Racial/Ethnic Differences in Staff-Assessed Pain Behaviors Among Newly Admitted Nursing Home Residents

UMMS Affiliation

Division of Epidemiology, Department of Population and Quantitative Health Sciences; Graduate School of Nursing

Publication Date


Document Type



Epidemiology | Geriatrics | Health Services Administration | Health Services Research | Pain Management | Psychiatry and Psychology | Race and Ethnicity


CONTEXT: Nonverbal pain behaviors are effective indicators of pain among persons who have difficulty communicating. In nursing homes, racial/ethnic differences in self-reported pain and pain management have been documented.

OBJECTIVES: We sought to examine racial/ethnic differences in nonverbal pain behaviors and pain management among residents with staff-assessed pain.

METHODS: We used the U.S. national Minimum Data Set 3.0 and identified 994,510 newly admitted nursing home residents for whom staff evaluated pain behaviors and pain treatments between 2010 and 2016. Adjusted prevalence ratios (aPRs) and 95% CIs estimated using robust Poisson models compared pain behaviors and treatments across racial/ethnic groups.

RESULTS: Vocal complaints were most commonly recorded (18.3% non-Hispanic black residents, 19.3% of Hispanic residents, and 30.3% of non-Hispanic white residents). Documentation of pain behaviors was less frequent among non-Hispanic black and Hispanic residents than non-Hispanic white residents (e.g., vocal complaints: aPRBlack: 0.76; 95% CI: 0.73-0.78; with similar estimates for other pain behaviors). Non-Hispanic blacks (47.3%) and Hispanics (48.6%) were less likely to receive any type of pharmacologic pain intervention compared with non-Hispanic white residents (59.3%) (aPRBlack: 0.87; 95% CI: 0.86-0.88; aPRHispanics: 0.87; 95% CI: 0.84-0.89).

CONCLUSION: Among residents requiring staff assessment of pain because they are unable to self-report, nursing home staff documented pain and its treatment less often in Non-Hispanic blacks and Hispanics than in non-Hispanic white residents. Studies to understand the role of differences in expression of pain, explicit bias, and implicit bias are needed to inform interventions to reduce disparities in pain documentation and treatment.


Nursing home, cognitive impairment, health disparities, long-term, pain behaviors, pain management

DOI of Published Version



Morrison R, Jesdale B, Dube C, Forrester S, Nunes A, Bova C, Lapane KL. Racial/Ethnic Differences in Staff-Assessed Pain Behaviors Among Newly Admitted Nursing Home Residents. J Pain Symptom Manage. 2020 Aug 31:S0885-3924(20)30720-X. doi: 10.1016/j.jpainsymman.2020.08.034. Epub ahead of print. PMID: 32882357. Link to article on publisher's site

Journal/Book/Conference Title

Journal of pain and symptom management

PubMed ID


Related Resources

Link to Article in PubMed