Community Health Worker Delivered Pain Self Management Improves Function in Older Adults with Cognitive Impairment

TL;DR

A program delivered by community health workers helps older adults with cognitive impairment and chronic pain improve their function and quality of life.

Contribution

A new telephone-based pain self-management program adapted for cognitive impairment is shown to be effective and feasible.

Findings

Participants in the intervention group showed significant improvements in function, pain, and quality of life.

The program had high retention and positive feedback from participants and community health workers.

Abstract

Older adults with chronic pain and mild cognitive impairment or Alzheimer’s disease–related dementias (MCI/ADRD) face dual challenges that undermine function and quality of life, yet few interventions address both conditions. We developed and tested STEPS-CI, a telephone-based pain self-management program delivered by community health workers (CHWs) and adapted for cognitive impairment. Fifty-two participants (mean age 67.1; 83% women; 46% African American; 27% rural, 44% Detroit-based) were randomized to intervention (n = 23) or control (n = 29). Participants in the intervention arm received seven weekly CHW-led sessions, supported by tailored materials co-designed with an advisory council from the National Council of Dementia Minds. At post-program follow-up, Global Impression of Change ratings showed significant improvements in function, pain, and quality of life for intervention vs. control participants (all p <.01) as well as in social participation (PROMIS 4-item scale, p=.03). These gains were accompanied by favorable trends in reduced pain interference and decreased self-reported pain medication use. The program was feasible and well-accepted, with 82% retention, >90% CHW fidelity to session protocols, and strong qualitative feedback highlighting relevance and accessibility. Findings suggest that CHWs can successfully deliver adapted behavioral pain management strategies to older adults with MCI/ADRD, producing functional benefits that matter to patients and families. This pilot study provides new data supporting advancement to a fully powered Behavioral Intervention Stage 3 trial to evaluate the efficacy of STEPS-CI for improving pain-related outcomes in diverse older adults living with both pain and dementia.