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BMC Geriatrics

Open Access

Erratum to: Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis

  • Annelore H. van Dalen-Kok1Email author,
  • Marjoleine Pieper1, 2,
  • Margot de Waal1,
  • Albert Lukas3,
  • Bettina S. Husebo4, 5 and
  • Wilco P. Achterberg1
BMC Geriatrics201515:109

https://doi.org/10.1186/s12877-015-0085-1

Received: 8 July 2015

Accepted: 8 July 2015

Published: 9 September 2015

The original article was published in BMC Geriatrics 2015 15:49

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

Notes

Authors’ Affiliations

(1)
Department of Public Health and Primary Care, Leiden University Medical Centre
(2)
Department of General Practice & Elderly Care Medicine, VU University Medical Centre Amsterdam
(3)
Malteser Hospital Bonn/Rhein-Sieg, Centre of Geriatric Medicine, Academic Hospital University of Bonn
(4)
Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen
(5)
Stavanger University Hospital

Copyright

© van Dalen-Kok et al. 2015

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