• Elyse R Thakur, Amber B Amspoker, Shubhada Sansgiry, A Lynn Snow, Melinda Stanley, Nancy Wilson, Jessica Freshour, and Mark E Kunik.
• Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
• Pain Med. 2017 Aug 1; 18 (8): 1476-1484.

ObjectiveTo identify factors associated with no analgesic treatment in community-dwelling older adults with mild-to-moderate dementia and moderate-to-severe pain.DesignSecondary analysis of a randomized controlled trial.SettingMichael E. DeBakey Veterans Affairs Medical Center.SubjectsTwo hundred and two older adults (mean age = 79.27 years).MethodsGuided by the Behavioral Model of Health Service Utilization, participants completed questionnaires regarding predisposing (age, gender, race, educational level, care partner relationship), enabling (income), and need (pain interference, depressive symptoms, cognitive functioning) characteristics.ResultsHierarchical logistic regression analyses revealed that participants with greater income (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.63-0.99) and greater pain interference (OR = 0.79, 95% CI = 0.63-0.99) were less likely to have no analgesic treatment. We also examined whether other factors such as depressive symptoms influenced the relationship between pain interference and pain treatment. Those with less pain interference were more likely to have no analgesic treatment (OR = 1.04, 95% CI = 1.01-1.08), but only if they had lower levels of depressive symptoms (b = -0.52, P  = 0.005).ConclusionThe initiation of analgesic trials is complicated for individuals with dementia and comorbid pain and depressive symptomology. Future research should focus on identifying the most effective assessment and treatment procedures to best direct clinical care for this population.© 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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