Title

Pain management in nursing home residents with cancer

UMMS Affiliation

Clinical and Population Health Research Program, Graduate School of Biomedical Sciences; Meyers Primary Care Institute; Department of Quantitative Health Sciences

Publication Date

4-1-2015

Document Type

Article

Disciplines

Epidemiology | Geriatrics | Health Services Research | Therapeutics

Abstract

OBJECTIVES: To assess improvements in pain management of nursing home (NH) residents with cancer since the implementation of pain management quality indicators.

DESIGN: Cross-sectional.

SETTING: One thousand three hundred eighty-two U.S. NHs (N = 1,382).

PARTICIPANTS: Newly admitted, Medicare-eligible NH residents with cancer (N = 8,094).

MEASUREMENTS: Nationwide data on NH resident health from Minimum Data Set 2.0 linked to all-payer pharmacy dispensing records (February 2006-June 2007) were used to determine prevalence of pain, including frequency and intensity, and receipt of nonopioid and opioid analgesics. Multinomial logistic regression was used to evaluate resident-level correlates of pain and binomial logistic regression to identify correlates of untreated pain. RESULTS: More than 65% of NH residents with cancer had any pain (28.3% daily, 37.3% < daily), 13.5% of whom had severe and 61.3% had moderate pain. Women; residents admitted from acute care or who were bedfast; and those with compromised activities of daily living, depressed mood, an indwelling catheter, or a terminal prognosis were more likely to have pain. More than 17% of residents in daily pain (95% confidence interval (CI) = 16.0-19.1%) received no analgesics, including 11.7% with daily severe pain (95% CI = 8.9-14.5%) and 16.9% with daily moderate pain (95% CI = 15.1-18.8%). Treatment was negatively associated with age of 85 and older (adjusted OR (aOR) = 0.67, 95% CI = 0.55-0.81 vs aged 65-74), cognitive impairment (aOR = 0.71, 95% CI = 0.61-0.82), presence of feeding tube (aOR = 0.77, 95% CI = 0.60-0.99), and restraints (aOR = 0.50, 95% CI = 0.31-0.82).

CONCLUSION: Untreated pain is still common in NH residents with cancer and persists despite pain management quality indicators. Geriatrics Society.

Keywords

analgesics, cancer, nursing home, pain

DOI of Published Version

10.1111/jgs.13345

Source

J Am Geriatr Soc. 2015 Apr;63(4):633-41. doi: 10.1111/jgs.13345. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Geriatrics Society

PubMed ID

25900481

Comments

First author Camilla Pimental is a doctoral student in the Clinical and Population Health Research Program in the Graduate School of Biomedical Sciences (GSBS) at UMass Medical School.

Related Resources

Link to Article in PubMed