906 Age and Ageing 2021; 50: 906–913 doi: 10.1093/ageing/afaa247 Published electronically 9 December 2020 © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions,please email: journals.permissions@oup.com RESEARCH PAPER The impact of pain on the course of ADL functioning in patients with dementia Annelore H.van Dalen-Kok 1,2 , Marjoleine J. C. Pieper 3 , Margot W. M. de Waal 1 , Jenny T.van der Steen 1 , Erik J. A. Scherder 4 ,Wilco P. Achterberg 1 1 Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands 2 Stichting Florence, Nursing home Mariahoeve, 2594 XZ The Hague, The Netherlands 3 Atlant Wonen en Welzijn,7361 TC Beekbergen,The Netherlands 4 Department of Clinical Neuropsychology, VU University Medical Center Amsterdam, 1081 BT, Amsterdam, The Netherlands Address correspondence to: Annelore H. van Dalen-Kok, Leiden University Medical Centre, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: +31(0)71-5268438; Fax: +31(0)71-5268259. Email: a.h.van_dalen@lumc.nl Abstract Background: Understanding if and how pain influences activities of daily living (ADL) in dementia is essential to improving pain management and ADL functioning. Tis study examined the relationship between the course of pain and change in ADL functioning, both generally and regarding specific ADL functions. Methods: Participants were Dutch nursing home residents (n = 229) with advanced dementia. ADL functioning was assessed with the Katz ADL scale, and pain with the Dutch version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-D). Changes of PACSLAC-D and Katz ADL scores were computed based on the difference in scores between baseline, 3-month and 6-month follow-up. Multivariate linear regression models were used to assess the relationships between change in pain score, change in total ADL score and specific ADL item scores during follow-up. Results: At baseline, residents had a median ADL score of 18 (interquartile range 13–22, range 6–24) and 48% of the residents were in pain (PACSLAC-D ≥ 4). Residents with pain were more ADL dependent than residents without pain. A change in pain score within the first 3 months was a significant predictor for a decline in ADL functioning over the 6-month follow- up (B = 0.10, SE = 0.05, P = 0.045), and specifically, a decline on the items ‘transferring’ over the 6-month follow-up and ‘feeding’ during the first 3 months of follow-up. Conclusions: Pain is associated with ADL functioning cross-sectionally, and a change in pain score predicts a decline in ADL functioning, independent of dementia severity. Awareness of (changes in) ADL activities is clearly important and might result in both improved recognition of pain and improved pain management. Keywords: dementia, pain, activities of daily living, nursing home, longitudinal study, older people Key Points • Recognition of pain in dementia is challenging and often leads to undertreatment, with negative consequences for quality of life. • Persons with dementia and pain were more ADL dependent compared with residents without pain. • Pain and a change in pain affect ADL functioning in dementia, independent of dementia severity. • Pain affects overall ADL functioning in dementia, as well as specific ADL activities such as transferring and feeding. • Changes in ADL functioning could serve as red flag for the presence of pain. Downloaded from https://academic.oup.com/ageing/article/50/3/906/6029102 by guest on 24 November 2022