The  relationship between pain and disruptive behaviors in nursing home residents with dementia.

The main reason for selecting this article is that during holidays I work in nursing home and I often come in contact with cases when people suffering from dementia are in pain which shows in several different ways.

Research presented in the article was conducted in the United States of America, state of Florida. It was carried out in University of Florida Health Science Center Institutional Review Board and it’s second in the row. There were 56 577 participants included in the research and they were all older than 65 years and were affected by Alzheimer’s disease or dementia. Purpose of this research was to discover how such people react to pain, whether they become aggressive, agitated or they don’t feel pain at all and start wandering.

The proximal factor taken in the account was pain and background factors were cognitive impairment, ADL impairment, age and sex. Participants were divided in three groups, according to their response: wandering, aggression and agitation.

Out of this research following results were collected.

In one week 91% out of all participants didn’t wander, 5% wandered 1-3 days, 2% wandered 4-6 days and 3% of participants wandered all 7 days.

Aggressive behavior was divided in four different groups. 76% of participants showed no aggressive behavior, 17% were slightly aggressive, 6% severely aggressive and 1% extremely aggressive.

With participants that tent to be agitated, it was discovered that 76% didn’t become agitated because of pain, slightly agitated were 12% of participants, 9% became quite agitated and 3% were severely agitated.

In the results the research team described that pain severity is negatively associated with the frequency of wandering behaviors. Nursing home residents with more severe pain are likely to display wandering behaviors.

Pain severity is positively associated with the frequency of aggressive behaviors. Nursing home residents with more severe pain are more likely to display aggressive behaviors.

Pain severity is positively associated with the frequency of agitated behaviors. Nursing home residents with more severe pain are more likely to display agitated behaviors.

So the conclusion is that the pain exacerbated disruptive behaviors that are not locomotion-based. In order to reduce these disruptive behaviors, their underlying causes, such as pain, should be investigated and well managed. However, pain assessment in cognitively impaired residents can be challenging. Comprehensive pain assessment should be developed further, and pain should be well controlled to reduce these problematic disruptive behaviors.