Community-dwelling older persons with dementia have a greater risk for inappropriate
and inadequate treatment of persistent pain. Shega and colleagues found that elderly
persons with cognitive impairment and persistent pain were at greatest risk for insufficient
analgesia. A cross-sectional design was used for this study by observing a convenience sample
of 115 dyads of community-dwelling elders and their caregivers. Pain assessment was
determined by both the older adult and their caregiver. Over half of the participants (54%) who
experienced daily pain reported no use of any analgesic. The majority of caregivers who
administered an analgesic used NSAIDs. No participant was prescribed a strong opioid, such
as morphine. Forty-six percent were reported to have had insufficient pain relief. Insufficient
pain relief was 1.07 times as likely for each additional year of age (95% confidence interval
(CI) = 1.01-1.14), 3.0 times as likely with advanced cognitive impairment (95% CI = 1.05-
9.10), and 2.5 times as likely for older adults with impairment in daily functioning (95% CI =
1.01-6.25). Limitations of this study include a sample of convenience and reliance on
caregivers’ report of pain. The study design was unclear on the distinction between provider
prescribing practices and caregiver administration practices. This vagueness in reviewing
provider prescribing patterns of opioids makes interpretation of the data uncertain. The results
suggest that older adults with dementia and persistent pain may not be prescribed or given
adequate analgesic. Further study is required to examine the impact of cognitive impairment
and adequacy of persistent pain management in this population.