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

Morrison, Reynolds A; Jesdale, Bill M.; Dubé, Catherine; Forrester, Sarah N.; Nunes, Anthony P.; Bova, Carol A.; Lapane, Kate L.

doi:10.1016/j.jpainsymman.2020.08.034

Cited by 25 publications

(15 citation statements)

References 69 publications

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“…A systematic and reliable pain assessment is essential [27,30]. For residents with dementia, a behavioral pain-assessment inventory like the MOBID-2 can be used to identify and manage pain [45,76]. Routine pain assessments can reveal both undiagnosed and untreated pain and improve non-pharmacological and pharmacological pain treatment [18].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home – A longitudinal study

et al. 2022

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The overall aim was to explore the prevalence and persistent regular prescription of opioids and paracetamol among nursing home (NH) residents with dementia at admission and over time. A total of 996 residents with dementia, mean (SD) age 84.5 (7.6) years and (36.1% men), were included at admission (A1). Yearly assessments were performed for two years (A2 and A3) or until death. Pain was assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale. Information regarding prescription of analgesics, general physical health, personal activities of daily living, severity of dementia, neuropsychiatric symptoms, and prescription of psychotropic drugs was collected. A generalized linear mixed model was used to explore whether pain severity was associated with persistent and persistent prescription of opioids and/or paracetamol across timepoints. At A1, 495 of 996 (49.7%) NH residents were prescribed analgesics and prevalence increased at the follow-ups (A2: n = 630, 65.1%; A3: n = 382, 71.2%). Paracetamol was the most frequently prescribed analgesic at all assessments (A1: 45.5%; A2: 59.5%; A3: 67.1%). Opioid prescriptions were quite prevalent (A1: 18.1%; A2: 25.1%; A3: 28.3%), with odds approximately 13 times (OR = 13.3, 95% CI 6.8–26.0) and 9 times (OR = 8.6, 95% CI 3.7–20.3) higher for prescription at follow-up A2 and A3, respectively, relative to prescription at A1. In adjusted analyses, higher pain intensity and poor physical health were associated with prescription and persistent prescription of opioids and paracetamol. In conclusion, prevalence and persistent prescription of analgesics were high in NH residents with dementia. The odds for the prescription of opioids at follow-up were high if prescribed at baseline. Interdisciplinary collaboration, routine assessment of pain at admission and regularly thereafter, and systematic drug reviews are essential to adequately assess and treat pain in NH residents with dementia.

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Section: Discussionmentioning

confidence: 99%

Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home – A longitudinal study

et al. 2022

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“…The face domain score is calculated by automated facial recognition software and analysis, and the other five domains are assessed by the device user-The Voice, The Movement, The Behaviour, The Activity and The Body. A summation of the domain scores results in a total numerical score (pain score), which conforms to the following pain intensity categories: no pain (0-6), mild pain (7)(8)(9)(10)(11), moderate pain (12)(13)(14)(15) and severe pain (16 or over). 14 A record is also made of whether the resident was at rest, or postmovement, when the assessment is conducted.…”

Section: Practice Impactmentioning

confidence: 99%

“…6 Pain intensity under-reporting appears to be a major contribution to minority individuals' pain management disparities. 6,7 Data on the pain experience for Aboriginal and Torres Strait Islander peoples are scarce, but there are many myths about their perception of pain. These myths suggest that they have high pain tolerance, are stoic and do not seek health care, yet in practice they are prescribed opiates twice as much as non-Indigenous patients.…”

Section: Introductionmentioning

confidence: 99%

“…Racial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than Whites, even after controlling for age, gender and pain intensity 6 . Pain intensity under‐reporting appears to be a major contribution to minority individuals' pain management disparities 6,7 . Data on the pain experience for Aboriginal and Torres Strait Islander peoples are scarce, but there are many myths about their perception of pain.…”

Section: Introductionmentioning

confidence: 99%

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Assessing pain using facial recognition software among Aboriginal aged care residents with cognitive impairment: A retrospective cohort study

Rissel

Tate²,

Moore

et al. 2023

Australas J Ageing

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Objective To assess the observed pain behaviours of Aboriginal residents with cognitive impairment in aged care facilities and compare these results with a matched national sample of non‐Aboriginal residents. Methods Observed pain behaviours of Aboriginal residents (N = 87) with cognitive impairment in aged care facilities across the Northern Territory of Australia were assessed using PainChek® Adult and compared with data from a matched national sample of non‐Aboriginal residents (N = 420). Pain scores were derived from inbuilt automated facial recognition and analysis software plus a series of digital checklists requiring manual input by care staff. Results The median total pain score for the Aboriginal residents was 2 (IQR 1–4) and for the matched external residents was 3 (IQR 2–5). In a multivariable negative binomial regression model, this difference in total pain score was statistically significant (p < 0.001). The pain score derived from the automated facial recognition and analysis component of the PainChek® Adult app was not statistically different between the two groups when adjusted for multiple observations and context of observation (odds ratio = 1.06, 95% confidence interval 0.97–1.16, p = 0.169). Conclusions We found under‐reporting of observed pain signs and behaviours for Aboriginal aged care residents by assessors. Further training in the assessment of pain in Aboriginal and Torres Strait Islander aged care residents may be necessary and a continuing shift in clinical practice to using technology and point‐of‐care assessment.

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“…Although findings are not always consistent, it has been reported that the Black residents in nursing homes experienced more pain and were less likely to be treated for pain compared to the White residents (3,20,21). Numerous racial differences in pain perception, response to and coping with pain, and pain treatment have been described.…”

Section: Racial Disparities and Painmentioning

confidence: 99%

Invariance of the PAINAD Scale Between the Black and White Residents Living With Dementia

et al. 2021

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The purpose of this study was to test the reliability and validity of the Pain Assessment in Advanced Dementia (PAINAD) and particularly consider whether or not this measure was invariant when used among the Black and White residents. Baseline data from an implementation study testing that included a sample of 553 residents, 30% of who were Black, from 55 nursing were included in this study. The Winsteps statistical program was used to perform the Rasch analysis and evaluate the reliability and validity of the measure based on internal consistency, infit and outfit statistics, mapping, and a differential item functioning (DIF) analysis. The AMOS statistical program was used for confirmatory factor analysis. The findings supported the reliability and validity of the PAINAD when used with these individuals and demonstrated that there was no evidence of invariance between the Black and White residents. All the items fit the model, but there was not a good spread of the items across the pain level of the participants. The majority of the participants (75%) were so low in pain signs or symptoms that they could not be differentiated. Based on the clinical practice and observations, it is recommended that additional items can be added to the measure such as observing the individual for evidence of resisting care, retropulsion when trying to stand, hitting or kicking when turning in bed, hitting or kicking when transferring from bed to chair, hitting or kicking when ambulating, or hitting or kicking when raising arms, less engagement with others, and decreased participation in the activities previously enjoyed.

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

Cited by 25 publications

References 69 publications

Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home – A longitudinal study

Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home – A longitudinal study

Assessing pain using facial recognition software among Aboriginal aged care residents with cognitive impairment: A retrospective cohort study

Invariance of the PAINAD Scale Between the Black and White Residents Living With Dementia

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