Jinjiao Wang1, Todd B Monroe2, Adam Simning3, Yeates Conwell3, Thomas V Caprio4, Xueya Cai5, Helena Temkin-Greener6, Ulrike Muench7, Fang Yu8, Song Ge9, Yue Li6. 1. School of Nursing, University of Rochester, Rochester, New York. Electronic address: Jinjiao_wang@urmc.rochester.edu. 2. The Ohio State University, College of Nursing, Columbus, Ohio. 3. University of Rochester Medical Center, Department of Psychiatry, Rochester, New York. 4. University of Rochester Medical Center, Department of Medicine, Rochester, New York; University of Rochester Medical Home Care, Rochester, New York; Finger Lakes Geriatric Education Center, Rochester, New York. 5. University of Rochester, Department of Biostatistics and Computational Biology, Rochester, New York. 6. University of Rochester, Department of Public Health Sciences, Rochester, New York. 7. University of California, San Francisco, School of Nursing, San Francisco, California. 8. University of Minnesota, School of Nursing, Minneapolis, Minnesota. 9. University of Houston Downtown, School of Nursing, Houston, Texas.
Abstract
BACKGROUND: Pain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD). AIMS: Examine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population. DESIGN: Analysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data. SETTINGS/PARTICIPANTS: 6,153 patients ≥65 years receiving care from a nonprofit HH agency in 2017. METHODS: Study outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission. RESULTS: Patients with ADRD (n = 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] = 1.35, p = .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD. CONCLUSIONS: HH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.
BACKGROUND: Pain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD). AIMS: Examine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population. DESIGN: Analysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data. SETTINGS/PARTICIPANTS: 6,153 patients ≥65 years receiving care from a nonprofit HH agency in 2017. METHODS: Study outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission. RESULTS: Patients with ADRD (n = 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] = 1.35, p = .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD. CONCLUSIONS: HH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.
Authors: Jinjiao Wang; Mary S Dietrich; Sandra F Simmons; Ronald L Cowan; Todd B Monroe Journal: Aging Ment Health Date: 2017-05-03 Impact factor: 3.658
Authors: Krista L Harrison; Christine S Ritchie; Kanan Patel; Lauren J Hunt; Kenneth E Covinsky; Kristine Yaffe; Alexander K Smith Journal: J Am Geriatr Soc Date: 2019-08-07 Impact factor: 5.562
Authors: Todd B Monroe; Stephen J Gibson; Stephen P Bruehl; John C Gore; Mary S Dietrich; Paul Newhouse; Sebastian Atalla; Ronald L Cowan Journal: BMC Med Date: 2016-05-10 Impact factor: 8.775
Authors: Jinjiao Wang; Jenny Y Shen; Fang Yu; Yeates Conwell; Kobi Nathan; Avantika S Shah; Sandra F Simmons; Yue Li; Erika Ramsdale; Thomas V Caprio Journal: J Am Med Dir Assoc Date: 2022-04-28 Impact factor: 7.802