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Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment
Journal article   Open access   Peer reviewed

Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment

Mary Ersek, Princess V Nash, Michelle M Hilgeman, Moni B Neradilek, Keela A Herr, Phoebe R Block and Amber N Collins
Journal of the American Geriatrics Society (JAGS), Vol.68(4), pp.794-802
04/2020
DOI: 10.1111/jgs.16293
PMCID: PMC9460938
PMID: 31868921
url
https://www.ncbi.nlm.nih.gov/pmc/articles/9460938View
Open Access

Abstract

To examine the frequency and severity of pain and use of pain therapies among long-term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity. Prospective individual data were collected over 1 to 3 days for each participant. Sixteen long-term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. Residents with moderate to severe cognitive impairment residing in a long-term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years). A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep). Experts' pain evaluations indicated that residents' usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week. Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week. J Am Geriatr Soc 68:794-802, 2020.
 Acetaminophen - therapeutic use Aged Aged, 80 and over Analgesics, Opioid - therapeutic use Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Cognitive Dysfunction - classification Cognitive Dysfunction - complications Female Humans Male Pain - complications Pain - drug therapy Pain Management - methods Pain Measurement - methods Pain Measurement - standards Prevalence Prospective Studies Severity of Illness Index Skilled Nursing Facilities - organization & administration United States

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