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

Ersek, Mary; Nash, Princess; Hilgeman, Michelle M.; Neradilek, Moni B.; Herr, Keela; Block, Phoebe; Collins, Amber N

doi:10.1111/jgs.16293

Cited by 20 publications

(18 citation statements)

References 52 publications

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“…Burdensome symptoms are highly distressing, largely preventable or treatable, and cause unnecessary suffering. Common burdensome symptoms for nursing home residents are pain (26%-86%) (Bernabei et al 1998;Won et al 1999Won et al , 2004Reynolds et al 2002;Hanson et al 2008;Duncan et al 2009;Hunnicutt et al 2017;Ersek et al 2020), eating problems (47%-70%) (Reynolds et al 2002;Hanson et al 2008Hanson et al , 2013Lindroos et al 2019), shortness of breath (10%-75%) (Hall et al 2002;Reynolds et al 2002;Hanson et al 2008;Duncan et al 2009;Drageset et al 2014;Hendriks et al 2015), and delirium (29%-46%) (Hall et al 2002;Duncan et al 2009;Cheung et al 2018).…”

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confidence: 99%

Restoring trust: COVID-19 and the future of long-term care in Canada

Estabrooks

Straus

Flood

et al. 2020

FACETS

163

257

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The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.

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confidence: 99%

Restoring trust: COVID-19 and the future of long-term care in Canada

Estabrooks

Straus

Flood

et al. 2020

FACETS

163

257

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“…Of 553,373 Medicare beneficiaries with chronic pain identified, 75,258 patients with ADRD and 435,870 patients without ADRD were living in communities (Table 2), and 37,117 patients with ADRD and 5128 patients without ADRD were residing in NHs (Table 3). In both settings, compared with patients without ADRD, those with ADRD were older (mean [SD] age: in community, 79 [10] vs 71 [9] years; in NH, 82 [10] vs 73 [13] years; both P < .001) and were more likely to be female (community, 71% vs 63%; NH, 75% vs 64%; both P < .001). The proportion of nonwhite was higher in patients with vs without ADRD in communities (21% vs 18%, P < .001) but was similar in NHs (20% vs 19%; P = .205).…”

Section: Resultsmentioning

confidence: 99%

“…In NHs, we also observed 64.5% of residents with ADRD receiving pain treatment, although the figure was lower than that (74.9%) of residents without ADRD. The discrepancy in the use of pain treatment between NH residents with and without ADRD may be explained by differences in pain severity, cognitive function, and communication ability [9,48]. The loss of verbal communication skills likely occurs among patients in the late stages of ADRD, leading to great difficulties in detecting pain [12].…”

Section: Discussionmentioning

confidence: 99%

“…Memory decline and decreased communication skills among patients with cognitive impairment have been implicated in the underuse of analgesics [5,6]. Findings of recent population-based studies, however, suggest that patients with ADRD were equally or more likely than patients without ADRD to receive analgesics for pain management [7][8][9][10]. The increasing analgesic use in patients with ADRD may result from increasing clinical awareness of the need for improved pain assessment and management in this patient population [7,10].…”

Section: Introductionmentioning

confidence: 99%

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Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia

et al. 2021

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Background Pain is common among individuals with Alzheimer’s disease and related dementias (ADRD), and use of opioids has been increasing over the last decade. Yet, it is unclear to what extent opioids are appropriately prescribed for patients with ADRD and whether the appropriateness of opioid prescribing differs by ADRD status. The objective of this study is to compare the quality of opioid prescribing among patients with or without ADRD who have chronic noncancer pain. Methods A nationally representative cohort study of Medicare beneficiaries aged 50 years or older who had chronic pain but who had no cancer, hospice, or palliative care from 2011 to 2015. Four indicators of potentially inappropriate opioid prescribing were measured in patients residing in communities (75,258 patients with and 435,870 patients without ADRD); five indicators were assessed in patients in nursing homes (NHs) (37,117 patients with and 5128 patients without ADRD). Each indicator was calculated as the proportion of eligible patients with inappropriate opioid prescribing in the year after a chronic pain diagnosis. Differences in proportions between ADRD and non-ADRD groups were estimated using a generalized linear model adjusting for covariates through inverse probability weighting. Results Patients with ADRD versus those without had higher concurrent use of opioids and central nervous system–active drugs (community 44.1% vs 33.3%; NH 58.8% vs 54.1%, both P < 0.001) and no opioids or scheduled pain medications for moderate or severe pain (NH 60.1% vs 52.5%, P < 0.001). The ADRD versus non-ADRD group had higher use of long-term opioids for treating neuropathic pain in communities (21.7% vs 19.5%, P = 0.003) but lower use in NHs (26.9% vs 36.0%, P < 0.001). Use of strong or high-dose opioids when naive to opioids (community 1.5% vs 2.8%; NH 2.5% vs 3.5%) and use of contraindicated opioids (community 0.08% vs 0.12%; NH 0.05% vs 0.21%) were rare for either group. Conclusion Potential inappropriate opioid prescribing in 2 areas of pain care was more common among patients with ADRD than among patients without ADRD in community or NH settings. Further studies aimed at understanding the factors and effects associated with opioid prescribing patterns that deviate from guidelines are warranted.

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“…2 Among residents with moderate to severe dementia, 45% experienced moderate to severe pain at some point in the previous week. 3 Yet, nursing home direct care staff may fail to recognize pain in residents unable to self-report pain owing to dementia 4 or may confuse indicators of pain with behavioral and psychological symptoms of dementia. 5 Pain assessment in people with cognitive impairment is challenging, as alterations in speech/language and memory often worsen as disease progresses.…”

Section: Introductionmentioning

confidence: 99%

A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain

Forrester¹,

Mbrah²,

Lapane³

2021

JPR

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Context: Pain assessment in people with cognitive impairment is challenging. Objective: The study sought to 1) identify pain subgroups based on staff-assessed pain, agitated and reactive behavior, functional status, and symptoms of depression; and 2) understand if cognitive impairment was associated with transitions between pain subgroups at nursing home admission, 3 months, and 6 months. Methods: Using national Minimum Data Set 3.0 data (2011-2016), we included 26,816 newly admitted residents with staff-assessed pain at admission, 3 months, and 6 months. Pain subgroups were identified by latent class analysis at each time point. Transitions between pain subgroups were described using latent transition analysis. Results: Five latent statuses of pain were identified at admission: "Behavioral and Severe Depression" (prevalence stable, severe or worsening cognitive impairment: 11%, mild/ moderate or improved cognitive impairment: 10%), "Functional" (21%; 25%), "Physical" (22%; 23%), "Behavioral" (23%, 19%), and "Low" (23%; 24%). Regardless of change in cognitive status, most residents remained in the same pain latent class. Among residents with stable, severe or worsening cognitive impairment, 11% in the "Behavioral" class transitioned to the "Behavioral and Severe Depression" class by 3 months. Fewer residents transitioned between latent classes in the 3-to 6-month period (>80% remained in their 3-month class). Conclusion:For nursing home residents unable to self-report pain, consideration of additional indicators including functioning, depressive symptoms, and agitation may be useful in identifying pain subgroups. Longitudinal changes in the pain subgroups over 6 months post-admission highlight that residents with severe cognitive impairment may be at risk for worsening pain.

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

Cited by 20 publications

References 52 publications

Restoring trust: COVID-19 and the future of long-term care in Canada

Restoring trust: COVID-19 and the future of long-term care in Canada

Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia

A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain

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