Pain management in nursing home residents with cancer

Abstract

OBJECTIVES: To assess improvements in pain management of nursing home (NH) residents with cancer since the implementation of pain management quality indicators. DESIGN: Cross-sectional. SETTING: One thousand three hundred eighty-two U.S. NHs (N = 1,382). PARTICIPANTS: Newly admitted, Medicare-eligible NH residents with cancer (N = 8,094). MEASUREMENTS: Nationwide data on NH resident health from Minimum Data Set 2.0 linked to all-payer pharmacy dispensing records (February 2006-June 2007) were used to determine prevalence of pain, including frequency and intensity, and receipt of nonopioid and opioid analgesics. Multinomial logistic regression was used to evaluate resident-level correlates of pain and binomial logistic regression to identify correlates of untreated pain. RESULTS: More than 65% of NH residents with cancer had any pain (28.3% daily, 37.3% < daily), 13.5% of whom had severe and 61.3% had moderate pain. Women; residents admitted from acute care or who were bedfast; and those with compromised activities of daily living, depressed mood, an indwelling catheter, or a terminal prognosis were more likely to have pain. More than 17% of residents in daily pain (95% confidence interval (CI) = 16.0-19.1%) received no analgesics, including 11.7% with daily severe pain (95% CI = 8.9-14.5%) and 16.9% with daily moderate pain (95% CI = 15.1-18.8%). Treatment was negatively associated with age of 85 and older (adjusted OR (aOR) = 0.67, 95% CI = 0.55-0.81 vs aged 65-74), cognitive impairment (aOR = 0.71, 95% CI = 0.61-0.82), presence of feeding tube (aOR = 0.77, 95% CI = 0.60-0.99), and restraints (aOR = 0.50, 95% CI = 0.31-0.82). CONCLUSION: Untreated pain is still common in NH residents with cancer and persists despite pain management quality indicators. Geriatrics Society.