Aggression strongly signals pain only when dementia reaches advanced stages, researchers find

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For a person with dementia, the link between aggressive behavior and physical pain is strong only in the condition's advanced stages, University of Florida researchers have found.

The investigators analyzed Minimum Data Set information from Florida long-term care facilities in 2009. This was the first “comprehensive assessment data from residents with dementia” in Medicare- or Medicaid-certified nursing homes, the researchers stated.

Residents with severe cognitive impairment had “significantly more frequent aggressive behaviors” when in pain, they discovered. This was not true of residents with less severe dementia.

Caregivers should monitor the frequency of aggressive behaviors and consider pain relief as a solution when they increase, the study authors concluded. “Accurate but simple pain assessment” for this population needs to be further developed, and aggression level should be part of this assessment, they added.

Detecting pain in people with dementia is a difficult but crucial aspect of caregiving, particularly as long-term care facilities make efforts to scale back on using antipsychotic medications, long-term care expert Alice Bonner, Ph.D., said on a call with providers in November. These findings out of Florida add nuance to the commonly held notion that behavioral changes might indicate pain.

Findings appear in Asian Nursing Research.

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