The original version of this article unfortunately contained some mistakes. The presentation of Table 2, Table 5 and Table 6 was incorrect. The corrected tables are given below.
Table 2.
Measurements of pain, neuropsychiatric symptoms and physical function
| Measurement of pain | Measurement of neuropsychiatric symptoms | Measurement of function | ||||
|---|---|---|---|---|---|---|
| First author | Rating scale | Method of detection | Rating scale | Method of detection | Rating scale | Method of detection |
| Ahn 201336 | MDS pain severity scale, combining pain frequency and pain intensity | Self-report, if not possible staff report based on proxy reports | MDS subscales; wandering-item, aggression behaviour scale (ABS), challenging behaviour profile (CBP) agitation subscale | Patient self-report, proxy and professional | MDS-ADL long form (7 items) | Staff observation |
| Bartels 20038 | No use of rating scale | Data collection instrument (3-month period), raters unknown | MDS for depression | Medical records | MDS (number of ADLs) | Medical records |
| Black 200639 | No use of rating scale | Medical records, preceding 6 months, interview surrogate and physician | No use of rating scales | Medical records, preceding 6 months, interview proxy and staff | No use of rating scale | Medical records, preceding 6 months, interview proxy and staff |
| Brummel-Smith 200240 | 1 out of 3 scales: faces or line scale, or word-based pain intensity scale | self-report, assessed by trained research assistants | No use of rating scales | Trained research assistants | No use of rating scale | Trained research assistants |
| Cipher 20044 | GMPI pain and suffering subscale | Part of neuropsychological evaluation by a licensed clinical geropsychologist | -GDS-15 “-26 dysfunctional behaviours with scores “1-7” | Part of neuropsychological evaluation by a licensed clinical geropsychologist | PRADLI | Part of neuropsychological evaluation by a licensed clinical geropsychologist |
| Cipher 200641 | GMPI | Part of neuropsychological evaluation by a licensed clinical geropsychologist and each instrument was administered after interviewing the resident, nursing staff and family members | GLDS, 19 categories with scores 1-7 | Part of neuropsychological evaluation by a licensed clinical geropsychologist and each instrument was administered after interviewing the resident, nursing staff and family members, Medical records, preceding 6 to max 26, Months | GLDS | Part of neuropsychological evaluation by a licensed clinical geropsychologist and each instrument was administered after interviewing the resident, nursing staff and family members |
| D’Astolfo 200644 | No use of rating scale | Medical records, preceding 6 to max 26 months | No use of rating scales | No use of rating scale | Medical records Ambulatory status: independent, requires assistance, wheel chair (or bedridden n?=?1) | |
| Gruber-Baldini 200545 | PGC-PIS, score ≥ 2 | Rating by supervisory staff member | CSDD | Rating by supervisory staff member | MDS; activities of daily living scale, SMOI | Rating/observation by supervisory staff member |
| CMAI | ||||||
| Kunik 200530 | PGC-PIS, item on level of pain in previous week, scores 1-6 | Interview with patient and proxy by trained interviewer/research assistant | CMAI | Interview with patient and proxy by trained interviewer/research assistant | - | - |
| HAM-D | ||||||
| NPI (subdomains delusion/hallucinations) | ||||||
| Leonard 200650 | MDS pain burden using a 4-level composite score based on pain frequency and intensity | - | MDS (Physical aggression: MDS item 'others were hit, shoved, scratched, sexually abused'; Depression: MDS score ≥3 on sum of 9 items, e.g. 'being sad', 'making negative statements', 'persistent anger with self or others', 'pained facial expressions'. (At least once in week before) | - | - | - |
| Leong 200735 | PAINAD for non-communicative patients | Interviews with patient and staff member by professionals for communicative patients | Depression with GDS-15 or STAI | Self-report or staff report | AAS | Not reported |
| Anxiety with Cornell | ||||||
| Lin 201146 | PAINAD-Chinese version | Observation immediately following instances of routine care by principal investigator and research assistant | No use of rating scales | Medical records and observations by professional | No use of rating scale | Medical records and observation by professional |
| Morgan 201247 | PGC-PIS worst pain item | Not reported | CMAI aggression subscale | Not reported | - | - |
| CMAI non-aggressive physical agitation subscale | ||||||
| HAM-D depression | ||||||
| Norton 201042 | PPQ, intensity item, 10–14 day baseline | Primary CNA and data used from medical records | RMBPC-NH, selection of 3 need driven behaviours, BEHAVE-AD | Primary CNA and unit staff | PSMS | Nurses and trained research assistants |
| Shega 200548 | VDS, 1 item on presence and severity of pain ‘right now’ | Interviews with patients and caregivers by trained research assistant | GDS-15 | Interview patient and proxy | KATZ | Interview patient and proxy |
| CMAI | IADL | |||||
| Shega 201049 | VDS, 5 point, ‘pain past 4 weeks’ | Interviews with patient by trained research assistant | Mental Health screening questionnaire; 5-item and 6 point scale | Interview with patient by trained research assistant | OARS/IADL; 3 point scale | Interview patient by trained research assistant |
| Torvik 201048 | VRS, 4 point, ‘pain right now’ | Patient self-report | DQoL, 29-items on 5 domains: self-esteem, aesthetics, positive affect, negative affect, belonging | Not reported | Barthel | Self-report and medical records |
| Tosato 20123 | InterRAI LTCF | InterRAI LTCF questions and observation of behaviour, any type of pain or discomfort of the body in previous 3 days by trained (research) staff | InterRAI LTCF 5 behavioural symptoms, previous 3 days | Not reported | MDS ADL Hierarchy Scale | Data recorded by study physicians |
| Volicer 200937 | MDS-RAI pain frequency (item J2a) | Combination of physical examination, patient history, observation, consultation caregiver and medical records by staff | MDS Depression Rating Scale | Combination of physical examination, patient history, observation, consultation caregiver and medical records by staff | - | - |
| MDS item J1e for delusions MDS item J1i for hallucinations | ||||||
| Volicer 201151 | MDS | Combination of physical examination, patient history, observation, consultation caregiver and medical records by staff | MDS items I1ee, E1a, E1d, E1f, E1b, E1i, E1l, E1m for depression | Combination of physical examination, patient history, observation, consultation caregiver and medical records by staff | - | - |
| MDS for delusions and hallucinations | ||||||
| MDS items B5b, E1b, E4aa, E4da for agitation | ||||||
| Williams 200543 | PGC-PIS, score =2, and 0–10 pain numeric rating scale | Registered nurses or licensed practical nurses and interview with overseeing supervisor | CSDD, score =7 | Rating by care supervisors, registered nurses and licensed practical nurses | MDS-ADL | Rating by care supervisors, registered nurses and licensed practical nurses |
| CMAI, any behaviour at least weekly | APAS | |||||
| SMOI | ||||||
| Zieber 200538 | DS-DAT, and a 7-point pain rating scale | Trained facility nurses, palliative care nurse consultants | PAS | Trained facility nurses | - | - |
Abbreviations: MDS Minimum Dataset, ADL Activities of Daily Living, GMPI Geriatric Multidimensional Pain and Illness Inventory, GDS-15 Geriatric Depression Scale-15 short version, PRADLI Psychosocial Resistance to Activities of Daily Living Index, GLDS Geriatric Level of Dysfunction Scale, PGC-PIS Philadelphia Geriatric Centre Pain Intensity Scale, CSDD Cornell Scale for Depression in Dementia, CMAI Cohen-Mansfield Agitation Inventory, SMOI Structured Meal Observational Instrument, HAM-D Hamilton Rating Scale for Depression, NPI Neuropsychiatric Inventory, PAINAD Pain Assessment in Advanced Dementia, STAI State-Trait Anxiety Inventory, AAS Adjusted Activity Scale, PPQ Proxy Pain Questionnaire, CNA Certified Nursing Assistant, RMBPC-NH Revised Memory and Behaviour Problems Checklist-Nursing Home, BEHAVE-AD Behavioural Pathology in Alzheimer’s disease, PSMS Physical Self Maintenance Scale, VDS Verbal Descriptor Scale, KATZ Index of Independence in Activities of Daily Living, IADL Instrumental Activities of Daily Living, OARS/IADL Older Americans Recourses and Services/Instrumental Activities of Daily Living, VRS Verbal Rating Scale, DQol Dementia Quality of life, APAS Albert Patient activity Scale, DS-DAT Discomfort Scale - Dementia of Alzheimer Type, PAS Pittsburgh Agitation Scale
Table 5.
Correlates of pain and neuropsychiatric symptoms
| Correlates of pain and specified NPS | |||||
|---|---|---|---|---|---|
| First author | N | Pain: prevalence | Neuropsychiatric symptoms: prevalence | Correlates of pain with NPS | Quality of study |
| Ahn 201336 | 56577 | Not reported | Wandering 9 % | AOR 0.77 (95 % CI: 0.73-0.81) with wandering | 10 |
| Subsample without psychotropic medication | |||||
| AOR 0.72 (95 % CI: 0.63-0.83) with wandering | |||||
| (Adjusted for cognition, ADL, sociodemographics) | |||||
| Kunik 200534 | 99 | Pain mean 2.4 (SD 1.2) | Delusions/hallucinations mean 0.35 (SD 0.48) | r = 0.15 (p > 0.05) with psychosis | 8.5 |
| Leong 200735 | 225 | Pain 44 %, chronic pain 34 % | Anxiety 48 % | SOR 1.8 (95 % CI: 1.0-3.0) with anxiety | 8.5 |
| Norton 201042 | 161 | Not reported | BEHAVE-AD mean 6..4 (SD 29.2) | r = 0.15 (p = 0.08) for pain intensity and emotional behaviour problems | 9 |
| RMBPC-NH mean 1.45 (SD 0.64) | r = 0.05 (p = 0.58) for pain intensity and resistiveness to care | ||||
| Torvik 201052 | 106 | Current pain in total group 55 %, in cognitive impaired group 52 % | Negative affect index (DQoL) mean 2.0 (SD 0.75), positive affect/humour index (DQoL) mean 3.4 (SD 0.9) | p < 0.01 for current pain and negative affect | 6.5 |
| p = 0.11 for current pain and with positive affect/humour | |||||
| Tosato 20123 | 2822 | Any pain 19 % (moderate/severe/excruciating pain 13 %) | Behavioural symptoms 37 % Psychiatric symptoms 21 % | AOR = 0.74 (95 % CI: 0.55-1.0) with wandering | 11.5 |
| AOR = 1.4 (95 % CI: 1.08-1.8) with resistance to care | |||||
| AOR 1.5 (95 % CI: 1.07-2.03) with delusions | |||||
| AOR 1.06 (95 % CI: 0.80-1.41) with verbal abuse | |||||
| AOR 1.08 (95 % CI: 0.75-1.55) with physical abuse | |||||
| (Adjusted for age, gender, country, cognitive impairment, number of diseases, ischemic heart disease, stroke, falls, communication problems, and a flare-up of a chronic or recurrent condition) | |||||
| Volicer 200937 | 929 | Daily pain 29 %, less than daily pain 19 % | Verbally abusive not easily altered 2 %, physically abusive not easily altered 12 % | r = 0.07 (p = 0.03) for pain frequency and verbal abuse | 11 |
| AOR = 0.9 (p = 0.53) with resisting care | |||||
| AOR = 0.7 (p = 1.2) with verbal abuse | |||||
| AOR = 0.7 (p = 0.16) with physical abuse | |||||
| Delusions 8 % | (Both multivariate models among others controlled for resisting care) | ||||
| Hallucinations 9 % | |||||
| Zieber 200538 | 58 | Not reported | Not reported | r = 0.46 (p < 0.01) for DS-DAT scores and resisting care | 8 |
| r = 0.42 (p < 0.01) for DS-DAT scores and aberrant vocalization | |||||
| Pain rating by palliative care nurse consultants: | |||||
| r = 0.51 (p < 0.01) with resisting care | |||||
| r = 0.40 (p < 0.01) with aberrant vocalizations | |||||
| Pain rating by facility nurse: | |||||
| r = 0.48 (p < 0.01) with resisting care | |||||
| r = 0.065 (p < 0.63) with aberrant vocalizations | |||||
| Correlates of pain and unspecified NPS | |||||
| First author | N | Pain: prevalence | Neuropsychiatric symptoms: prevalence | Correlates of pain with unspecified NPS | Quality of study |
| Black 200639 | 123 | Pain 63 % | Psychiatric disorders or behaviour problems 85 %, behaviour problems 67 % | SOR 1.9 (95 % CI: 0.7-5.3) with psychiatric/behaviour problems | 6.5 |
| SOR 1.2 (95 % CI: 0.5-2.5) with behaviour problems | |||||
| Brummel-Smith 200240 | 104 (excluding those unable to self-report pain) | Moderate-severe pain 60 % | ≥1 disruptive behaviours (wandering, verbal disruption, physical aggression, regressive behaviour, hallucinations) | SOR 1.8 (95 % CI: 0.8-4.0) with ≥ 1 disruptive behaviour | 7 |
| No-mild pain 40 % | |||||
| 50 subject unable to answer | |||||
| 70 % in dementia sample n = 154 | |||||
| Cipher 20044 | 234 | Persistent pain 72 % | Dysfunctional behaviours mean 4.4 (SD 0.76) | r = 0.22 (p < 0.05) with dysfunctional behaviours | 7.5 |
| Cipher 200641 | 277 | Acute pain 29 % | - | r = 0.18 (p < 0.05) with GLDS mean behavioural intensity | 7.5 |
| Chronic pain 59 % | |||||
| Norton 201042 | 161 | Not reported | BEHAVE-AD mean 61.4 (SD 29.2) | r = 0.18 (p = 0.03) for pain intensity and disruptive behaviour problems | 9 |
| RMBPC-NH mean 1.45 (SD 0.64) | r = 0.05 (p = 0.53) for pain intensity and global need driven behaviours | ||||
| Tosato 20123 | 2822 | Any pain 19 % (moderate/severe/excruciating pain 13 %) | Behavioural symptoms 37 % | AOR = 1.4 (95 % CI: 1.04-1.8) with socially inappropriate behaviour | 11.5 |
| Psychiatric symptoms 21 % | (Adjusted for age, gender, country, cognitive impairment, number of diseases, ischemic heart disease, stroke, falls, communication problems, and a flare-up of a chronic or recurrent condition) | ||||
| Williams 200539 | 331 | Pain 21 %, in nh 23 %, in rc/al 20 % (self-report for subgroup mmse > 10 was higher: 39 % and 25 %) | Behavioural symptoms 58 % | OR = 1.1 (95 % CI: 0.49-2.29) and AOR = 1.2 (95 % CI: 0.57-2.36) with behavioural symptoms | 10 |
| (Adjusted for: sex, race, age, cognitive status, number of 10 comorbidities, impairments of 7 activities of daily living) | |||||
Abbreviations: AOR Adjusted Odds Ratio, ADL Activities of Daily Living, SD Standard Deviation, r correlation coefficient, SOR Self-Calculated Odds Ratio, BEHAVE-AD Behavioural Pathology in Alzheimer’s disease, RMBPC-NH Revised Memory and Behaviour Problems Checklist-Nursing Home, DQoL Dementia Quality of life, DS-DAT Discomfort Scale - Dementia of Alzheimer Type, GLDS Geriatric Level of Dysfunction Scale, rc/al residential care/assisted living, MMSE Mini Mental State Examination, OR Odds Ratio
Table 6.
Correlates of pain with physical function
| Correlates of pain and ADL or IADL | |||||
|---|---|---|---|---|---|
| First author | N | Pain: prevalence | Physical function: prevalence | Correlates of pain with ADL or IADL | Quality of study |
| Brummel-Smith 200236 | 104 (excluding those unable to self-report pain) | Moderate-severe pain 60 %, no-mild pain 40 % (50 subject unable to answer) | ≥1 ADL limitations | SOR 1.9 (95 % CI: 0.6-6.0) with ≥ 1 ADL limitation | 7 |
| 92 % in dementia sample (n = 154) | |||||
| Cipher 20044 | 234 | Persistent pain 72 % | ADL independency mean 0.09 (SD 0.99) | Correlations with GMPI ’pain and suffering’ | 7.5 |
| r = −0.04 (α > 0.05) with ADL independency | |||||
| Shega 200544 | 115 | Any current pain self-report 32 %, caregiver report 53 % | KATZ mean 8.5 (SD 2.7), IADL mean 15.3 (SD 3.9) | For self-report pain | 9.5 |
| No association ADL and IADL (p > 0.05) | |||||
| For caregiver pain report | |||||
| No association with ADL or IADL (p > 0.05) | |||||
| Shega 201045 | 5549 | Moderate or greater pain: 35.8 % | Any IADL impairment: 66.5 % | OR = 1.74 (95 % CI: 1.15-2.62) with any iADL impairment | 9 |
| (Adjusted for demographics) | |||||
| Torvik 201048 | 106 | Current pain in total group 55 %, in cognitive impaired group 52 % | Highly or moderate ADL dependent 36 % | p = 0.20 for current pain and ADL | 6.5 |
| SOR = 0.5 (95 % CI: 0.2-1.2) for current pain and ADL high/medium v.s. low | |||||
| Tosato 20123 | 2822 | Any pain 19 % (moderate/severe/excruciating pain 13 %) | No disability 8 %, assistance required 43 %, dependent 49 % | SOR 1.0 (95 % CI: 0.9-1.2) with ADL-dependent | 11.5 |
| SOR 0.9 (95 % CI: 0.75-1.09) with ADL assistance required | |||||
| (Adjusted for age, gender, country, cognitive impairment, number of diseases, ischemic heart disease, stroke, falls, communication problems, and a flare-up of a chronic or recurrent condition) | |||||
| Correlates of pain and other functional impairments | |||||
| First author | N | Pain: prevalence | Physical function: prevalence | Correlates of pain with ADL or IADL | Quality of study |
| Black 200639 | 123 | Pain 63 % | Nutrition/hydration problems total sample 85 % | SOR 1.9 (95 % CI: 0.7-5.3) with nutrition/hydration problems | 6.5 |
| Brummel-Smith 200240 | 104 (excluding those unable to self-report pain) | Moderate-severe pain 60 %, no-mild pain 40 % (50 subject unable to answer) | ≥1 ADL limitations | SOR 1.6 (95 % CI: 0.6-4.2) with bladder incontinence | 7 |
| 92 % in dementia sample (n = 154) | |||||
| D’Astolfo 200644 | 140 | Pain 64 % (musculoskeletal pain 40 %) | Use of wheel chair 60 % | SOR 1.5 (95 % CI: 0.7-3.0) with use of wheel chair or bedridden | 7 |
| Requires assistance 34 % | SOR 1.0 (95 % CI: 0.5-2.0) with requires assistance | ||||
| (Analyses in sample of no dementia-severe dementia) | |||||
| Lin 201146 | 112 | Observed pain 37 % (PAINAD > =2) | Being restrained 46 %; observed care activities: bathing 43 %, assisted transfer 31 %, self-transfer 26 % | OR = 5.4 (95 % CI: 2.3-12.5) and AOR = 3.0 (95 % CI: 1.0-8.7) with being restrained | 12 |
| OR = 23.4 (95 % CI: 3.0-188) and AOR = 19.2 (95 % CI: 2.3-162) with bathing | |||||
| OR = 29.7 (95 % CI: 3.6-242) and AOR = 11.3 (95 % CI: 1.2-102) with assisted transfer, both compared to self-transfer | |||||
| (Adjusted for gender, age, wound, restraint, tube present in body, recent fall, severity of dementia and type of activity) | |||||
| Williams 200543 | 331 | Pain 21 %, in nh 23 %, in rc/al 20 % (self-report for subgroup MMSE > 10 was higher: 39 % and 25 %) | Low activity 47 %, immobile 12 % | OR = 0.65 (95 % CI: 0.38-1.11) and AOR = 0.64 (95 % CI: 0.37-1.10) with low activity | 10 |
| Low food intake 53 % | OR = 1.1 (95 % CI: 0.49-2.29) and AOR = 0.8 (95 % CI: 0.37-1.69) with immobility | ||||
| Low fluid intake 51 % | OR = 1.18 (95 % CI: 0.64-2.17) and AOR = 1.03 (95 % CI: 0.56-1.87) with low food intake | ||||
| OR = 1.20 (95 % CI: 0.67-2.15) and AOR 1.14 (95 % CI: 0.66-1.99) with low fluid intake | |||||
| (Adjusted for: sex, race, age, cognitive status, number of 10 comorbidities, impairments of 7 activities of daily living) | |||||
Abbreviations: SOR Self-Calculated Odds Ratio, ADL Activities of Daily Living, SD Standard Deviation, r correlation coefficient, GMPI Geriatric Multidimensional Pain and Illness Inventory, PAINAD Pain Assessment in Advanced Dementia, OR Odds Ratio, AOR Adjusted Odds Ratio, KATZ Index of Independence in Activities of Daily Living, IADL Instrumental Activities of Daily Living, nh nursing home, rc/al residential care/assisted living, MMSE Mini Mental State Examination
Footnotes
The online version of the original article can be found under doi:10.1186/s12877-015-0048-6.
Contributor Information
Annelore H. van Dalen-Kok, Email: a.h.van_dalen@lumc.nl
Marjoleine Pieper, Email: m.j.c.pieper@lumc.nl.
Margot de Waal, Email: m.w.m.de_waal@lumc.nl.
Albert Lukas, Email: albert.lukas@malteser.org.
Bettina S. Husebo, Email: bettina.husebo@igs.uib.no
Wilco P. Achterberg, Email: w.p.achterberg@lumc.nl