Pain reports and pain medication treatment in nursing home residents with and without dementia

Aim The purpose of this pilot study was to determine if a diagnosis of dementia influenced pain self‐reports and pain medication use in a group of verbally communicative nursing home (NH) residents. Methods The study design was a between groups, cross‐sectional chart audit and a seven‐question structured pain interview comparing outcomes in residents with and without a diagnosis of dementia. The study was carried out at a large metropolitan NH in the southern USA. The participants consisted of 52 long‐stay NH residents capable of self‐consent with at least one order for pain medication (opioid or non‐narcotic) either pro re nata, scheduled or both. Approximately 40% (n = 20) had a diagnosis of dementia. Results Although each group had similar pain‐related diagnoses, residents without a dementia diagnosis were significantly more likely to have a medication order for an opioid (OR 4.37,95% CI 1.29–14.73, P = 0.018). Based on self‐reported pain interview responses, no statistically significant differences were identified between the groups for chronic pain symptoms. However, among residents who reported current pain, those with a dementia diagnosis reported greater pain intensity (based on a 0–10 numeric rating scale) than did those without dementia (median 8.0 vs 6.0, respectively; P = 0.010). Conclusions Verbally communicative NH residents with mild and moderate cognitive impairment can report their pain symptoms and pain intensity. Nurses in long‐term care might assume that residents with dementia cannot reliably self‐report their pain; however, suffering from untreated severe pain could exacerbate cognitive impairment, worsen functional impairment and severely impair sleep. A brief, focused pain interview might be one method for increasing the detection of moderate to severe pain in verbally communicative NH residents with dementia. Geriatr Gerontol Int 2014; 14: 541–548.