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Pain in Nursing Home Residents

July 31, 2017

Findings of a recent study published in the Journal of the American Medical Directors Association suggest that a substantial number of nursing home (NH) residents experienced consistently high or substantially worsening pain levels during the last 6 months of life.

Studying point-in-time prevalence of pain among NH residents is important; researchers felt there was a lack of information tracking actual changes in pain among NH residents in their last 6 months of life.

Genevieve N Thompson, PhD, University of Manitoba (Winnipeg, Manitoba, Canada) and colleagues conducted a secondary analysis of Resident Assessment Instrument-Minimum Data Set 2.0 data captured as part of the longitudinal Translating Research in Elder Care data repository. Data from 27 urban NHs in western Canada was analyzed (2017;18[8]:700-706).
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Of the NH residents in the facilities who had died, 962 residents had an MDS assessment completed within 30 days of death and had resided in a NH for at least 6 months. Pain trajectories were stratified by residents who were not severely cognitively impaired and those with severe impairment at death, as based on the Cognitive Performance Scale.

Authors found that, in the 6 months before death, 60.1% of residents who did not have severe cognitive impairment experienced consistently low pain, 34.6% reported experiencing either moderate-to-severe pain or significant increases in pain, and 5.3% experienced some degree of pain improvement.

After analyzing the pain trajectories, researcher found that most residents without severe cognitive impairment experienced no-to-mild pain in their final 6 months (65.5%); but they identified one group of NH residents with a pattern of worsening pain or consistently high pain until death (38.2%).

The proportion of residents with low/mild pain trajectories was statistically greater among those who were severely impaired vs those without severe cognitive impairment, however, across both groups, the general pain trajectory trend was similar: ~60% of NH residents experiencing either consistent low or mild pain the last 6 months of life, and ~34% experiencing either substantially high or increasing pain levels.

Authors concluded that a large number of NH residents experienced consistently high or worsening pain levels during their final 6 months of life, highlighting the need for providers to better manage resident pain levels during this period of time.—Amanda Del Signore

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