Xian Shen1, Ilene H Zuckerman2, Jacqueline B Palmer2, Bruce Stuart2. 1. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. xshen@umaryland.edu. 2. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.
Abstract
BACKGROUND: Managing pain for the elderly is challenging due to their concurrent illnesses, underreport of pain, complex clinical manifestation of pain and higher chance of medication-related side effects. The objectives of this study were (a) to evaluate trends in annual prevalence of moderate-to-severe pain and persistent pain among Medicare beneficiaries residing in nursing homes; and (b) to identify resident and facility characteristics associated with persistent pain. METHODS: This was an observational study using linked data from 2006 to 2009 Medicare Current Beneficiary Survey and Minimum Data Set 2.0. Pain level was determined by a validated scale based on two items from Minimum Data Set 2.0 regarding frequency and intensity of pain. An episode of persistent pain was identified if moderate-to-severe pain reported at a Minimum Data Set 2.0 assessment was not alleviated at subsequent assessment. The Cochran-Armitage trend test was performed to detect trends in moderate-to-severe pain and persistent pain between 2006 and 2009. Generalize linear models using generalized estimating equation were used to identify characteristics associated with persistent pain. RESULTS: Annual prevalence of moderate-to-severe pain consistently declined from 29.3% in 2006 to 22.2% in 2009 (p < .01), while approximately 60% of beneficiaries experienced persistent pain annually (p = .50). Younger age, moderate initial pain, presence of diabetes, and skilled nursing home stays with assessments <21 days apart were associated with higher risks for persistent pain. CONCLUSIONS: Annual prevalence of moderate-to-severe pain has consistently declined among Medicare Beneficiaries in nursing homes. However, resolution of pain among residents experiencing moderate-to-severe pain was still problematic.
BACKGROUND: Managing pain for the elderly is challenging due to their concurrent illnesses, underreport of pain, complex clinical manifestation of pain and higher chance of medication-related side effects. The objectives of this study were (a) to evaluate trends in annual prevalence of moderate-to-severe pain and persistent pain among Medicare beneficiaries residing in nursing homes; and (b) to identify resident and facility characteristics associated with persistent pain. METHODS: This was an observational study using linked data from 2006 to 2009 Medicare Current Beneficiary Survey and Minimum Data Set 2.0. Pain level was determined by a validated scale based on two items from Minimum Data Set 2.0 regarding frequency and intensity of pain. An episode of persistent pain was identified if moderate-to-severe pain reported at a Minimum Data Set 2.0 assessment was not alleviated at subsequent assessment. The Cochran-Armitage trend test was performed to detect trends in moderate-to-severe pain and persistent pain between 2006 and 2009. Generalize linear models using generalized estimating equation were used to identify characteristics associated with persistent pain. RESULTS: Annual prevalence of moderate-to-severe pain consistently declined from 29.3% in 2006 to 22.2% in 2009 (p < .01), while approximately 60% of beneficiaries experienced persistent pain annually (p = .50). Younger age, moderate initial pain, presence of diabetes, and skilled nursing home stays with assessments <21 days apart were associated with higher risks for persistent pain. CONCLUSIONS: Annual prevalence of moderate-to-severe pain has consistently declined among Medicare Beneficiaries in nursing homes. However, resolution of pain among residents experiencing moderate-to-severe pain was still problematic.
Authors: Shao-Hsien Liu; Jacob N Hunnicutt; Christine M Ulbricht; Catherine E Dubé; Anne L Hume; Kate L Lapane Journal: Drugs Aging Date: 2019-06 Impact factor: 3.923
Authors: Kevin M Fain; G Caleb Alexander; David D Dore; Jodi B Segal; Andrew R Zullo; Carlos Castillo-Salgado Journal: J Am Geriatr Soc Date: 2016-11-07 Impact factor: 7.538