Predictors of pain in nursing home residents with dementia: a cross-sectional study

The aim of this study was to investigate the association between care activities and pain and restraint and pain in residents with dementia.

If pain in people with dementia is not identified or alleviated in a timely manner, it could lead to an adverse effect on their physical, mental, social health and quality of life. Care activities and restraint might cause pain, but little is known as to whether they are true risk-factors of pain in people with dementia.

A cross-sectional research design was employed.

One hundred and twelve people with dementia were chosen from two nursing homes located in northern Taiwan. The demographic and clinical data collected included diagnoses, analgesics, restraints, recent falls, etc. The severity of dementia was assessed using the Clinical Dementia Rating Scale. The researchers observed every participant immediately following instances of routine care and then recorded the level of pain using the Chinese version of the Pain Assessment in Advanced Dementia scale.

About 36·6% of the participants had a Chinese version of the Pain Assessment in Advanced Dementia scale score above two points and an overall mean score of 1·50 (SD 1·81) with a range from 0-8. Only one resident with dementia received regular analgesic. Pain level in residents with dementia that needed assisted care was higher than in residents who were able to move about freely. It showed a positive correlation between level of pain and the severity of dementia among residents. The major predictors for pain in residents with dementia included restraint, assisted bathing and assisted transfer.

The findings confirm the association between care activities and pain and between restraint and pain in residents with dementia.

Formal caregivers need to minimise the triggering of pain when they assist residents' daily activities and avoid unnecessary restraints, while offering personalised, conventional nursing care to residents with late-stage dementia.