***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To compare the efficacy of Preventing Aggression in Veterans with Dementia ( PAVeD ) with that of usual care in decreasing incidence of aggression ( primary outcome ) and pain and improving depression , pleasant events , caregiver burden , and patient-caregiver relationship quality ( secondary outcomes ) . DESIGN R and omized controlled trial with assessment s at baseline and 3 , 6 , 9 , and 12 months SETTING : Houston , TX . PARTICIPANTS A total of 203 community-dwelling veterans with pain and dementia and their caregivers . INTERVENTION PAVeD , 6 to 8 weekly sessions of 45-minute home visits with masters-level clinicians providing instruction to caregivers on recognizing pain , enhancing communication , and making daily activities pleasant and enjoyable , and at least two elective sessions . MEASUREMENTS Cohen-Mansfield Agitation Inventory ( primary outcome ) , Philadelphia Geriatric Pain Intensity Scale , Geriatric Depression Scale , Pleasant Events Schedule-AD , Burden Interview , Mutuality Scale ( secondary outcomes ) , Client Satisfaction Question naire . RESULTS There were no significant differences in aggression incidence between intervention and control groups , although the PAVeD group had significantly better mutuality than controls . CONCLUSIONS PAVeD may need to address a broader range and more in-depth coverage of aggression risk factors with person-centered tailoring to target certain types of distress . Interventions to prevent aggression may also need to address medical providers in addition to caregivers Neuropsychiatric symptoms of Alzheimer ’s disease ( AD ) such as depression may be associated with pain , which according to the literature may be inadequately recognized and managed in this population . This study aim ed to identify the factors associated with analgesic use in persons with AD ; in particular , how AD severity , functional status , neuropsychiatric symptoms of AD , co-morbidities and somatic symptoms are associated with analgesic use .  236 community-dwelling persons with very mild or mild AD at baseline , and their caregivers , were interviewed over five years as part of the prospect i ve ALSOVA study . Generalized Estimating Equations ( GEEs ) were used to estimate unadjusted and adjusted odds ratios ( ORs ) for the factors associated with analgesic use over a five year follow-up . The proportion of persons with AD using any analgesic was low ( 13.6 % ) at baseline and remained relatively constant during the follow-up ( 15.3 % at Year 5 ) . Over time , the most prevalent analgesic changed from non-steroidal anti-inflammatories ( 8.1 % of persons with AD at Year 1 ) to acetaminophen ( 11.1 % at Year 5 ) . Depressive symptoms ( measured by the Beck Depression Inventory , BDI ) were independently associated with analgesic use , after effects of age , gender , education , AD severity , comorbidities and somatic symptoms were taken into account . For every one unit increase in BDI , the odds of analgesic use increased by 4 % ( OR = 1.04 , 95 % confidence interval CI = 1.02 - 1.07 ) . Caregiver depressive symptoms were not statistically significantly associated with analgesic use of the person with AD . Depressive symptoms were significantly associated with analgesic use during the five year follow-up period . Possible explanations warranting investigation are that persons with AD may express depressive symptoms as painful somatic complaints , or untreated pain may cause depressive symptoms . Greater awareness of the association between depressive symptoms and analgesic use may lead to safer and more effective prescribing for these conditions OBJECTIVE To assess the current identification and management of patients with dementia in a primary care setting ; to determine the accuracy of identification of dementia by primary care physicians ; to examine reasons ( triggers ) for referral of patients with suspected dementia to the geriatric assessment team ( GAT ) from the primary care setting ; and to compare indices of identification and management of dementia between the GAT and primary care network ( PCN ) physicians and between the GAT and community care ( CC ) . DESIGN Retrospective chart review and comparisons , based on quality indicators of dementia care as specified in the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia , were conducted from matching charts obtained from 3 groups of health care providers . SETTING Semirural region in the province of Alberta involving a PCN , CC , and a GAT . PARTICIPANTS One hundred patients who had been assessed by the GAT r and omly selected from among those diagnosed with dementia or mild cognitive impairment by the GAT . MAIN OUTCOME MEASURES Diagnosis of dementia and indications of high- quality dementia care listed in PCN , CC , and GAT charts . RESULTS Only 59 % of the patients diagnosed with dementia by the GAT had a documented diagnosis of dementia in their PCN charts . None of the 12 patients diagnosed with mild cognitive impairment by the GAT  had been diagnosed by the PCN . Memory decline was the most common reason for referral to the GAT . There were statistically significant differences between the PCN and the GAT on all quality indicators of dementia , with underuse of diagnostic and functional assessment tools and lack of attention to w and ering , driving , medicolegal , and caregiver issues , and underuse of community supports in the PCN . There was higher congruence between CC and the GAT on assessment and care indices . CONCLUSION Dementia care remains a challenge in primary care . Within our primary care setting , there are opportunities for synergistic collaboration among the health care professionals from the PCN , CC , and the GAT . Currently they exist as individual entities in the system . An integrated model of care is required in order to build capacity to meet the needs of an aging population To determine whether medication use differs by cognitive status among community dwelling elderly , a survey was made of a stratified r and om sample of 4110 black and white participants , aged 65 or older from the Duke Established Population s for Epidemiologic Studies of the Elderly in five adjacent urban and rural counties in the Piedmont area of North Carolina . Main outcome measures were usage of prescription medications , non-prescription medications , and medicines within therapeutic classes in the previous 2 weeks as determined during an in-home interview ; and total number of prescription and non-prescription medicines  used in the previous 2 weeks . Multivariate analyses , using weighted data adjusted for sampling design , were conducted to assess the association between drug use patterns and cognitive status , as assessed by the Short Portable Mental Status Question naire , while adjusting for demographic , health status , and access to health care factors . Participants with cognitive impairment ( 13.7 % of sample ) were less likely to use any prescription medications ( Adjusted OR = 0.66 , 95 % CI = 0.48 - 0.90 ) or any non-prescription medications ( Adjusted OR = 0 . 71 , 95 % CI = 0.56 - 0.89 ) than cognitively intact subjects . Both groups took a similar number of prescription and non-prescription medications . Those who were cognitively impaired were less likely to take analgesics ( Adjusted OR = 0.66 , 95 % CI = 0.52 - 0.83 ) , but were more likely to take central nervous drugs ( Adjusted OR = 1.55 , 95 % CI 1.18 - 2.04 ) than those who were cognitively intact . We conclude that drug use patterns by community-dwelling elderly people differ with cognitive status . Future research needs to examine medication use by specific causes of cognitive impairment Objective To determine whether a systematic approach to the treatment of pain can reduce agitation in people with moderate to severe dementia living in nursing homes . Design Cluster r and omised controlled trial . Setting 60 clusters ( single independent nursing home units ) in 18 nursing homes within five municipalities of western Norway . Participants 352 residents with moderate to severe dementia and clinical ly significant behavioural disturbances r and omised to a stepwise protocol for the treatment of pain for eight weeks with additional follow-up four weeks after the end of treatment ( 33 clusters ; n=175 ) or to usual treatment ( control , 27 clusters ; n=177 ) . Intervention Participants in the intervention group received individual daily treatment of pain for eight weeks according to the stepwise protocol , with paracetamol ( acetaminophen ) , morphine , buprenorphine transdermal patch , or pregabaline . The control group received usual treatment and care . Main outcome measures Primary outcome measure was agitation ( scores on Cohen-Mansfield agitation inventory ) . Secondary outcome measures were aggression ( scores on neuropsychiatric inventory-nursing home version ) , pain ( scores on mobilisation-observation-behaviour-intensity-dementia-2 ) , activities of daily living , and cognition ( mini-mental state examination ) . Results Agitation was significantly reduced in the intervention group compared with control group after eight weeks ( repeated measures analysis of covariance adjusting for baseline score , P<0.001 ) : the average reduction in scores for agitation was 17 % ( treatment effect estimate −7.0 , 95 % confidence interval −3.7 to −10.3 ) . Treatment of pain was also significantly beneficial for the overall severity of neuropsychiatric symptoms ( −9.0 , −5.5 to −12.6 ) and pain ( −1.3 , −0.8 to −1.7 ) , but the groups did not differ significantly for activities of daily living or cognition . Conclusion A systematic approach to the management of pain significantly reduced agitation in residents of nursing homes with moderate to severe dementia . Effective management of pain can play an important part in the treatment of agitation and could reduce the number of unnecessary prescriptions for psychotropic drugs in this population . Trial registration Clinical Trials.gov NCT01021696 and Norwegian Medicines Agency EudraCTnr 2008 - 007490 - 20 The analgesia received in the 1st week of treatment by 100 consecutive acute hip fracture patients ( 88 female ) was prospect ively studied . A modified mental test was performed on all patients prior to surgery . Patients with cognitive impairment ( modified mental score < 5 ) received only 74 % of the paracetamol , 43 % of the non-steroidal anti-inflammatory drugs ( NSAIDs ) , 52 % of the opioid and 64 % of the morphine that cognitively intact patients received . These differences were significant for paracetamol ( Mann-Whitney test ; p=0.001 ) and opioid ( Mann-Whitney test ; p=0 . 0012 ) but not for NSAIDs or morphine . Either hip fracture patients with a reduced mental score perceive less pain than their more cognisant peers , or the treating clinicians perceive their pain as less , or both AIMS To investigate the extent of concomitant use of analgesic and psychotropic medicines among home-dwelling elderly people aged at least 75 years in Finl and . METHODS This was a population -based study in Finl and , performed as part of Kuopio 75 + study focusing on the clinical epidemiology of diseases , medication and functional capacity . A r and om sample of 700 persons was drawn from the total population of the city of Kuopio , eastern Finl and , aged 75 years on January 1 , 1998 ( n = 4518 ) . Ninety-nine persons could not be examined and 78 were living in long-term institutions , so that the number of home-dwelling elderly persons amounted to 523 . A trained nurse interviewed the participants about their use of medicines , and a geriatrician examined their overall physical and mental status . Dementia and depression were diagnosed according to the DSM IV criteria . Both regular and irregular prescribed and nonprescribed drug use was recorded . RESULTS Every fourth elderly person ( 27.2 % ) used analgesics and psychotropics concomitantly , this use becoming twice as common with advancing age ( 19.6 % in the age group 75 - 79 years , 38.2 % among the oldest , aged 85 + years ) . Concomitant use of psychotropics and opioids  also became more common with increasing age ( 2.8 % in age group 75 - 79 years and 9.6 % in the oldest group , aged 85 + years ) . The use of opioids  was nearly twice as common among concomitant users ( 19.7 % ) than among those using only analgesics ( 11.3 % ) . Concomitant users suffered from interfering daily pain and daily pain at rest more commonly than nonusers of analgesics .  Depression , sleeping problems and polypharmacy were more common among the concomitant users , who had also had more hip fractures than the rest . CONCLUSIONS Concomitant use of analgesics and psychotropics becomes more common with advancing age and is a potential risk factor for adverse drug effects Advanced dementia patients may be at substantial risk for undetected or undertreated pain . To examine the treatment of pain  following hip fracture , a prospect i ve cohort study was conducted in an academic teaching hospital . Fifty-nine cognitively intact elderly patients with hip fracture and 38 patients with hip fracture and advanced dementia were assessed daily . The cognitively intact patients rated their pain on a numeric scale ranging from 0 ( none ) to 4 ( very severe ) . Analgesics prescribed and administered were recorded and compared to hip fracture patients with advanced dementia . The advanced dementia patients received one-third the amount of morphine sulfate equivalents as the cognitively intact patients . Forty-four percent of cognitively intact individuals reported severe to very severe pain preoperatively and 42 % reported similar pain postoperatively . Half the cognitively intact patients who experienced moderate to very 
    Output:
    
Pain was more commonly reported by informal caregivers than the person with dementia themselves .
Limited evidence was available for pain-focused behavioural observation assessment .
In regard to pain treatment ,  paracetamol use was more common in community-dwelling people with dementia compared with people without dementia .
However , non-steroidal anti-inflammatory drugs ( NSAIDs ) were used less .
For stronger analgesics , community-dwelling people with dementia were more likely to receive strong opioids ( eg , fentanyl ) than people without dementia .
This review identifies a dearth of high- quality studies exploring pain assessment and /or treatment for community-dwelling people with dementia , not least into non-pharmacological interventions .