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. Cross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety). 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. 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. 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, = .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; = .039). Apathy (OR, 0.884; = .041) and lack of inhibition (OR, 0.904; = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; = .042; lack of inhibition OR, 0.894; = .034). 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.

中文翻译：

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疼痛和神经精神症状对疗养院居民活动的影响（COSMOS 试验）

本研究旨在确定疼痛和痴呆相关行为是否与疗养院居民的不同类型活动相关，并根据痴呆严重程度进行控制。来自多组分集群随机对照 COSMOS 试验（沟通、系统性疼痛治疗、药物审查、活动组织和安全性的缩写）的横截面基线数据。来自挪威 33 家疗养院、67 个疗养院（集群）的 723 名患者共入组。年龄≥65岁、预期寿命>6个月且具有有效活动数据的参与者有资格入选。活动按时间（每周小时数）和类型（认知、社交、身体和无活动）进行操作。使用简易精神状态检查 (MMSE) 评估认知功能，使用动员-观察-行为-强度-痴呆-2 疼痛量表 (MOBID-2) 评估疼痛，​​使用神经精神库存疗养院版本 (NPI-NH) 评估行为）。使用线性回归和逻辑回归进行分析。对痴呆严重程度进行敏感性分析以解释效果修改。共有 289 名参与者（平均年龄 86.2 [SD 7.6]；74% 为女性）。严重痴呆症参与者的疼痛评分越高，活动时间越少（估计值 0.897，= 0.043）。NPI-NH 情绪簇（抑郁和焦虑）得分越高，参与认知活动的可能性就越高（比值比 [OR]，1.073；= .039）。冷漠（OR，0.884；= .041）和缺乏抑制（OR，0.904；= .042）与参与社交活动以及不参与活动的可能性较低相关（冷漠OR，0.880；= .042） ；缺乏抑制 OR，0.894；= .034)。疼痛和痴呆相关行为可能会影响疗养院活动的参与。迫切需要调查什么类型的活动会刺激处于不同阶段的痴呆症患者。