2 results
421 - Prevalence of Pain in Dementia Subtypes: Data from a National Sample of Aged Care Residents in Australia
- Atee M, Morris T, Macfarlane S, Cunningham C
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- Journal:
- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, p. 43
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- Article
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Background:
Pain is poorly identified in dementia due to complete or partial loss in communication, which is associated with progressive cognitive impairment. If it goes untreated, pain can lead to behavioral disturbances (e.g., agitation/aggression), delirium, inappropriate pharmacotherapy (e.g., psychotropics), hospitalizations and caregiver distress. There are limited prevalence data in the literature on pain in dementia subtypes.
Objective:This study aims to investigate the prevalence and intensity of pain in various dementia subtypes in aged care residents living with dementia (RLWD), using a technology-driven pain assessment tool.
Methods:A 1-year retrospective cross-sectional study was conducted on the presence and intensity of pain in referrals to Dementia Support Australia from residential aged care homes (RACHs), using PainChek®. PainChek® is a pain assessment tool that uses artificial intelligence algorithms (e.g., automated facial recognition and analysis) to identify facial expressions indicative of pain in conjunction with other digital checklists of pain behaviors such as vocalization and movement cues. Presence and intensity of pain were identified using PainChek® categories (scores): no pain (0-6), mild pain (7-11), moderate pain (12-15) and severe pain (16-42).
Results:During the study period (01/11/2017-31/10/2018), a sample of 479 referrals (age: 81.9 ± 8.3 years old; 55.5% female) from 370 RACHs with Alzheimer’s disease (AD; 40.9%), vascular dementia (VaD; 12.7%), mixed dementia (MD; 5.9%), dementia with Lewy body (DLB; 2.9%), and frontotemporal dementia (FTD; 2.3%) were examined. Pain was prevalent in two-thirds (65.6%) of the referrals with almost half (48.4%) of these categorized as experiencing moderate-severe pain. MD and those with DLB (78.6% each) shared the highest prevalence of pain, followed by AD (64.3%) > VaD (62.3%) > FTD (54.6%). Prevalence of severe pain was as follow: MD (17.9%) > AD (12.3%) > VaD (11.5%) > FTD (9.1%) > DLB (7.1%).
Conclusion:To date, this is the largest study that presented data on pain prevalence and intensity in major dementia subtypes in the RACH setting. Moderate-severe pain is highly prevalent in RLWD, which appears to differ by dementia subtypes. This may reveal the impact of neuropathological etiology of those subtypes on the neurobiology of pain.
Word count:344 words
422 - Evaluating the Clinical Impact of National Dementia Behavior Support Programs on Neuropsychiatric Outcomes in Australia
- Atee M, Macfarlane S, Morris T, Whiting D, Healy M, Alford M, Cunningham C
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- Journal:
- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, p. 44
-
- Article
-
- You have access Access
- Export citation
-
Background:
People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviors and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies.
Objective:This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centered care interventions delivered by national multidisciplinary dementia-specific behavior support programs.
Methods:A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behavior Management Advisory Service (DBMAS) and the Severe Behavior Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version “NPI-Q” was administered for DBMAS referrals whereas the nursing home version “NPI-NH” was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen’s effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters.
Results:A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer’s disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect.
Conclusions:Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.
Word count:350 words