Daily pain a continuing problem in nursing homes
One in four nursing home residents live with daily pain, according to a study published in the Journal of the American Geriatric Society.1 The results highlight the need for an interdisciplinary approach to pain management, the authors concluded.
This study of nursing home residents in four states highlights the magnitude of the continuing problem of pain for many residents. Results document the prevalence and undertreatment of nonmalignant pain and its associated negative effects on mood and functional activity. The authors, representing the Systematic Assessment of Geriatric drug use via Epidemiology (SAGE) study group, provide concrete evidence to support their urgent call for increased education and research to improve the recognition and management of pain in nursing homes.
This cross-sectional study of nursing home residents admitted to Medicare/Medicaid-certified nursing homes in four states (Kansas, Maine, Mississippi, and South Dakota) from 1992 to 1995 documents the prevalence and under-treatment of nonmalignant pain in the nursing home setting and associated mood disorders, functional impairment, and social engagement problems. It also documents present practice patterns for pain management in nursing homes.
Of the 49,971 residents in the study group, 74% were women, 82% were aged 75 or older, and 9% were nonwhite. Signs and symptoms were evaluated by a multidisciplinary team of professionals who relied on patient self-reporting whenever possible. The focus of the study was the presence of daily pain, defined as any type of physical pain or discomfort in any part of the body occurring daily over the seven days preceding the assessment.
Across the group, 26.3% reported having daily pain. Approximately 75% of those patients received analgesia according to the WHO analgesics ladder (WHO I — 25%, WHO II — 45%, and WHO III — 5%). However, a full 25% of those patients with documented daily pain received no analgesia. More likely not to receive analgesics were residents who were over 85 years old, cognitively impaired, males, and racial minorities.
Patients reporting daily pain had more restrictions in their daily activities and mood disorders. Accordingly, a higher percentage of that population (2 1/2 times that of patients not reporting daily pain) were afforded physical and occupational services. However, in spite of documented increased incidence of psychosocial health problems, the residents with daily pain received the same rates of antidepressants (15%), anxiolytics (10%), and recreational (5%) and psychological therapies (0.5%) as other residents.
Acknowledging the priority of maximizing function and quality of life for this population, the authors of this study, representing SAGE, conclude that a more multidisciplinary approach and more attention to psychosocial health issues are needed. They call for increased education and research to improve the recognition and management of pain in nursing homes with particular attention to populations at increased risk for under-recognition and under-treatment.
Reference
1. Won A, Lapante K, Gambassi G, et al. Correlates and management of nonmalignant pain in the nursing home discussing palliative care with patients. J Am Geriatr Soc 1999; 47:936-942.
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