Pain and Behavioral Symptoms in Dementia: A Pilot Study

本研究的目的是测试一种专注于治疗老年痴呆症患者慢性疼痛的干预措施，目的是减少保护性行为症状，如攻击性。第二个目的是了解在没有和存在建议干预的情况下，晨间护理、观察到的疼痛和保护性行为症状之间关系的机制。老年人特别容易出现不明原因和治疗不足的疼痛，他们接受的镇痛药物往往比认知完好的同龄人少得多。此外，多达90%的痴呆症患者表现出保护性行为症状。尽管研究人员和临床医生已经假设疼痛和保护行为症状之间存在关联，但很少有研究探索这种关系。本准实验研究将采用三组重复测量设计，以未经治疗的对照组为对照，评估个性化疼痛治疗干预对老年痴呆症养老院居民的影响。从3家养老院（每家10家）中选择30名中度至重度认知障碍、至少有一种潜在疼痛的慢性肌肉骨骼疾病、并表现出保护性行为症状（对护理的抗拒、言语和/或身体攻击）的居民作为有目的的样本。舒适和反应性增强（CARE）干预，由一名高级执业护士实施，包括两个部分：1)镇痛药物部分和2)社会心理部分。这两种治疗成分将在干预设施中以相反的顺序引入，在最后阶段，每个参与者将暴露于附加的CARE干预，预计这将与参与者的最佳结果相关。研究结果包括疼痛自我报告、观察到的疼痛、保护性行为症状、镇痛药物的使用和社会心理干预的使用。如果可能的话，干预效果的分析将使用方差分析，或相应的非参数分析技术（Wilcoxon符号秩和检验）。在整个干预过程中保留的现场记录的内容分析将用于修改干预措施并评估在更大的随机临床试验中进行测试的可行性。

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.