/behavioral problems (85%), gastrointestinal problems (81%), and infections (80%). Sixty-three percent of residents had recognized pain, and 95% of those residents received pain medications. In a multivariate regression analysis, staff-identified pain was associated with aspiration (P = 0.008), peripheral vascular disease (P = 0.021), musculoskeletal disorders (P = 0.032), higher cognitive function (P = 0.013), and use of pain medications, including nonopiates (P = 0.004) and the combination of opiates and nonopiates (P = 0.001). NH residents with advanced dementia experience a complex mixture of multiple chronic and acute comorbidities. These results suggest the need for clinicians in long-term care facilities to be vigilant in assessing and treating pain, particularly as cognitive function declines in those with advanced dementia.