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Comment & Response
February 2014

What Is Discomfort in Persons With Dementia Who Are Agitated?

Author Affiliations
  • 1School of Aging Studies, University of South Florida, Tampa
  • 2Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2014;174(2):297-298. doi:10.1001/jamainternmed.2013.11997

To the Editor It is important to evaluate quality of life in persons with dementia, especially in those who cannot communicate possible sources of discomfort. Therefore, it is important to have tools to evaluate the presence of discomfort. A recent Research Letter proposed a Source of Discomfort Scale (SODS) and reported that when it was applied in 179 agitated nursing home residents, the mean number of 20 observed items was 3.1 Possible pain, measured in only 89 residents, was responsible for only 8% of variance in the SODS. The main problem with this scale is that the most common source of discomfort was that “the resident was sleepy or tired.” Daytime sleepiness is very common in persons with dementia, especially in those who have advanced disease.2 There is no reason to assume that the person who is sleepy is uncomfortable. Being tired may actually be a good state because it may mean that the person had recently participated in some meaningful activity.

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