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dc.contributor.authorMorrison, Reynolds A.
dc.contributor.authorJesdale, William M.
dc.contributor.authorDube, Catherine E.
dc.contributor.authorNunes, Anthony P
dc.contributor.authorBova, Carol A.
dc.contributor.authorLiu, Shao-Hsien
dc.contributor.authorLapane, Kate L.
dc.date2022-08-11T08:08:24.000
dc.date.accessioned2022-08-23T15:54:08Z
dc.date.available2022-08-23T15:54:08Z
dc.date.issued2020-07-01
dc.date.submitted2020-07-16
dc.identifier.citation<p>Morrison RA, Jesdale BM, Dubé CE, Nunes AP, Bova CA, Liu SH, Lapane KL. Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment. Dement Geriatr Cogn Disord. 2020 Jul 1:1-9. doi: 10.1159/000508096. Epub ahead of print. PMID: 32610321. <a href="https://doi.org/10.1159/000508096">Link to article on publisher's site</a></p>
dc.identifier.issn1420-8008 (Linking)
dc.identifier.doi10.1159/000508096
dc.identifier.pmid32610321
dc.identifier.urihttp://hdl.handle.net/20.500.14038/29490
dc.description.abstractOBJECTIVE: Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment. METHODS: The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010-2016, n = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs. RESULTS: Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93-0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85-0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment. CONCLUSIONS: The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners' perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=32610321&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1159/000508096
dc.subjectCognitive impairment
dc.subjectDementia
dc.subjectNursing homes
dc.subjectPain
dc.subjectGeriatrics
dc.subjectGeropsychology
dc.subjectHealth Services Administration
dc.subjectHealth Services Research
dc.subjectPain Management
dc.subjectPsychiatry and Psychology
dc.titleDifferences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment
dc.typeJournal Article
dc.source.journaltitleDementia and geriatric cognitive disorders
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/1713
dc.identifier.contextkey18546361
html.description.abstract<p>OBJECTIVE: Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment.</p> <p>METHODS: The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010-2016, n = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs.</p> <p>RESULTS: Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93-0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85-0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment.</p> <p>CONCLUSIONS: The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners' perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.</p>
dc.identifier.submissionpathfaculty_pubs/1713
dc.contributor.departmentSchool of Nursing
dc.contributor.departmentDivision of Epidemiology, Department of Population and Quantitative Health Sciences
dc.source.pages1-9


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