&lt;p&gt;Prevalence of Pain on Admission by Level of Cognitive Impairment in Nursing Homes&lt;/p&gt;

Dubé, Catherine; Morrison, Reynolds A; Mack, Deborah; Jesdale, Bill M.; Nunes, Anthony P.; Liu, Shao‐Hsien; Lapane, Kate L.

doi:10.2147/jpr.s270689

Cited by 15 publications

(31 citation statements)

References 41 publications

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“…Consistent with previous research [ 1 , 3 , 8 , 18 – 21 ], we showed a lower prevalence of opioid use among residents with higher levels of cognitive impairment or with a diagnosis of dementia. While it is well recognized that pain is often poorly detected among residents who face challenges in expressing and/or communicating their pain symptoms to staff and family [ 1 , 3 , 8 , 18 – 20 ], this does not fully explain the lower use of opioids evident among residents with dementia across pain strata. There may be a reluctance to use opioids for pain management, even when otherwise indicated, among those with dementia because of concerns about medication risks [ 7 , 42 ].…”

Section: Discussionsupporting

confidence: 92%

“…Nonetheless, relatively higher opioid prescribing in LTC may be expected given the high burden of pain in this population [ 1 ]. Prevalence estimates of non-cancer pain among LTC residents range from approximately 25–50%, depending on the study population, pain measure, and time period examined [ 8 – 11 ]. For some residents in pain, opioids may be an appropriate alternative when other therapies are contraindicated or ineffective [ 12 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Research suggests that up to one quarter of LTC residents with severe pain do not receive any analgesic or adjuvant therapy [ 1 ]. Residents with cognitive and/or communication impairment appear to be at particular risk for both the under-recognition and under-treatment of pain [ 1 , 3 , 8 , 18 – 21 ]. In addition to distress related to uncontrolled pain, it can also lead to a worsening of residents’ cognitive and functional status [ 11 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

et al. 2022

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Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

et al. 2022

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“…A possible explanation for this result is that pain is often underreported and underdiagnosed among individuals with cognitive impairment and dementia. 14,15,23…”

Section: Discussionmentioning

confidence: 99%

Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents

Mbrah

Nunes

Hume

et al. 2021

Pain

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“… 1 Despite similar frequencies of painful conditions across levels of cognitive impairment, residents with worse cognitive function have decreased pain documented in nursing homes. 2 Among residents with moderate to severe dementia, 45% experienced moderate to severe pain at some point in the previous week. 3 Yet, nursing home direct care staff may fail to recognize pain in residents unable to self-report pain owing to dementia 4 or may confuse indicators of pain with behavioral and psychological symptoms of dementia.…”

Section: Introductionmentioning

confidence: 99%

A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain

Forrester¹,

Mbrah²,

Lapane³

2021

JPR

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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.

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<p>Prevalence of Pain on Admission by Level of Cognitive Impairment in Nursing Homes</p>

Cited by 15 publications

References 41 publications

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents

A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain

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