Factors related to identification and treatment of pain underlying neuropsychiatric symptoms: a prospective study...

BACKGROUND: Pain identification and treatment are important for managing the neuropsychiatric symptoms of dementia and improving quality of life in people with the condition. Quantitative clarification of facilitators and barriers to pain identification and treatment is warranted for multi-component programme implementation. This study aimed to identify the factors related to pain identification and treatment in both care recipients and providers, through the implementation of a multi-component dementia care programme for managing neuropsychiatric symptoms. METHODS: This study used longitudinal data from naturalistic long-term care settings between April 2022 and March 2025 in Tokyo, Japan. A total of 1,282 care recipients with 3,497 evaluations was included. Care professionals from community and residential care providers participated in a multi-component programme for managing neuropsychiatric symptoms associated with dementia. They provided information concerning care recipients using a web-based tool. Care professionals held interdisciplinary discussion meetings to evaluate neuropsychiatric symptoms, identify their underlying causes and establish an action plan to address the identified causes. We conducted a multilevel binomial regression analysis using pain identification and treatment as dependent variables. The independent variables included sex, type of dementia and type of provider at the between-person level. Within-person-level variables included the types of caregivers involved in the meetings, prescribed medications, the number of identified causes other than pain and the levels of neuropsychiatric symptoms per evaluation. RESULTS: Of the 3,497 evaluations, 1,617 (46%) identified pain, and 517 (32% of evaluations with pain identified) targeted pain in the action plans. Pain identification was more likely to occur in individuals with greater number of identified causes underlying neuropsychiatric symptoms, fewer symptoms of apathy and those in residential care providers compared to home care management agencies or individual home care providers. Pain treatment was significantly more likely to appear in action plans that included care managers in interdisciplinary discussion meetings, in individuals with fewer identified causes underlying neuropsychiatric symptoms, fewer symptoms of hallucinations, and in those receiving care from residential care providers rather than home care management agencies. CONCLUSIONS: The involvement of care managers in interdisciplinary discussion meetings may facilitate pain treatment to address the neuropsychiatric symptoms of dementia. Educational strategies are warranted to help front-line care workers improve their pain management skills.