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J Am Geriatr Soc. 2019 Dec 23. doi: 10.1111/jgs.16293. [Epub ahead of print]

Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment.

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Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Administration (VA) Medical Center, Philadelphia, Pennsylvania.
Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama.
Department of Psychology and the Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama.
Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.
The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington.
The University of Iowa College of Nursing, Iowa City, Iowa.



To examine the frequency and severity of pain and use of pain therapies among long-term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity.


Prospective individual data were collected over 1 to 3 days for each participant.


Sixteen long-term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey.


Residents with moderate to severe cognitive impairment residing in a long-term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years).


A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep).


Experts' pain evaluations indicated that residents' usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week.


Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week.


dementia; long term carenursing homepain assessment; pain measurement


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