The prevalence of pain in nursing-home patients with dementia

Dementia leads to cognitive imparment and loss of the ability to communicate.
As a result patients suffering from (advanced) dementia are less capable in
expressing pain. It is expected that there is an underdiagnosis of pain
complaints in these patients resulting in undertreatement. There are no
reliable data on this topic. Studies comparing the number of prescribed
painkillers between patients with and without dementia show less prescriptions
in the first group of patients. This underscores the hypotheses of
underdiagnosis. Until recently there was no assessment tool for measurement of
pain in dementia patients. Furthermore, there is literature which suggests that
specific forms of dementia could amplify or attenuate the affective awareness
of pain. In the past few years intensive research has been carried out to
develop reliable scales for measuring pain in demented patients. This has
resulted in some instruments with moderate psychometric qualities. Last year a
few of them have been translated into Dutch. The validity and reliability have
been studied and resulting in the PACSLAC having good psychometric qualities
and being preferred by care-givers.

The objective of this research project is to extend the knowledge of the
prevalence of pain in patients who are admitted to a psychogeriatric wards of
two nursing-homes.
The key question is: what's the prevalence of pain in a group of nursing-home
patients with dementia?

Age, gender, type of dementia (Alzheimer, vascular, etc.) will be extracted
from the patients' charts. Co-morbidity suspect for pain complaints will be
classified according to the classification for disease in nursing-homes (a
Dutch classification system based on the ICD-9 and ICD-10 modified for use in
Dutch nursing-homes). To get a proper view on the cognitive level and the
degree of dementia all patients have to complete a Minimal Mental State
Examination (MMSE) and severity of dementia will be rated by the Global
Deterioration Scale (GDS). All prescribed medication will be recorded and
classified using the ATC-system.
Pain will be measured using the PACSLAC during morning care. All measurements
will be done by one instructed nurse. Finally, all charts of the included
patients will be read carefully for notifications that reflect pain in the two
weeks before the measurement.

There is minimal burden since the design is almost entirely observational.
Patients will not receive any kind of pain stimuli. Care will be carried out
"as usual". There are no expected risks for the patients. In case patients
will be found to have previously unknown pain, the treating physician and
family will be informed. The physician and family are to decide whether this
pain should be treated or not.