Understanding Various Pain Trajectories in NH Residents

A recent study aimed to gain insights into the changing patterns of pain experienced by residents in nursing homes (NH) over time, with the goal of improving care strategies and prioritizing interventions. The researchers conducted a comprehensive analysis to identify and define distinct patterns of pain trajectories among NH residents.

“Understanding changes in [NH] resident pain over time would provide a more informed perspective, allowing opportunities to alter the course of illness, plan care, and set priorities,” wrote the study authors. “Therefore, the purpose of this analysis was to identify and characterize clinically meaningful, dynamic pain trajectories in NH residents.”

To accomplish this, the study employed a retrospective longitudinal approach, examining pain scores of NH residents who had a stay of more than 100 days. The total sample size included 4864 residents. The researchers utilized a statistical technique called group-based trajectory modeling, which enabled them to categorize NH residents into different pain trajectories based on their pain scores recorded in the Minimum Data Set 3.0 assessments.

Once these trajectories were identified, the researchers analyzed the relationships between residents' demographic and clinical characteristics and the specific pain trajectory they belonged to.

The analysis revealed the presence of four distinct pain trajectories among NH residents:

1. Consistent Pain Absence (48.9%): This group experienced minimal or no pain consistently over time.
2. Decreasing-Increasing Pain Presence (21.8%): These residents initially reported decreasing pain, but their pain levels increased as time went on.
3. Increasing-Decreasing Pain Presence (15.3%): The pain levels of this group increased initially and then gradually decreased over time.
4. Persistent Pain Presence (14.0%): Residents in this trajectory experienced persistent and consistent pain throughout the study period.

Certain demographic and clinical factors were found to be associated with specific pain trajectories. For instance, residents who were younger in age, female, and lived in rural areas were more likely to belong to the persistent pain presence trajectory. Clinical characteristics like obesity and intact cognitive function were also linked to the persistent pain presence trajectory. Interestingly, a smaller percentage of residents with moderate or severe cognitive impairments were categorized into any of the pain trajectory groups.

Notably, residents with a diagnosis of Alzheimer's disease or dementia were less likely to be part of trajectories involving pain. This finding highlights the challenges in accurately assessing and identifying pain in residents with cognitive impairments, indicating a need for specialized pain assessment techniques for this vulnerable group.

The study's findings underscore the importance of NH staff being well-informed about the distinct pain trajectories that residents may experience.

This knowledge can help health care professionals tailor their care strategies to effectively address and manage pain for different groups of residents. For example, for residents at risk of persistent pain due to factors like obesity, fractures, or contractures, targeted interventions could be developed to mitigate this pain. Additionally, since residents with cognitive impairments like Alzheimer's disease are less likely to be identified as being in pain, it is crucial to enhance proxy pain assessment skills among staff to ensure their needs are met.

In conclusion, this study sheds light on the diverse pain experiences of NH residents over time and provides valuable insights into the associated demographic and clinical factors. By understanding and acknowledging these pain trajectories, healthcare providers can enhance their ability to provide appropriate care and interventions to improve residents' overall quality of life.

Reference:

Cole CS, Carpenter JS, Blackburn J, Chen CX, Jones BL, Hickman SE. Pain trajectories of nursing home residents. J Am Geriatr Soc. 2023;71(4):1188-1197. doi:10.1111/jgs.18182