Self-Reported Pain in Persons With Dementia Predicts Subsequent Decreased Psychosocial Functioning

Objectives: Pain self-report is the assessment gold standard in cognitively intact populations but has been discouraged in persons with dementia because of significant evidence that pain intensity is often underreported by persons with dementia. However, most community-dwelling persons with dementia are cared for in primary care settings where a more in depth pain assessment is unlikely. Therefore, it is vital to know the clinical predictive value of self-report pain assessment in this population. Psychosocial functioning is a meaningful focus for clinical prediction, because psychosocial constructs are integrally related to quality of life, physical functioning, and one's ability to function in the presence of pain. The purpose of this study was to investigate the degree to which answers to simple self-report pain questions can predict changes in psychosocial functioning 4 months later in community-dwelling older adults with dementia. Design: Longitudinal. Patients and caregivers were assessed every 4 months for 24 months. Setting: Veterans Affairs Medical Center, Houston, TX. Participants: One hundred seventy-one patients over age 60 years diagnosed with dementia in the previous year and with no previous aggression were recruited from Veterans Administration clinics. Measurements: Pain, agitation, depression, involvement in pleasant events, caregiver burden, psychosis, and patient/caregiver relationship quality (mutuality). Results: Pain scores at each time period were predictive of increased agitation and depression and decreased pleasant event frequency 4 months later. Conclusions: Our results suggest that persons with dementia who affirmatively respond to pain questions are at higher risk for developing negative psychosocial states. (Am J Geriatr Psychiatry 2009; 17:873-880)