A systematic review of the relation between pain and neuropsychiatric symptoms in nursing home residents with dementia

Dementia and pain are common in nursing home (NH) residents. Several studies have investigated the relation between pain and neuropsychiatric symptoms (NPS) in NH residents with dementia, but there is a lack of systematic reviews regarding this relation. The aim was to systematically review observational studies studying the relation between pain and NPS in NH residents with dementia. A systematic search was conducted in the PubMed, MEDLINE, CINAHL, APA PsycInfo, AgeLine, Cochrane, and Idunn databases for studies published from January 2013 to June 2025. Studies with a quantitative design where self-report, staff assessment, and/or chart review were used to assess pain and NPS were included. Of 530 articles considered, 18 studies (15 cross-sectional studies and 3 longitudinal studies), 19 articles, were included (N = 84 to 97,789 participants). Fourteen articles had good or strong quality, while five had fair or poor quality. A variety of assessment tools for assessing pain and NPS were used, both self-reporting and staff-reporting. The presence and the severity of pain were associated with more frequent and more severe NPS, while changes in pain were associated with changes in NPS. An association between the presence of pain and agitation/aggression was frequently reported, as well as between pain and depressive symptoms. The findings in studies reporting the association between other NPS and pain were inconclusive. In conclusion, strong associations between pain and agitation/aggression and depression were reported in NH residents wtih dementia. Assessing and treating pain is important. There is still a lack of longitudinal studies.