Pain and Associated Factors in Nursing Home Residents

Connie S Cole; Justin Blackburn; Janet S Carpenter; Chen X Chen; Susan E Hickman

doi:10.1016/j.pmn.2023.03.002

Pain and Associated Factors in Nursing Home Residents

Pain Manag Nurs. 2023 Aug;24(4):384-392. doi: 10.1016/j.pmn.2023.03.002. Epub 2023 Mar 30.

Authors

Connie S Cole¹, Justin Blackburn², Janet S Carpenter³, Chen X Chen³, Susan E Hickman⁴

Affiliations

¹ School of Nursing, Indiana University, Indianapolis, Indiana; School of Medicine, University of Colorado, Aurora, Colorado; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana. Electronic address: connie.cole@cuanschutz.edu.
² Richard Fairbanks School of Public Health, Indiana University Purdue University, Indianapolis, Indiana.
³ School of Nursing, Indiana University, Indianapolis, Indiana.
⁴ School of Nursing, Indiana University, Indianapolis, Indiana; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana.

PMID: 37003932
PMCID: PMC10440293 (available on 2024-08-01)
DOI: 10.1016/j.pmn.2023.03.002

Abstract

Background: Understanding factors associated with risk of pain allows residents and clinicians to plan care and set priorities, however, factors associated with pain in nursing home residents has not been conclusively studied.

Aim: To evaluate the association between pain and nursing home (NH) resident demographic and clinical characteristics.

Design: Retrospective analysis of Minimum Data Set 3.0 records of nursing home residents residing in 44 Indiana NHs between September 27, 2011 and December 27, 2019 (N = 9,060).

Results: Pain prevalence in this sample of NH residents was 23.7%. Of those with pain, 28.0% experienced moderate to severe/frequent pain and 54.6% experienced persistent pain. Risk factors for moderate to severe/frequent pain include female sex; living in a rural setting; intact, mildly, or moderately impaired cognition; arthritis; contracture; anxiety; and depression. In contrast, stroke and Alzheimer's disease and Alzheimer's-disease related dementias (AD/ADRD) were associated with decreased risk of reporting moderate to severe/frequent pain, likely representing both the under-assessment and under-reporting of pain among cognitively impaired NH residents. Risk factors for persistent pain included age <70, Black race, living in a rural location, intact cognition, contracture, and depression.

Conclusions: Pain remains a pressing problem for NH residents. In this study, we identified demographic and clinical factors associated with moderate to severe frequent pain and persistent pain. Residents with a diagnosis of AD/ADRD were less likely to report pain, likely representing the difficulty of evaluating pain in these residents. It is important to note that those with cognitive impairment may not experience any less pain, but assessment and reporting difficulties may make them appear to have less pain. Knowledge of factors associated with pain for NH residents has the potential for improving the ability to predict, prevent, and provide better pain care in NH residents.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Cognition
Cognitive Dysfunction*
Female
Humans
Nursing Homes*
Pain / epidemiology
Retrospective Studies

Grants and funding

T32 AG044296/AG/NIA NIH HHS/United States