Pain Among Community-Dwelling Older Adults with Dementia: Factors Associated with Undertreatment.

Objective: To identify factors associated with no analgesic treatment in community-dwelling older adults with mild-to-moderate dementia and moderate-to-severe pain.

Design: Secondary analysis of a randomized controlled trial.

Setting: Michael E. DeBakey Veterans Affairs Medical Center.

Subjects: Two hundred and two older adults (mean age = 79.27 years).

Methods: Guided by the Behavioral Model of Health Service Utilization, participants completed questionnaires regarding predisposing (age, gender, race, educational level, care partner relationship), enabling (income), and need (pain interference, depressive symptoms, cognitive functioning) characteristics.

Results: Hierarchical logistic regression analyses revealed that participants with greater income (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.63-0.99) and greater pain interference (OR = 0.79, 95% CI = 0.63-0.99) were less likely to have no analgesic treatment. We also examined whether other factors such as depressive symptoms influenced the relationship between pain interference and pain treatment. Those with less pain interference were more likely to have no analgesic treatment (OR = 1.04, 95% CI = 1.01-1.08), but only if they had lower levels of depressive symptoms (b = -0.52, P  = 0.005).

Conclusion: The initiation of analgesic trials is complicated for individuals with dementia and comorbid pain and depressive symptomology. Future research should focus on identifying the most effective assessment and treatment procedures to best direct clinical care for this population.