Psychosocial Correlates of Chest Binding in Transgender and Gender-Diverse Youth.

Chronic pain is a common problem among residents living in nursing homes, particularly for individuals living with dementia. The prevalence of pain ranges from 13 to 80% depending on the type of measure used (verbal response versus objective assessment), activity during the assessment, and the cognitive ability of the resident(; ; ). Common causes for pain include musculoskeletal changes, neurological problems, wounds or ulcerations, or lingering pain post fractures(). Chronic pain results in a decline in function and engagement in activities, depression, anxiety, decreased sleep, decreased quality of life, increase in behavioral symptoms, and increased use of high-cost health care services (; ). Given communication and recall challenges, residents with dementia are less likely to be evaluated or treated for pain (; ). The management of chronic pain among older adults with dementia is complicated due to normal age changes and the impact this has on safe use of pharmacologic options, patient and caregiver beliefs and knowledge about pain and pain management (; ). Pharmacologic interventions are commonly used as the first line of treatment for pain (; ). Unfortunately, pharmacologic treatments can have a negative impact on older adults. Nonsteroidal anti-inflammatory medication can impair kidney function and cause gastrointestinal bleeding, acetaminophen can impact liver function, and opioids can cause confusion, delirium, sedation, constipation, resulting in poor food and fluid intake (; ). Nonpharmacologic approaches to pain management include options such as (1) physical interventions including exercise (e.g., Tai Chi or yoga) or general physical activity, physical therapy, or position changes; (2) physical modalities such as transcutaneous electrical nerve stimulation (TENS), massage, use of heat or ice; (3) cognitive behavioral approaches (e.g., altering negative cognitions and emotions associated with pain such as stress, anxiety, or sadness and altering lifestyle around sleep, nutrition, and physical activity); (4) mind-body interventions such as acupuncture or hypnosis; or (5) distraction such as listening to music, relaxation techniques, playing a game, or pet therapy. Prior comprehensive reviews evaluating the effectiveness of these interventions supported a small to moderate impact to reduce pain (; ). Based on current clinical practice guidelines for pain, nonpharmacologic treatment of pain should be considered the first treatment approach for pain management (). However, these interventions unfortunately are underutilized among older adults living with dementia (; ; ).