Pain as an underrecognized geriatric syndrome in hospitalized older adults with major neurocognitive disorder: clinical correlates and outcomes

Eur Geriatr Med. 2026 Mar 10. doi: 10.1007/s41999-026-01450-w. Online ahead of print.

ABSTRACT

AIM: This study aims at investigating pain as an underrecognized geriatric syndrome in hospitalized older adults with major neurocognitive disorder, and to evaluate its association with frailty, quality of life, and short-term mortality.

METHODS: This prospective observational cohort study was conducted in an acute geriatric care unit. Dementia was diagnosed according to DSM-5 criteria and staged using the Clinical Dementia Rating (CDR). Pain was assessed with the Pain Assessment in Advanced Dementia (PAIN-AD) scale. Frailty (Clinical Frailty Scale) and quality of life (EQ-5D-3L) were evaluated. Analyses included correlation, linear and Cox regression, and Kaplan-Meier survival methods.

RESULTS: A total of 292 hospitalized older adults with major neurocognitive disorder were included (mean age 87.8 ± 6.2 years; 63.4% women). Clinically relevant pain-related behaviours (PAIN-AD ≥ 2) were observed in 62.4% of participants and increased progressively with dementia severity. Despite this high prevalence, only 20.3% of patients with PAIN-AD ≥ 2 were receiving pharmacological analgesic treatment at hospital admission. Compared with participants with PAIN-AD ≤ 1, those with PAIN-AD ≥ 2 showed lower functional autonomy, poorer nutritional status, higher frailty levels, greater acute clinical severity, and longer hospital stay. PAIN-AD scores were positively associated with frailty and poorer health-related quality of life, controlled for multiple covariates. At 3-month follow-up, mortality was significantly higher among patients with PAIN-AD ≥ 2 (40.1% vs 16.3%). In Cox regression analysis, PAIN-AD ≥ 2 remained independently associated with increased short-term mortality (HR 2.39, 95% CI 1.20-4.74), after adjustment for demographic factors, dementia severity, nutritional status, acute illness severity, and analgesic therapy.

CONCLUSIONS: Pain assessed by observational tools is frequent and clinically relevant in hospitalized older adults with major neurocognitive disorder and is associated with increased vulnerability and adverse short-term outcomes.

PMID:41806162 | DOI:10.1007/s41999-026-01450-w