Division of Epidemiology, Department of Population and Quantitative Health Sciences
Epidemiology | Geriatrics | Health Services Administration | Health Services Research | Nervous System Diseases | Pain Management | Psychiatry and Psychology
Context: Pain assessment in people with cognitive impairment is challenging.
Objective: The study sought to 1) identify pain subgroups based on staff-assessed pain, agitated and reactive behavior, functional status, and symptoms of depression; and 2) understand if cognitive impairment was associated with transitions between pain subgroups at nursing home admission, 3 months, and 6 months.
Methods: Using national Minimum Data Set 3.0 data (2011-2016), we included 26,816 newly admitted residents with staff-assessed pain at admission, 3 months, and 6 months. Pain subgroups were identified by latent class analysis at each time point. Transitions between pain subgroups were described using latent transition analysis.
Results: Five latent statuses of pain were identified at admission: "Behavioral and Severe Depression" (prevalence stable, severe or worsening cognitive impairment: 11%, mild/moderate or improved cognitive impairment: 10%), "Functional" (21%; 25%), "Physical" (22%; 23%), "Behavioral" (23%, 19%), and "Low" (23%; 24%). Regardless of change in cognitive status, most residents remained in the same pain latent class. Among residents with stable, severe or worsening cognitive impairment, 11% in the "Behavioral" class transitioned to the "Behavioral and Severe Depression" class by 3 months. Fewer residents transitioned between latent classes in the 3- to 6-month period ( > 80% remained in their 3-month class).
Conclusion: For nursing home residents unable to self-report pain, consideration of additional indicators including functioning, depressive symptoms, and agitation may be useful in identifying pain subgroups. Longitudinal changes in the pain subgroups over 6 months post-admission highlight that residents with severe cognitive impairment may be at risk for worsening pain.
agitation, dementia, depressive symptoms, latent transition analysis, long-term care
Rights and Permissions
Copyright © 2021 Forrester et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
DOI of Published Version
Forrester S, Mbrah A, Lapane KL. A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain. J Pain Res. 2021 Jul 26;14:2283-2293. doi: 10.2147/JPR.S302305. PMID: 34345184; PMCID: PMC8324982. Link to article on publisher's site
Journal of pain research
Forrester SN, Mbrah A, Lapane KL. (2021). A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain. Population and Quantitative Health Sciences Publications. https://doi.org/10.2147/JPR.S302305. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1438
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License
Epidemiology Commons, Geriatrics Commons, Health Services Administration Commons, Health Services Research Commons, Nervous System Diseases Commons, Pain Management Commons, Psychiatry and Psychology Commons