Psychiatric Disorders and Pain Treatment in Community Nursing Homes

Abstract

Objectives Effective pain assessment and pain treatment are key goals in community nursing homes, but residents’ psychiatric disorders may interfere with attaining these goals. This study addressed whether: (a) pain assessment and treatment obtained by nursing home residents with psychiatric disorders differs from that obtained by residents without psychiatric disorders; (b) this difference is found consistently across the four types of psychiatric disorder most prevalent in nursing homes (dementia, depression, serious mental illness, substance use disorder); and (c) male gender, non-white race, and longer length of stay add to psychiatric disorder to elevate risk of potentially adverse pain ratings and pain treatments. Design Cross-sectional. Participants 13,507 National Nursing Home Survey 2004 (NNHS 2004) residents. Measures Demographic, diagnostic, pain, and medication items from the NNHS 2004. Results Compared to residents without psychiatric disorders, those with psychiatric disorders were less likely to be rated as having pain in the last 7 days, and had lower and more “missing”/ “don't know” pain severity ratings. They also were less likely to obtain opioids, and more likely to be given only non-opioid pain medications, even after statistically adjusting for demographic factors, physical functioning, and pain severity. These effects generally held across all four types of psychiatric disorders most prevalent in nursing homes, and were compounded by male, non-white, and longer-stay status. Conclusion Psychiatric disorders besides dementia may impact pain assessment and treatment in nursing homes. Nursing home residents with psychiatric disorders, especially male, non-white, and longer-stay residents, should be targeted for improved pain care.

Depression and cognitive impairment among newly admitted nursing home residents in the USA

“…Our estimate of the prevalence of depression upon nursing home admission is consistent with the previous estimates (Bagchi et al ., ; Brennan & SooHoo, ). Given the Centers for Medicare and Medicaid Services quality indicator highlighting the importance of recognizing depression in the nursing home setting, we were somewhat surprised that less than half received any form of treatment for their depression.…”

Association between dementia and psychiatric disorders in long-term care residents

“…Furthermore, residents with psychiatric disorders, and especially those suffering from dementia, are less likely than residents without psychiatric disorders to be rated as having pain. [ 25 ] Nursing home staff are still experiencing problems identifying signs of psychiatric disorder. [ 26 ] Previous research among Spanish elderly institutionalized in residential care facilities has shown that over a period of 20 months, there was a significant decrease in resident QoL.…”

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

“…Based on the most recent version of the Centers for Medicare and Medicaid Services (CMS) Nursing Home Data Compendium (CMS, 2016), just over 1.4 million residents were residing in U.S. nursing homes on December 31, 2014, corresponding to 2.6% of the over-65 population and 9.5% of the over-85 population. It has been found that among long-term care residents, approximately 75% of residents have one or more mental health diagnosis (Brennan & SooHoo, 2020), with dementia, depression, anxiety disorders, and serious mental illness being the most prevalent (Brennan & SooHoo, 2014, 2020; Lemke & Schaefer, 2010). Although there is strong overlap between the skills of psychologists working in long-term care (LTC) and those working in other settings, there are unique aspects of the provision of care in LTC settings.…”