Dementia Care: Addressing Pain and Maximizing Comfort

Abstract Pain is common in older people who have Dementia, and is associated with a number of chronic and acute conditions. There is evidence that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated. Pain has a powerful effect on mood, sleep quality, functional ability, and overall quality of life. Rejecting care due to pain is very common among patients with Dementia. An association between pain and increased agitation has been noted, Significant reduction of agitation and psychotropic usage have been demonstrated by pain treatment in patients with moderate to severe dementia. This project was conducted in six memory care units with 150 residents at 815 bedded long-term geriatric care facility. All residents in memory care units from May 2018 to December 2019 were individually assessed for pain management, rejection of care, usage of psychotropics, falls and physical altercations. Trained interdisciplinary staff to evaluate pain by using PAIN AD. Educated interdisciplinary team on pharmacological and non-pharmacological pain management, and Pain management has improved from 40% to 90%, Rejection of care reduced from 80% to 30%. Usage of antipsychotics reduced by 12%. Falls reduced from 12% to 2%. Physical altercations reduced to zero. Staff call out due to work related injury significantly reduced. Staff verbalized improved job satisfaction and increased morale.

this study was to develop a caregiver-assisted pain coping skills training protocol tailored for community-dwelling adults with mild-moderate dementia and their family caregivers. We conducted interviews with patients and caregivers to develop the protocol. We then conducted a single arm pilot test of the intervention's feasibility and acceptability. Patients were recruited from an outpatient memory care clinic and screened for pain using the validated Pain, Enjoyment, General Activity (PEG) scale. The intervention included five sessions of training in pain assessment, relaxation, pleasant activity scheduling, and integrative movement. Initially sessions were conducted in person or by videoconference according to the dyad's preference; during COVID-19 (latter half of study) all sessions were conducted remotely. Eleven dyads consented and provided baseline data [patients: mean age=77.7 years (SD=4.8), 70% non-Hispanic white; caregivers: mean age=69.6 years (SD=13.3); 91% non-Hispanic white; 73% spouses]. Nine dyads (82%) completed all five sessions. Caregivers reported high levels of satisfaction with the intervention (mean=3.4 on 1-4 scale) and frequent use of pain coping skills (mean=3-4 days/week). On average, patients reported pre-post decreases in pain severity (mean=-1.2, SD=1.8) and pain interference (mean=-0.64, SD=0.67) on the Brief Pain Inventory. Overall these findings suggest that a behavioral pain coping intervention for patients with mild-moderate dementia and their caregivers is feasible, acceptable, and potentially helpful for managing pain.

DEMENTIA CARE: ADDRESSING PAIN AND MAXIMIZING COMFORT Deepa Vinoo, NYC Health Hospitals/Coler, Roosevelt Island, New York, United States
Pain is common in older people who have Dementia, and is associated with a number of chronic and acute conditions. There is evidence that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated. Pain has a powerful effect on mood, sleep quality, functional ability, and overall quality of life. Rejecting care due to pain is very common among patients with Dementia. An association between pain and increased agitation has been noted, Significant reduction of agitation and psychotropic usage have been demonstrated by pain treatment in patients with moderate to severe dementia. This project was conducted in six memory care units with 150 residents at 815 bedded long-term geriatric care facility. All residents in memory care units from May 2018 to December 2019 were individually assessed for pain management, rejection of care, usage of psychotropics, falls and physical altercations. Trained interdisciplinary staff to evaluate pain by using PAIN AD. Educated interdisciplinary team on pharmacological and non-pharmacological pain management, and Pain management has improved from 40% to 90%, Rejection of care reduced from 80% to 30%. Usage of antipsychotics reduced by 12%. Falls reduced from 12% to 2%. Physical altercations reduced to zero. Staff call out due to work related injury significantly reduced. Staff verbalized improved job satisfaction and increased morale. Chronic low back pain is the leading cause of disability among older adults. The impact of psychological factors, including high levels of stress, are associated with increased risk for pain. Despite the growing evidence suggesting that psychological well-being is associated with better health outcomes, limited research has examined positive psychological factors in the context of pain among older adults. In this secondary data analyses of we examined the association of perceived stress on pain and physical functioning, and the moderating role of positive affect and well-being (PAW) on these relationships. A total of 60 adults over the age of 60 completed completed questionnaires assessing perceived stress (Perceived Stress Scale) and positive affect and well-being (Neuro-QOL PAW). The Back Performance Scale measured back-related physical functioning and movementevoked pain. We hypothesized that PAW would be inversely associated with pain outcomes and would moderate the relationship between perceived stress and pain. Bivariate correlations assessed the association between study variables, while the interaction of PAW and perceived stress was examined via linear regression. Age (r=.30), income (r=.28), and being married (r=.32) were associated with higher PAW scores, while there was an inverse association with movement-evoked pain (r=-.28). After controlling for demographic covariates, moderation analysis revealed that higher levels of perceived stress were associated with poorer physical functioning, but only among those with lower positive affect and well-being (b=0.14). As seen, examining the influence of positive psychological functioning on pain-related outcomes has important clinical implications that may promote positive pain adaptation in this population.

RURAL OLDER ADULTS' EXPERIENCES WITH PAIN FROM CHRONIC ILLNESSES AND ITS TREATMENT
Hyunjin Noh, 1 Zainab Suntai, 1 and Cho Rong Won, 2 1.

University of Alabama, Tuscaloosa, Alabama, United States, 2. University of Alabma, Tuscaloosa, Alabama, United States
Although pain control is an essential factor in promoting quality of life, pain is undertreated among certain sub-populations, such as older adults and rural residents.
The purpose of this study was to explore pain experiences and its treatment among rural older adults. A qualitative research design was adopted to capture the common essence of participants' experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 55+, have good thinking skills, resident of Alabama, have chronic/serious health conditions, and experienced pain or discomfort in the last 3 months. Twenty-three participants were recruited from rural counties of West and South Alabama through the local Area Agency on Aging and health and senior service centers. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes and repeated patterns from the data. Our results revealed themes in four categories: 1) impact of pain: physical limitations and coping strategies, 2) Impact of Covid-19: physical health, social, and mental health impact, 3) challenges in pain treatment: transportation (driver/ time/cost/Covid-19 exposure) and non-transportation related problems (lacking resources/mistrust/limited health insurance coverage), and 4) suggestions: transportationrelated (more transportation options/financial assistance) and non-transportation-related support (improved insurance coverage/non-pharmacological care) . Findings of this study highlight rural older adults' unique needs in access to pain treatment, further amplified during the Covid-19 pandemic. Increase in sustainable, funded transportation programs and the supply of local pain specialists is critical to meet such needs and improve their quality of life. Consistent with the theme of the conference this year, this symposium explores the impact of the pandemic and our commitment to redress structural racism and health inequities on health of older adults, and our collective capacity to transform and innovate through our gerontological health sciences lens. Each presenter will focus on one sector of care: (1) the health system and healthcare workforce; (2) older persons; and (3) families and care partners. The first presenter provides a systems-level perspective on key disruptors in healthcare systems for care of older adults and the workforce, and emerging innovations to address increasingly transparent care inequities. Emerging research implications as a result of these disruptions will be highlighted. The second presenter highlights how the predominant features of the pandemic in older adults, loneliness and isolation, are co-occurring with significant resilience and innovation, and the resultant potential to create a paradigm shift in how we design and advance communities of care. The third presenter provides the perspective of family members and care partners of older adults during the time of the pandemic, focusing on disruptions that have informed changes going forward,