The Association of Chronic Pain with Suicidality in Hospitalized Patients with Dementia: A retrospective study of the U.S. Nationwide Inpatient Sample, 2016-2020

Abstract Background and Objectives Chronic pain is common in older adults and is associated with psychological distress, including suicidality. In patients with dementia, impaired cognitive and communication may further increase vulnerability. This study aimed to investigate associations between chronic pain and suicidality in hospitalized patients with dementia. Research Design and Methods This population-based, retrospective cross-sectional study analyzed hospitalizations of patients aged ≥60 years with dementia between 2016 and 2020, extracted from the U.S. Nationwide Inpatient Sample (NIS). Chronic pain, suicide attempts, and suicidal ideations were identified using ICD-10-CM diagnostic codes. Propensity score matching (1:4) was performed to balance baseline characteristics, including age, sex, race, dementia type, and major comorbidities. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Stratified analyses were conducted by age, dementia type, sex, Charlson Comorbidity Index (CCI), race, and insurance. Results After matching, 29,185 hospitalized patients with dementia were analyzed (5,837 with chronic pain; 23,348 without). Chronic pain was significantly associated with higher odds of suicidal ideations (adjusted odds ratio [aOR] = 1.49, 95% CI: 1.30-1.71, p < 0.001) and suicide attempt (aOR = 2.02, 95% CI: 1.08-3.76, p = 0.028). Stronger associations were observed among patients aged 60-69 years, those with CCI ≥ 1, without Medicare/Medicaid. Only 16 suicide attempts occurred in the chronic pain group, limiting statistical precision. Discussion and Implications Chronic pain is associated with increased suicidality in hospitalized older patients with dementia. Longitudinal studies are needed to confirm these findings.