UMMS Affiliation

Division of Epidemiology, Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Geriatrics | Health Services Administration | Nervous System Diseases | Pain Management | Pathological Conditions, Signs and Symptoms | Psychiatry and Psychology


Purpose: To provide contemporary estimates of pain by level of cognitive impairment among US nursing home residents without cancer.

Methods: Newly admitted US nursing home residents without cancer assessed with the Minimum Data Set 3.0 at admission (2010-2016) were eligible (n=8,613,080). The Cognitive Function Scale was used to categorize level of cognitive impairment. Self-report or staff-assessed pain was used based on a 5-day look-back period. Estimates of adjusted prevalence ratios (aPR) were derived from modified Poisson models.

Results: Documented prevalence of pain decreased with increased levels of cognitive impairment in those who self-reported pain (68.9% no/mild, 32.9% severe) and those with staff-assessed pain (50.6% no/mild, 37.2% severe staff-assessed pain). Relative to residents with no/mild cognitive impairment, pharmacologic pain management was less prevalent in those with severe cognitive impairment (self-reported: 51.3% severe vs 76.9% in those with no/mild; staff assessed: 52.0% severe vs 67.7% no/mild).

Conclusion: Pain was less frequently documented in those with severe cognitive impairment relative to those with no/mild impairments. Failure to identify pain may result in untreated or undertreated pain. Interventions to improve evaluation of pain in nursing home residents with cognitive impairment are needed.


cognitive impairment, dementia, nursing homes, pain

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DOI of Published Version



Dube CE, Morrison RA, Mack DS, Jesdale BM, Nunes AP, Liu SH, Lapane KL. Prevalence of Pain on Admission by Level of Cognitive Impairment in Nursing Homes. J Pain Res. 2020 Oct 20;13:2663-2672. doi: 10.2147/JPR.S270689. PMID: 33116808; PMCID: PMC7586014. Link to article on publisher's site

Journal/Book/Conference Title

Journal of pain research

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution-Noncommercial 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License