Non-malignant pain symptom subgroups in nursing home residents
Department of Quantitative Health Sciences; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences
Epidemiology | Geriatrics | Health Services Research | Pain Management
CONTEXT: Despite many nursing home residents experiencing pain, research about the multidimensional nature of non-malignant pain in these residents is scant.
OBJECTIVES: To identify and describe pain symptom subgroups and to evaluate whether subgroups differed by sex.
METHODS: Using Minimum Data Set 3.0 data (2011-2012), we identified newly admitted nursing home residents reporting pain (n=119,379). A latent class analysis included 13 indicators: markers for pain (i.e., severity, frequency, impacts sleep and function) and depressive symptoms. Sex was evaluated as a grouping variable. Multinomial logistic models identified the association between latent class membership and covariates, including age and cognitive impairment.
RESULTS: Four latent subgroups were identified were: Severe (15.2%), Moderate Frequent (26.4%), Moderate Occasional with (26.4%) and without (32.0%) Depressive Symptoms. Measurement invariance by sex was ruled out. Depressed mood, sleep disturbances, and fatigue distinguished subgroups. Age > /= 75 years was inversely associated with belonging to the Severe, Moderate Frequent, or Moderate Occasional with Depressive Symptoms subgroups. Residents with severe cognitive impairment had reduced odds of membership in the Severe Pain subgroup (adjusted odds ratio (aOR): 0.84; 95% confidence interval (CI): 0.78-0.90) and Moderate Frequent Pain subgroup (aOR: 0.60; 95% CI: 0.56-0.64) but increased odds in the Moderate Occasional Pain with Depressive Symptoms subgroup (aOR: 1.12; 95% CI: 1.06-1.18).
CONCLUSION: Identifying subgroups of residents with different patterns of pain and depressive symptoms highlights the need to consider physical and psychological components of pain. Expanding knowledge about pain symptom subgroups may provide a promising avenue to improve pain management in nursing home residents.
latent class analysis, non-malignant pain, nursing homes, pain symptoms
DOI of Published Version
J Pain Symptom Manage. 2019 Mar;57(3):535-544.e1. doi: 10.1016/j.jpainsymman.2018.11.023. Epub 2018 Dec 1. Link to article on publisher's site
Journal of pain and symptom management
Ulbricht CM, Hunnicutt JN, Gambassi G, Hume AL, Lapane KL. (2019). Non-malignant pain symptom subgroups in nursing home residents. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.jpainsymman.2018.11.023. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1239