University of Massachusetts Medical School Faculty Publications


Cognitive Impairment and Pain Among Nursing Home Residents With Cancer

UMMS Affiliation

Department of Quantitative Health Sciences; Graduate School of Biomedical Sciences, Clinical and Population Health Research Program

Publication Date


Document Type



Geriatrics | Musculoskeletal, Neural, and Ocular Physiology | Neoplasms | Pain Management | Palliative Care | Pathological Conditions, Signs and Symptoms | Psychological Phenomena and Processes | Therapeutics


CONTEXT: The prevalence of pain and its management has been shown to be inversely associated with greater levels of cognitive impairment.

OBJECTIVES: To evaluate whether the documentation and management of pain varies by level of cognitive impairment among nursing home residents with cancer.

METHODS: Using a cross-sectional study, we identified all newly admitted U.S. nursing home residents with a cancer diagnosis in 2011-2012 (n = 367,462). Minimum Data Set 3.0 admission assessment was used to evaluate pain/pain management in the past five days and cognitive impairment (assessed via the Brief Interview for Mental Status or the Cognitive Performance Scale for 91.6% and 8.4%, respectively). Adjusted prevalence ratios with 95% CI were estimated from robust Poisson regression models.

RESULTS: For those with staff-assessed pain, pain prevalence was 55.5% with no/mild cognitive impairment and 50.5% in those severely impaired. Pain was common in those able to self-report (67.9% no/mild, 55.9% moderate, and 41.8% severe cognitive impairment). Greater cognitive impairment was associated with reduced prevalence of any pain (adjusted prevalence ratio severe vs. no/mild cognitive impairment; self-assessed pain 0.77; 95% CI 0.76-0.78; staff-assessed pain 0.96; 95% CI 0.93-0.99). Pharmacologic pain management was less prevalent in those with severe cognitive impairment (59.4% vs. 74.9% in those with no/mild cognitive impairment).

CONCLUSION: In nursing home residents with cancer, pain was less frequently documented in those with severe cognitive impairment, which may lead to less frequent use of treatments for pain. Techniques to improve documentation and treatment of pain in nursing home residents with cognitive impairment are needed.


UMCCTS funding, nursing homes, cancer, cognitive impairment, pain

DOI of Published Version



J Pain Symptom Manage. 2018 Jun;55(6):1509-1518. doi: 10.1016/j.jpainsymman.2018.02.012. Epub 2018 Feb 26. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Journal of pain and symptom management

PubMed ID