Dementia is a progressive, eventually terminal disease that currently affects 4.7 million people in the United States (US). Previous research indicates that pain in persons with dementia is highly prevalent and is associated with a variety of adverse outcomes, including diminished quality of life, poorer psychosocial functioning, increased behavioral symptoms such as agitation, and worsened functional ability. However, there is limited research exploring outcomes of pain on healthcare and other service utilization in the dementia population, particularly in the community-dwelling dementia population. The purpose of the proposed study is to explore the effect of pain on key health outcomes in community-dwelling older adults with dementia, including emergency department use, hospitalizations, and transitions in living arrangements. Although the focus of this study will be on pain as the main predictor, it will also explore whether other potential variables, such as depressive symptoms and comorbidities, are risk factors for acute care utilization and transitions in living arrangements in the community-dwelling dementia population.
The aims of this study are, in a nationally representative sample of community-dwelling older adults with dementia, to: 1) Describe the frequency and reasons for emergency department visits and hospitalizations over a year long period; 2) Model the contribution of pain and other risk factors to acute care utilization; and 3) Explore whether pain and other risk factors contribute to transitions in living arrangements over a three-year long period. The data for this proposed study will be derived from the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally-representative cohort of older adults in the US, linked to Medicare claims data files. The NHATS study began in 2011 and conducts in-person interviews on an annual basis. The initial NHATS initial cohort included 8,245 community-dwelling older adults, of whom 1,038 met the criteria for dementia. This study will use descriptive statistics, Poisson regression, and discrete-time hazard survival analysis to analyze the data. The knowledge gained from this study will help us to understand the impact that pain may have on community- dwelling older adults with dementia in the US. This information will help clinicians and policy-makers as they develop interventions and services that promote independence and quality of life in this vulnerable population.
This study has the potential to contribute significantly to the knowledge about pain and other potential risk factors associated with acute care utilization and transitions in living arrangements in community-dwelling older adults with dementia. There is a large and growing population of community-dwelling older adults with dementia and this vulnerable population has both a high prevalence of pain and high utilization of healthcare services. As recognized by the National Institute of Nursing Research in their strategic plan, investigation of symptoms such as pain will provide the necessary information for the development of clinical practice guidelines and policies aimed at improving healthcare interventions and services for vulnerable populations.
| Hunt, Lauren J; Coombs, Lorinda A; Stephens, Caroline E (2018) Emergency Department Use by Community-Dwelling Individuals With Dementia in the United States: An Integrative Review. J Gerontol Nurs 44:23-30 |
| Hunt, Lauren J; Ritchie, Christine S; Cataldo, Janine K et al. (2018) Pain and Emergency Department Use in the Last Month of Life Among Older Adults With Dementia. J Pain Symptom Manage 56:871-877.e7 |
