Was pain documented less often in nursing home residents with severe cognitive impairment?

Details

The study aimed to provide contemporary estimates of pain by level of cognitive impairment among US nursing home residents without cancer. Eligible residents were newly admitted, had no cancer, and were assessed at admission using the Minimum Data Set 3.0 between 2010 and 2016 (n=8,613,080).

Researchers used the Cognitive Function Scale to categorize cognitive impairment. Pain was self-reported or assessed by staff based on a 5-day look-back period. Adjusted prevalence ratios (aPR) were estimated using modified Poisson models.

Documented pain prevalence decreased as cognitive impairment increased. Among residents who self-reported pain, the documented prevalence was 68.9% for those with no or mild impairment and 32.9% for those with severe impairment. Among those whose pain was assessed by staff, it was 50.6% and 37.2%, respectively.

Pharmacologic pain management was also less prevalent among residents with severe impairment than among those with no or mild impairment: 51.3% versus 76.9% in the self-report group, and 52.0% versus 67.7% in the staff-assessed group.

The authors concluded that pain was documented less frequently in residents with severe cognitive impairment than in those with no or mild impairment. They noted that failure to identify pain may lead to untreated or undertreated pain and called for interventions to improve pain evaluation in nursing home residents with cognitive impairment.