School
of Nursing
Funded Research
Projects: Aging and Elder Care
Pain
and Behavioral Symptoms in Dementia: A Pilot Study
Principal Investigator:
Lois L. Miller
Abstract:
The purpose of this
study is to test an intervention focused on the treatment of chronic pain
for institutionalized older adults with dementia, with the intention of
also reducing protective behavioral symptoms, such as aggression. A secondary
purpose is to understand the mechanism that underlies the relationships
among morning care, observed pain, and protective behavioral symptoms,
both in the absence and presence of the proposed intervention. Older persons
are at special risk for unidentified and under treated pain, often receiving
significantly less analgesic medications than their cognitively intact
peers. In addition, protective behavioral symptoms are exhibited by as
many as 90 percent of persons with dementia. Although researchers and
clinicians have hypothesized an association between pain and protective
behavioral symptoms, little research has explored this relationship. This
quasi-experimental study will use a 3-group repeated measures design with
an untreated control group, to evaluate the effects of an individualized
pain treatment intervention on nursing home residents with dementia. A
purposive sample of 30 residents who are moderately to severely cognitively
impaired, have at least one potentially painful chronic musculoskeletal
condition, and exhibit protective behavioral symptoms (resistiveness to
care, verbal and/or physical aggression) will be selected from 3 nursing
homes (n=10 per facility). The Comfort And Responsiveness Enhancement
(CARE) intervention, implemented by an advanced practice nurse consists
of two components: 1) an analgesic drug component and 2) a psychosocial
component. The two treatment components will be introduced in opposite
sequence in intervention facilities, and during the final phase each participant
will be exposed to the additive CARE intervention, which is expected to
be associated with the best outcomes for participants. Outcomes of interest
include self- report of pain, observed pain, protective behavioral symptoms,
analgesic drug use, and psychosocial intervention use. Analysis of the
effects of the intervention will use ANOVA if possible, or the corresponding
nonparametric analytic technique (Wilcoxon signed rank sum tests). Content
analysis of field notes kept throughout the intervention will be used
to modify the intervention and evaluate the feasibility of testing it
in a larger randomized clinical trial.
Dates of Project:
4/1/2002 – 1/31/2006
Funding Source: National Institute of Nursing Research