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

OBJECTIVES 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. DESIGN Prospective individual data were collected over 1 to 3 days for each participa...

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Published in:Journal of the American Geriatrics Society (JAGS) 2020-04, Vol.68 (4), p.794-802
Main Authors: Ersek, Mary, Nash, Princess V., Hilgeman, Michelle M., Neradilek, Moni B., Herr, Keela A., Block, Phoebe R., Collins, Amber N.
Format: Article
Language:English
Subjects:
Acetaminophen
Acetaminophen - therapeutic use
Aged
Aged, 80 and over
Analgesics, Opioid - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Cognitive ability
Cognitive Dysfunction - classification
Cognitive Dysfunction - complications
Dementia
Dementia disorders
Female
Humans
long term carenursing homepain assessment
Male
Medical records
Nursing homes
Opioids
Pain
Pain - complications
Pain - drug therapy
Pain Management - methods
pain measurement
Pain Measurement - methods
Pain Measurement - standards
Prevalence
Prospective Studies
Severity of Illness Index
Skilled Nursing Facilities - organization & administration
Sleep
United States
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Summary:OBJECTIVES 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. DESIGN Prospective individual data were collected over 1 to 3 days for each participant. SETTING Sixteen long‐term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. PARTICIPANTS 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). MEASUREMENTS 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). RESULTS 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. CONCLUSION 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
ISSN:0002-8614
1532-5415
1532-5415
DOI:10.1111/jgs.16293