There are four distinct pain trajectories experienced by nursing facility residents, according to a new study. Investigators urge clinicians to use the findings to help uncover and treat hidden pain among residents with dementia.
The researchers, from the Regenstrief Institute and Indiana University School of Nursing, examined data from more than 46,000 pain assessments among over 4,800 residents from 44 facilities.
Residents with pain typically had one of the following outcomes:
- persistent pain over time (14%)
- pain initially increasing, holding steady and then decreasing over time (15%)
- pain initially decreasing, holding steady and then increasing over time (22%)
- pain consistently absent (49%)
Evidence of common pain trajectories can help clinicians to “better understand pain, how it changes over time, and what risk factors are associated … among older adults and those with cognitive impairment,” said the study’s senior author Susan Hickman, PhD, in a statement.
Residents with Alzheimer’s and other dementias were likely underrepresented in pain diagnosis and treatment, the researchers added. This is due to problems with communication and the difficulties in clinical pain evaluation in patients who are cognitively impaired, they noted.
The study’s lead author, Connie Cole, PhD, DNP, APRN, said that identifying residents who for these reasons are not represented in the study’s pain trajectories may provide impetus for nursing home staff to improve assessment and evaluation.
“It is important that nursing home staff understand, recognize and respond to the factors associated with the identified pain trajectories to improve mitigation of potentially persistent pain … or improve proxy pain assessment skills for residents at risk for underreporting of pain,” she and her colleagues wrote.
“It’s critical that we continue to shine a spotlight on the unmet needs of these vulnerable individuals,” Hickman added.
Full findings were published in the Journal of the American Geriatrics Society.
In related news, another study has found that multisite pain may be linked to the rate of cognitive decline in dementia. People with chronic pain in many parts of the body have higher odds of developing dementia and experienced faster cognitive decline, the authors reported in PNAS.
“Multisite chronic pain may lead to up to eight years of accelerated hippocampal aging, an effect that may underlie a series of cognitive burdens,” said Tu Yiheng, a professor with the Institute of Psychology of the Chinese Academy of Sciences.