Impact of pain and neuropsychiatric symptoms on activities in nursing home residents (COSMOS trial)

Beek, S.H. van de; Erdal, A.; Husebo, B.S.; Vislapuu, M.; Achterberg, W.P.; Caljouw, M.A.A.

doi:doi:10.1016/j.jamda.2024.01.012

Objective: This study aims to identify whether pain and dementia-related behavior are associated with
different types of activities in nursing home residents, controlled for dementia severity.
Design: Cross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronymfor Communication, Systematic pain treatment,Medication review, Organization of activities, and Safety).
Setting and Participants: A total of 723 patients from 33 Norwegian nursing homes with 67 units
(clusters). Participants aged >= 65 years, with a life expectancy of >6 months, and with valid data on
activity were eligible for inclusion.
Methods: Activity was operationalized in time (hours per week) and type (cognitive, social, physical, and
no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain
with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and...Show moreObjective: This study aims to identify whether pain and dementia-related behavior are associated with
different types of activities in nursing home residents, controlled for dementia severity.
Design: Cross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronymfor Communication, Systematic pain treatment,Medication review, Organization of activities, and Safety).
Setting and Participants: A total of 723 patients from 33 Norwegian nursing homes with 67 units
(clusters). Participants aged >= 65 years, with a life expectancy of >6 months, and with valid data on
activity were eligible for inclusion.
Methods: Activity was operationalized in time (hours per week) and type (cognitive, social, physical, and
no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain
with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and behavior
with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using
linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for
effect modification.
Results: A total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain
score was associated with less time spent on activity in participants with severe dementia (estimate
0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated
with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P ¼ .039). Apathy
(OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood
of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P = .042; lack
of inhibition OR, 0.894; P = .034).
Conclusion and Implications: Pain and dementia-related behavior may influence the participation in
activities in the nursing home. There is an urgent need to investigate what type of activity stimulates
people in different stages of dementia.
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Impact of pain and neuropsychiatric symptoms on activities in nursing home residents (COSMOS trial)