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Kovacevic M, Montes M, Tirone V, Pridgen S, Smith DL, Burns JW, Held P. Treating a common comorbidity: Pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address. J Trauma Stress 2024; 37:47-56. [PMID: 38091254 DOI: 10.1002/jts.22979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 02/13/2024]
Abstract
Posttraumatic stress disorder (PTSD) commonly co-occurs with pain and has been implicated in the maintenance of chronic pain. However, limited research has examined whether intervening for PTSD can hinder or optimize treatment outcomes for co-occurring pain and PTSD. In the present study, we examined changes in pain, PTSD, and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. We also explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Linear mixed models revealed that participants' pain interference decreased throughout treatment, d = 0.15, p = .039. Higher levels of pretreatment pain interference were associated with higher PTSD, p = .001, and depressive symptom severity, p = .014, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, β = -.03; p < .001, but not depressive symptoms. These findings indicate that ITPs for PTSD can reduce pain interferences, albeit to a small degree, and that reductions in pain interference can contribute to reductions in PTSD symptom severity. Future studies should examine which treatment components contribute to larger changes in symptom severity for veterans with co-occurring pain and PTSD.
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Affiliation(s)
- Merdijana Kovacevic
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Mauricio Montes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Vanessa Tirone
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Pridgen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Dale L Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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2
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Iacono A, Campitelli MA, Bronskill SE, Hogan DB, Iaboni A, Maclagan LC, Gomes T, Tadrous M, Evans C, Gruneir A, Guan Q, Hadjistavropoulos T, Cotton C, Gill SS, Seitz DP, Ho J, Maxwell CJ. Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis. Drugs Aging 2022; 39:811-827. [PMID: 35976489 PMCID: PMC9381389 DOI: 10.1007/s40266-022-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.
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Affiliation(s)
- Anita Iacono
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tara Gomes
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Unity Health, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrea Gruneir
- ICES, Toronto, ON, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Qi Guan
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Sudeep S Gill
- ICES, Toronto, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Dallas P Seitz
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. .,ICES, Toronto, ON, Canada. .,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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3
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Dunbar MS, Edelen MO, McMullen T, Bruckenthal P, Ahluwalia SC, Chen EK, Dalton SE, Paddock S, Rodriguez A, Mandl S, Mota T, Saliba D. Development and testing of a standardized pain interview assessment for use in post-acute care. J Am Geriatr Soc 2022; 70:1035-1046. [PMID: 35235202 DOI: 10.1111/jgs.17653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pain is highly prevalent among patients in post-acute care (PAC) settings and can affect quality of life, treatment outcomes, and transitions in care. Routine, accurate assessment of pain across settings is important for pain management and care planning; however, existing PAC assessment instruments do not assess patient pain in a standardized manner. METHODS We developed and tested a set of pain interview data elements for use across PAC settings (skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, home health agencies) as part of a larger effort undertaken by the Centers for Medicare & Medicaid Services to develop standardized assessment data elements to meet the requirements of the IMPACT Act of 2014. The interview assessed six pain constructs: presence; frequency; interference with sleep; interference with rehabilitation therapies [if applicable]; interference with daily activities; worst pain; and pain relief from treatments/medications). A total of 3031 PAC patients at 143 PAC settings (across 14 U.S. geographic/metropolitan areas in 10 states) participated in a national field test of standardized data elements from November 2017 to August 2018. We assessed item response distributions, time to complete interviews, inter-assessor agreement, and, for a subset of patients, change in responses between admission and discharge assessments. We also conducted focus groups with nurse assessors about their experiences administering the items. RESULTS For patients reporting any pain, average time to complete the pain interview was 3.1 min (SD = 1.3), and interrater reliability was excellent for all data elements (kappa range: 0.95-0.99). Findings were similar across types of PAC settings. Qualitative data from nurses emphasized ease of administration and high perceived clinical utility. CONCLUSION Findings provide support for feasibility of implementing a standardized pain interview assessment in PAC settings. This tool can support tracking of patient needs across settings and interoperability of data in electronic medical records.
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Affiliation(s)
| | - Maria O Edelen
- RAND Corporation, Boston, Massachusetts, USA.,Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tara McMullen
- Pain Management, Opioid Safety, and PDMP Program Office, Veterans Health Administration, Washington, District of Columbia, USA
| | | | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, California, USA.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | | | - Susan Paddock
- NORC at the University of Chicago, Chicago, Illinois, USA
| | | | - Stella Mandl
- Division of Health Care Financing, Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, District of Columbia, USA
| | - Teresa Mota
- Abt Associates, Cambridge, Massachusetts, USA
| | - Debra Saliba
- RAND Corporation, Santa Monica, California, USA.,University of California Los Angeles/JH Borun Center for Gerontological Research, Los Angeles, California, USA.,VA GLAHS, GRECC and HSR&D Center of Innovation, Los Angeles, California, USA
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4
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Umucu E, Reyes A, Carrola P, Mangadu T, Lee B, Brooks JM, Fortuna KL, Villegas D, Chiu CY, Valencia C. Pain intensity and mental health quality of life in veterans with mental illnesses: the intermediary role of physical health and the ability to participate in activities. Qual Life Res 2020; 30:479-486. [PMID: 32974882 PMCID: PMC7515555 DOI: 10.1007/s11136-020-02642-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2020] [Indexed: 01/14/2023]
Abstract
Purpose The purpose of this study was to examine the intermediary role of physical health quality of life and ability to participate social roles and activities in the relationship between pain intensity and mental health quality of life in veterans with mental illnesses. Methods This is a cross-sectional correlational design study. Our participants are 156 veterans with self-reported mental illness (Mage = 37.85; SDage = 10.74). Descriptive, correlation, and mediation analyses were conducted for the current study. Results Pain intensity was negatively correlated with physical health QOL, ability to participate in social roles and activities, and mental health QOL. Physical health QOL and ability to participate in social roles and activities were positively associated with mental health QOL, respectively. Physical health QOL was positively correlated with a ability to participate in social roles and activities. Study results indicate that the effect of pain intensity on mental health QOL can be explained by physical health QOL and ability to participate. Conclusions Specific recommendations for practitioners include implementing treatment goals that simultaneously focus on physical health and ability to participate in social roles and activities for clients who present with both physical pain and low mental health QOL.
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Affiliation(s)
- Emre Umucu
- Department of Rehabilitation Sciences, The University of Texas at El Paso, 500 W University Ave, El Paso, TX, 79968, USA.
| | - Antonio Reyes
- Division of Special Education and Counseling, CA State University - Los Angeles, Los Angeles, CA, USA
| | - Paul Carrola
- Department of Educational Psychology and Special Services, The University of Texas at El Paso, El Paso, TX, USA
| | - Thenral Mangadu
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, USA
| | - Beatrice Lee
- Department of Rehabilitation Sciences, The University of Texas at El Paso, 500 W University Ave, El Paso, TX, 79968, USA
| | - Jessica M Brooks
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Karen L Fortuna
- The Geisel School of Medicine at Dartmouth, Dartmouth College, Concord, NH, USA
| | - Diana Villegas
- Department of Rehabilitation Sciences, The University of Texas at El Paso, 500 W University Ave, El Paso, TX, 79968, USA
| | - Chung-Yi Chiu
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Carolina Valencia
- Department of Rehabilitation Sciences, The University of Texas at El Paso, 500 W University Ave, El Paso, TX, 79968, USA
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5
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Amspoker AB, Snow AL, Renn BN, Block P, Pickens S, Morgan RO, Kunik ME. Patient Versus Informal Caregiver Proxy Reports of Pain Interference in Persons With Dementia. J Appl Gerontol 2020; 40:414-422. [PMID: 32026743 DOI: 10.1177/0733464820902632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To better understand reports of pain interference, we examined ratings made by PWDs, as well as corresponding ratings about PWDs, as reported by the caregiver. We aimed to assess alignment between and predictors of caregiver and PWD report of pain interference. Methods: The sample consisted of 203 veterans with pain and mild to moderately severe dementia and an informal caregiver. Results: Most PWDs and their caregivers reported at least some pain interference and similar levels of pain interference. PWDs with greater cognitive impairment reported less pain interference, whereas caregivers who perceived the PWD to have greater depression reported more pain interference. Conclusions: PWD and caregiver characteristics were differentially associated with PWD versus caregiver report of pain interference. Results suggest the importance of caregiver reports to inform assessment, as well as factors complicating assessment. Pain in Dementia As one ages, the risk of developing both dementia and pain increases substantially (Scherder et al., 2009). It is estimated that 30% to 50% of persons with dementia (PWDs) experience persistent pain, a complex multifactor problem (Corbett et al., 2014). Despite the high prevalence of pain among older adults with dementia, and major advances in pain management, pain often remains unrecognized or undertreated (Hodgson et al., 2014).
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Affiliation(s)
- Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - A Lynn Snow
- The University of Alabama, Tuscaloosa, USA.,Tuscaloosa VA Medical Center, AL, USA
| | | | | | - Sabrina Pickens
- The University of Texas Health Science Center at Houston, USA
| | - Robert O Morgan
- The University of Texas School of Public Health, Houston, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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6
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Sirsch E, Lukas A, Drebenstedt C, Gnass I, Laekeman M, Kopke K, Fischer T. Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline. J Am Med Dir Assoc 2020; 21:149-163. [DOI: 10.1016/j.jamda.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 10/25/2022]
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7
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Naylor JC, Wagner HR, Johnston C, Elbogen EE, Brancu M, Marx CE, Strauss JL. Pain Intensity and Pain Interference in Male and Female Iraq/Afghanistan-era Veterans. Womens Health Issues 2019; 29 Suppl 1:S24-S31. [PMID: 31253239 DOI: 10.1016/j.whi.2019.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic pain conditions are common among both male and female Iraq/Afghanistan-era veterans and can have substantial negative impacts on quality of life and function. Although in general women tend to report higher levels of pain intensity than men, findings remain mixed on whether gender differences in pain exist in Iraq/Afghanistan-era veterans. Additionally, the relationships between functional impairment, pain intensity, and gender remain unknown. METHODS This project examined gender differences in pain intensity and pain interference in 875 male and female Iraq/Afghanistan-era veterans. Nonparametric Wilcoxon rank-tests examined gender differences in pain scores. Multivariable generalized linear regression modeling was used to evaluate the magnitude of pain intensity and interference across levels of chronicity and gender, and to evaluate the role of chronicity in gender effects in measures of pain and function. RESULTS Pain intensity and interference scores were significantly greater among both male and female veterans reporting chronic pain relative to acute pain. Women veterans endorsed higher levels of pain intensity and pain interference compared with men. Results derived from multivariable analyses implicated pain intensity as a factor underlying gender differences in functional impairment among chronic pain sufferers, indicating that gender differences in functional measures were eliminated after controlling statistically for pain intensity. CONCLUSIONS Results demonstrate that the effects of functional impairment are impacted by pain intensity, and not by gender.
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Affiliation(s)
- Jennifer C Naylor
- Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC), Durham, North Carolina.
| | - H Ryan Wagner
- Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Cynthia Johnston
- Durham Veterans Affairs Medical Center, Durham, North Carolina; Pharmacy Practice Department, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina
| | - Eric E Elbogen
- Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Mira Brancu
- Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Christine E Marx
- Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC), Durham, North Carolina
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- VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC), Durham, North Carolina
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- VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Jennifer L Strauss
- Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
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Commonly Initiated Opioids and Risk of Fracture Hospitalizations in United States Nursing Homes. Drugs Aging 2018; 35:925-936. [PMID: 30187291 DOI: 10.1007/s40266-018-0583-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the comparative safety of initiating commonly used opioids among older, long-stay United States nursing home residents with fracture hospitalizations. METHODS We conducted a new-user retrospective cohort study of nursing home residents initiating short-acting oxycodone, hydrocodone, or tramadol by merging the 2011-2013 Minimum Data Set 3.0 to Medicare hospitalization and pharmacy claims. Residents (≥ 65 years, no cancer or hospice use) contributed treatment episodes (> 120 days with no prior opioid claims) and were followed for 180 days until incident fracture hospitalization (hip, femur, humerus, pelvis, radius/ulna), death (competing risk), treatment changes (e.g., discontinuation), or administrative censoring. Competing risks models with inverse probability of treatment weighting were used to estimate subdistribution hazard ratios (HRSD) and 95% confidence intervals (CI). RESULTS Overall, 110,862 residents contributed 134,432 treatment episodes: 14,373 oxycodone; 69,182 hydrocodone; and 50,877 tramadol initiators. The incidences of fracture hospitalizations per 100 person-years were 9.4 (95% CI 7.5-11.7) for oxycodone, 7.9 (95% CI 7.1-8.8) for hydrocodone, and 5.0 (95% CI 4.3-5.7) for tramadol initiators. In weighted models, oxycodone initiators had a similar rate of fractures to hydrocodone initiators (HRSD 1.08, 95% CI 0.79-1.48). Tramadol initiators had lower fracture rates than hydrocodone initiators (HRSD 0.67, 95% CI 0.56-0.80). CONCLUSIONS The lower rate of fractures that we documented among tramadol initiators compared with hydrocodone initiators is consistent, albeit attenuated compared with prior studies among community-dwelling older adults. However, overall fracture rates were lower than in community settings, potentially due to the limited risk of falling in this population with limited mobility.
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Symptoms, Nutrition, Pressure Ulcers, and Return to Community Among Older Women With Heart Failure at Skilled Nursing Facilities: A Pilot Study. J Cardiovasc Nurs 2018; 33:22-29. [PMID: 29200058 DOI: 10.1097/jcn.0000000000000422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mortality rate is high for older women with heart failure (HF) who are discharged to skilled nursing facilities (SNFs) after hospitalization, but little is known about their symptoms, nutritional factors, and pressure ulcer status and whether these variables predict the women's return to the community. OBJECTIVES The aims of this study are to characterize symptoms (ie, dyspnea, cognitive dysfunction, depression, and pain) and nutritional and pressure ulcer status, evaluate relationships among symptoms, and examine predictors of return to the community among older women with HF admitted to SNFs. METHODS In this pilot observational study, data were collected retrospectively from the electronic medical records and the Minimum Data Set 3.0. RESULTS Data were obtained for 45 women with HF (mean age, 84.8 years). Frequency of symptoms was dyspnea 18%, cognitive dysfunction 20%, depression 5%, and pain 78%. Mean body mass index (BMI) was 29.8 kg/m. Frequency of pressure ulcer risk was 85% and 18% had pressure ulcers. The 4 symptoms were not significantly related. Younger age (odds ratio, 0.90; P = .023) and BMI of 25 kg/m or greater (odds ratio, 5.31; P = .017) predicted return to the community. CONCLUSIONS The women in this study had frequent pain, moderately frequent cognitive dysfunction, and high pressure ulcer risk. Surprisingly, few women had dyspnea or depression. Women who were younger with higher BMI were more likely to return to the community. The study needs to be replicated in a larger more diverse group of older patients with HF.
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Schalet BD, Kallen MA, Heinemann AW, Deutsch A, Cook KF, Foster L, Cella D. Using PROMIS Pain Interference Items to Improve Quality Measurement in Inpatient Rehabilitation Facilities. J Am Med Dir Assoc 2018; 19:846-851.e2. [PMID: 29804893 DOI: 10.1016/j.jamda.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/16/2018] [Accepted: 03/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference items for use in a quality measure and to compare the resulting quality score, along with internal reliability and validity, to a similar item set in the Minimum Data Set Version 3.0 (MDS). DESIGN Cross-sectional, observational study. SETTING One freestanding inpatient rehabilitation facility (IRF) and one large hospital-based IRF. PARTICIPANTS Patients with neurologic disorders. Of 1055 consecutive admissions, 26% were excluded based on clinician-determined cognitive impairment or emotional distress. Of the remainder, 50% consented and completed the survey near the end of their IRF stay (N = 391). Of these, more than half (57%) reported pain over the last day (n = 224). MEASUREMENTS Psychometric statistics and quality scores were computed from a 55-question survey, including the MDS and PROMIS pain interference items. RESULTS Estimates for internal reliability were higher for the PROMIS 2-item scale compared to the MDS: Cronbach α (0.86 vs 0.48) and interitem correlations (0.75 vs 0.31). The PROMIS-2 items were better able to detect differences in patients with mild and severe pain intensity (Cohen d = 1.57) relative to the corresponding MDS items (Cohen d = 0.81). Two quality scores based on the PROMIS-2 items, reflecting low and high levels of pain interference, showed 46% or 12% of patients meeting these thresholds. This compared to a 30% rate when patients were classified by the MDS as experiencing pain interference. CONCLUSIONS PROMIS pain interference items appear to be more internally consistent than similar MDS items. The graded PROMIS items permit the creation of multiple quality scores, showing predictable overlap with corresponding MDS quality scores. Because PROMIS items provide finer distinctions, they allow greater latitude in reporting quality scores. We recommend further study of pain interference scores across IRFs to improve their reliability and validity.
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Affiliation(s)
- Benjamin D Schalet
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Quality Measurement and Health Policy Program, eHealth, Quality & Analytics Division, RTI International, Chicago, IL
| | - Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Linda Foster
- Alexian Brothers Rehabilitation Hospital, Elk Grove Village, IL
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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11
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Hunnicutt JN, Chrysanthopoulou SA, Ulbricht CM, Hume AL, Tjia J, Lapane KL. Prevalence of Long-Term Opioid Use in Long-Stay Nursing Home Residents. J Am Geriatr Soc 2017; 66:48-55. [PMID: 28940193 DOI: 10.1111/jgs.15080] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Overall and long-term opioid use among older adults have increased since 1999. Less is known about opioid use in older adults in nursing homes (NHs). DESIGN Cross-sectional. SETTING U.S. NHs (N = 13,522). PARTICIPANTS Long-stay NH resident Medicare beneficiaries with a Minimum Data Set 3.0 (MDS) assessment between April 1, 2012, and June 30, 2012, and 120 days of follow-up (N = 315,949). MEASUREMENTS We used Medicare Part D claims to measure length of opioid use in the 120 days from the index assessment (short-term: ≤30 days, medium-term: >30-89 days, long-term: ≥90 days), adjuvants (e.g., anticonvulsants), and other pain medications (e.g., corticosteroids). MDS assessments in the follow-up period were used to measure nonpharmacological pain management use. Modified Poisson models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for age, gender, race and ethnicity, cognitive and physical impairment, and long-term opioid use. RESULTS Of all long-stay residents, 32.4% were prescribed any opioid, and 15.5% were prescribed opioids long-term. Opioid users (versus nonusers) were more commonly prescribed pain adjuvants (32.9% vs 14.9%), other pain medications (25.5% vs 11.0%), and nonpharmacological pain management (24.5% vs 9.3%). Long-term opioid use was higher in women (aPR = 1.21, 95% CI = 1.18-1.23) and lower in racial and ethnic minorities (non-Hispanic blacks vs whites: APR = 0.93, 95% CI = 0.90-0.94) and those with severe cognitive impairment (vs no or mild impairment, aPR = 0.82, 95% CI = 0.79-0.83). CONCLUSION One in seven NH residents was prescribed opioids long-term. Recent guidelines on opioid prescribing for pain recommend reducing long-term opioid use, but this is challenging in NHs because residents may not benefit from nonpharmacological and nonopioid interventions. Studies to address concerns about opioid safety and effectiveness (e.g., on pain and functional status) in NHs are needed.
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Affiliation(s)
- Jacob N Hunnicutt
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Stavroula A Chrysanthopoulou
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christine M Ulbricht
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Anne L Hume
- Department of Family Medicine, Alpert Medical School, Brown University, Memorial Hospital of Rhode Island, Providence, Rhode Island.,Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
| | - Jennifer Tjia
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Kennelty KA, Jensen LL, Gehring M, Gilmore-Bykovskyi A, Roiland RA, Kordahl R, Kind AJH. Preventing Opioid Prescription Theft and Ensuring SeCure Transfer of Personal Health Information when Patients Transition from the Hospital to a Nursing Home. J Am Geriatr Soc 2016; 64:e23-5. [PMID: 27459132 DOI: 10.1111/jgs.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Korey A Kennelty
- Department of Veterans Affairs, William S Middleton Hospital, Madison, Wisconsin.,Geriatrics Division, Department of Medicine, School of Medicine and Public Health, School of Pharmacy, University of Wisconsin, Madison, Wisconsin
| | - Laury L Jensen
- Department of Veterans Affairs, William S Middleton Hospital, Madison, Wisconsin
| | - Michael Gehring
- Department of Veterans Affairs, William S Middleton Hospital, Madison, Wisconsin.,Geriatrics Division, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Andrea Gilmore-Bykovskyi
- Department of Veterans Affairs, William S Middleton Hospital, Madison, Wisconsin.,School of Nursing, University of Wisconsin, Madison, Wisconsin
| | - Rachel A Roiland
- Department of Veterans Affairs, William S Middleton Hospital, Madison, Wisconsin
| | - Rebecca Kordahl
- Department of Veterans Affairs, William S Middleton Hospital, Madison, Wisconsin
| | - Amy J H Kind
- Department of Veterans Affairs, William S Middleton Hospital, Madison, Wisconsin.,Geriatrics Division, Department of Medicine, School of Medicine and Public Health, School of Pharmacy, University of Wisconsin, Madison, Wisconsin.,School of Nursing, University of Wisconsin, Madison, Wisconsin
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Ersek M, Neradilek MB, Herr K, Jablonski A, Polissar N, Du Pen A. Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial. J Am Med Dir Assoc 2016; 17:348-56. [PMID: 26897592 PMCID: PMC4988793 DOI: 10.1016/j.jamda.2016.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To enhance pain practices in nursing homes (NHs) using pain assessment and management algorithms and intense diffusion strategies. DESIGN A cluster, randomized controlled trial. The intervention consisted of intensive training and support for the use of recommended pain assessment and management practices using algorithms (ALGs). Control facilities received pain education (EDU) only. SETTING Twenty-seven NHs in the greater Puget Sound area participated. Facilities were diverse in terms of size, quality, and ownership. PARTICIPANTS Data were collected from 485 NH residents; 259 for the intervention and 226 for the control group. MEASUREMENTS Resident outcomes were nursing assistant (proxy) report and self-reported resident pain intensity. Process outcomes were adherence to recommended pain practices. Outcomes were measured at baseline, completion of the intervention (ALG) or training (EDU), and again 6 months later. RESULTS Among 8 comparisons of outcome measures between ALG and EDU (changes in 4 primary pain measures compared at 2 postintervention time points) there was only 1 statistically significant but small treatment difference in proxy- or self-reported pain intensity. Resident-reported worst pain decreased by an average of 0.8 points from baseline to 6 months among the EDU group and increased by 0.2 points among the ALG (P = .005), a clinically nonsignificant difference. There were no statistically significant differences in adherence to clinical guideline practice recommendations between ALG and EDU following the intervention. CONCLUSIONS Future research needs to identify and test effective implementation methods for changing complex clinical practices in NHs, including those to reduce pain.
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Affiliation(s)
- Mary Ersek
- Professor of Palliative Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, University of Pennsylvania School of Nursing, 418 Curie Blvd., Room 329, Philadelphia, PA 19104-6096, Phone: (215) 746-3563, Fax: (215) 222-2592
| | - Moni Blazej Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA 98112-2913, Phone: (206) 329-9325, Fax: (206) 324-5915
| | - Keela Herr
- Professor & Chair, Adult & Gerontology Nursing, College of Nursing, University of Iowa, 101 Nursing Building, 50 Newton Road, Iowa City, IA 52242-1121, Phone: (319) 335-7080
| | - Anita Jablonski
- Associate Professor, College of Nursing, Seattle University, 410 Garrand, Seattle, WA 98122, Phone: (206) 296-5679
| | - Nayak Polissar
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA 98112-2913, Phone: (206) 329-9325, Fax: (206) 324-5915
| | - Anna Du Pen
- Retired, 14555 Wild Swan NE, Bainbridge Island, WA 98110-4102, Phone: (206) 780-8373
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Budnick A, Kuhnert R, Könner F, Kalinowski S, Kreutz R, Dräger D. Validation of a Modified German Version of the Brief Pain Inventory for Use in Nursing Home Residents with Chronic Pain. THE JOURNAL OF PAIN 2016; 17:248-56. [DOI: 10.1016/j.jpain.2015.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 11/15/2022]
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Takai Y, Yamamoto-Mitani N, Kawakami S, Abe Y, Kamiyama M, Saito S. Differences between Nurses' and Care Workers' Estimations of Pain Prevalence among Older Residents. Pain Manag Nurs 2015; 16:20-32. [DOI: 10.1016/j.pmn.2014.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/09/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
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16
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Takai Y, Yamamoto-Mitani N, Suzuki M, Furuta Y, Sato A, Fujimaki Y. Developing and validating a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment. Arch Gerontol Geriatr 2013; 57:403-10. [DOI: 10.1016/j.archger.2013.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 05/22/2013] [Accepted: 06/01/2013] [Indexed: 10/26/2022]
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17
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Prevalence of Pain Among Residents in Japanese Nursing Homes: A Descriptive Study. Pain Manag Nurs 2013; 14:e1-9. [DOI: 10.1016/j.pmn.2011.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 01/26/2011] [Accepted: 01/26/2011] [Indexed: 11/23/2022]
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18
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Saliba D, Jones M, Streim J, Ouslander J, Berlowitz D, Buchanan J. Overview of Significant Changes in the Minimum Data Set for Nursing Homes Version 3.0. J Am Med Dir Assoc 2012; 13:595-601. [DOI: 10.1016/j.jamda.2012.06.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 06/01/2012] [Accepted: 06/01/2012] [Indexed: 11/30/2022]
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Saliba D, Buchanan J. Making the investment count: revision of the Minimum Data Set for nursing homes, MDS 3.0. J Am Med Dir Assoc 2012; 13:602-10. [PMID: 22795345 DOI: 10.1016/j.jamda.2012.06.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 06/01/2012] [Accepted: 06/01/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Minimum Data Set (MDS) is a potentially powerful tool for implementing standardized assessment in nursing homes (NHs). Its content has implications for residents, families, providers, researchers, and policymakers, all of whom have expressed concerns about the reliability, validity, and relevance of MDS 2.0. Some argue that because MDS 2.0 fails to include items that rely on direct resident interview, it fails to obtain critical information and effectively disenfranchises many residents from the assessment process. PURPOSE Design a major revision of the MDS, MDS 3.0, and evaluate whether the revision improves reliability, validity, resident input, clinical utility, and decreases collection burden. DESIGN AND METHODS In the form design phase, we gathered information from a wide range of experts, synthesized existing literature, worked with a national consortium of VA researchers to revise and test eight sections, pilot tested a draft MDS 3.0 and revised the draft based on results from the pilot. In the national validation and evaluation phase, we tested MDS 3.0 in 71 community NHs and 19 VHA NHs, regionally distributed throughout the United States. The sample was selected based on scheduled MDS 2.0 assessments. Comatose residents were excluded. A total 3822 residents of community NHs in eight states were included. The evaluation was designed to test and analyze inter-rater agreement (reliability) between research nurses and between facility staff and research nurses, validity of key sections, response rates for interview items, anonymous feedback on changes from participating nurses, and time to complete the MDS assessment. RESULTS The reliability for research nurse to research nurse and for research nurse to facility staff was good or excellent for most items. Response rates for the resident interview sections were high: 90% for cognitive, 86% for mood, 85% for preferences, and 87% for pain. Staff survey responses showed increased satisfaction with clinical relevance, validity and clarity compared with MDS 2.0. The test version of the MDS 3.0 took 45% less time for facilities to complete. IMPLICATIONS Improving the reliability, accuracy, and usefulness of the MDS has profound implications for NH care and public policy. Enhanced accuracy supports the primary legislative intent that MDS be a tool to improve clinical assessment and supports the credibility of programs that rely on MDS.
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Affiliation(s)
- Debra Saliba
- UCLA/Jewish Home Borun Center for Gerontological Research, Los Angeles, CA, USA.
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Lapane KL, Quilliam BJ, Chow W, Kim M. The Association Between Pain and Measures of Well-Being Among Nursing Home Residents. J Am Med Dir Assoc 2012; 13:344-9. [DOI: 10.1016/j.jamda.2011.01.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 01/13/2011] [Indexed: 11/26/2022]
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Feasibility and clinical utility of the Japanese version of the Abbey pain scale in Japanese aged care. Pain Manag Nurs 2012; 15:439-48. [PMID: 24882023 DOI: 10.1016/j.pmn.2012.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 02/18/2012] [Accepted: 02/21/2012] [Indexed: 11/20/2022]
Abstract
Active usage of observational pain scales in Japanese aged-care facilities has not been previously described. Therefore, to examine the feasibility and clinical utility of the Abbey Pain Scale-Japanese version (APS-J), this study examined the interrater reliability of the APS-J among a researcher, nurses, and care workers in aged-care facilities in Japan. This study also aimed to obtain nurses' and care workers' opinions on use of the scale. The following data were collected from 88 residents of two aged-care facilities: demographics, Barthel Index, Folstein Mini-Mental Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and APS-J for pain. The researchers, nurses, and care workers independently assessed the residents' pain by using the APS-J, and intraclass correlation coefficients (ICC) for interrater reliability and Cronbach alpha for internal consistency were examined. The ICC between researchers and nurses, researchers and care workers, and nurses and care workers were 0.68, 0.74, and 0.76, respectively. Nurses and care workers were invited for focus group interviews to obtain their opinions regarding APS-J use. During these interviews, nurses and care workers stated that the observational points of APS-J subscales were the criteria they normally used to evaluate residents' pain. Several nurses and care workers reported a gap between the estimated pain intensity and APS-J score. Unclear APS-J criteria, difficulties in observing residents, and insufficient practice guidelines were also reported. Our findings indicate that the APS-J has moderate reliability and clinically utility. To facilitate APS-J usage, education and clinical guidelines for pain management may be required for nurses and care workers.
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Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan: a nationwide survey. Pain Manag Nurs 2011; 14:e59-66. [PMID: 23972872 DOI: 10.1016/j.pmn.2011.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 11/22/2022]
Abstract
This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required.
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Engel-Yeger B, Dunn W. Relationship Between Pain Catastrophizing Level and Sensory Processing Patterns in Typical Adults. Am J Occup Ther 2011. [DOI: 10.5014/ajot.2011.09004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We examined the relationship between pain perception, as expressed by pain catastrophizing level, and sensory processing patterns among typical adults.
METHOD. Two hundred ninety healthy adults participated in this study: 138 men and 152 women. Their ages ranged from 18 to 50 (mean age = 30.2 ± 6.8). All participants completed the Adolescent/Adult Sensory Profile and the Pain Catastrophizing Scale (PCS).
RESULTS. PCS scores significantly correlated with Low Registration, Sensory Sensitivity, and Sensation Avoiding. Women had higher sensory sensitivity and a higher pain catastrophizing level than did men.
CONCLUSION. Sensory processing patterns may be related to individual pain perception, as expressed in pain catastrophizing level. Intervention programs should take these factors into account to be more focused on the specific needs of each client, facilitate his or her optimal engagement in daily living activities, and elevate well-being.
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Affiliation(s)
- Batya Engel-Yeger
- Batya Engel-Yeger, PhD, is Senior Lecturer, Occupational Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905 Israel;
| | - Winnie Dunn
- Winnie Dunn, PhD, OTR, FAOTA, is Professor and Chair, Department of Occupational Therapy Education, School of Allied Health, University of Kansas Medical Center, Kansas City
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Literature Review of Pain Prevalence Among Older Residents of Nursing Homes. Pain Manag Nurs 2010; 11:209-23. [DOI: 10.1016/j.pmn.2010.08.006] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/27/2010] [Accepted: 08/27/2010] [Indexed: 11/19/2022]
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Skibitsky M, Edelen MO, Martin JL, Harker J, Alessi C, Saliba D. Can standardized sleep questionnaires be used to identify excessive daytime sleeping in older post-acute rehabilitation patients? J Am Med Dir Assoc 2010; 13:127-35. [PMID: 21450184 DOI: 10.1016/j.jamda.2010.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 05/06/2010] [Accepted: 05/06/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Excessive daytime sleeping is associated with poorer functional outcomes in rehabilitation populations and may be improved with targeted interventions. The purpose of this study was to test simple methods of screening for excessive daytime sleeping among older adults admitted for postacute rehabilitation. DESIGN Secondary analysis of data from 2 clinical samples. SETTING Two postacute rehabilitation (PAR) units in southern California. PARTICIPANTS Two hundred twenty-six patients older than 65 years with Mini-Mental State Examination (MMSE) score higher than 11 undergoing rehabilitation. MEASUREMENTS The primary outcome was excessive daytime sleeping, defined as greater than 15% (1.8 hours) of daytime hours (8 am to 8 pm) sleeping as measured by actigraphy. RESULTS Participants spent, on average, 16.2% (SD 12.5%) of daytime hours sleeping as measured by actigraphy. Thirty-nine percent of participants had excessive daytime sleeping. The Pittsburgh Sleep Quality Index (PSQI) was significantly associated with actigraphically measured daytime sleeping (P = .0038), but the Epworth Sleepiness Scale (ESS) was not (P = .49). Neither the ESS nor the PSQI achieved sufficient sensitivity and specificity to be used as a screening tool for excessive daytime sleeping. Two additional models using items from these questionnaires were not significantly associated with the outcome. CONCLUSIONS In an older PAR population, self-report items from existing sleep questionnaires do not identify excessive daytime sleeping. Therefore we recommend objective measures for the evaluation of excessive daytime sleeping as well as further research to identify new self-report items that may be more applicable in PAR populations.
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Affiliation(s)
- Megan Skibitsky
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Pokela N, Simon Bell J, Lihavainen K, Sulkava R, Hartikainen S. Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study. ACTA ACUST UNITED AC 2010; 8:233-44. [DOI: 10.1016/j.amjopharm.2010.05.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2010] [Indexed: 11/25/2022]
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Takai Y, Uchida Y. Frequency and type of chronic pain care approaches used for elderly residents in Japan and the factors influencing these approaches. Jpn J Nurs Sci 2010; 6:111-22. [PMID: 20021580 DOI: 10.1111/j.1742-7924.2009.00129.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To assess the frequency at which various chronic pain care (CPC) approaches were used while managing older residents of the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to assess the factors related to nurses and care workers that influence this care. METHODS A descriptive study design was used. The population comprised 31 nurses, 92 care workers, and 18 residents with chronic pain in eight HSFERC centers located in three provincial cities in Japan. A questionnaire was formulated by using the data collected by a literature review to assess the frequencies at which various CPC approaches were applied and the factors that might influence this care. RESULTS The most frequently preferred CPC approaches were gentle handling and support while providing daily care, listening attentively, and providing a recreational activity. The factors that affected the provision of CPC were the qualifications, years of experience of aged care, and experience of studying about chronic pain. The nurses tended to have a misconception regarding the manner in which the residents complained of pain and their pain sensitivity. Furthermore, organizational strategies for pain management were not reported by the nurses and care workers. CONCLUSIONS In order to provide effective and active CPC, ongoing education about pain and cooperation between nurses and care workers to manage residents' pain are highly recommended.
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Affiliation(s)
- Yukari Takai
- Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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Edelen MO, Saliba D. Correspondence of verbal descriptor and numeric rating scales for pain intensity: an item response theory calibration. J Gerontol A Biol Sci Med Sci 2010; 65:778-85. [PMID: 20106962 DOI: 10.1093/gerona/glp215] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Assessing pain intensity in older adults is critical and challenging. There is debate about the most effective way to ask older adults to describe their pain severity, and clinicians vary in their preferred approaches, making comparison of pain intensity scores across settings difficult. METHODS A total of 3,676 residents from 71 community nursing homes across eight states were asked about pain presence. The 1,960 residents who reported pain within the past 5 days (53% of total, 70% female; age: M = 77.9, SD = 12.4) were included in analyses. Those who reported pain were also asked to provide a rating of pain intensity using either a verbal descriptor scale (VDS; mild, moderate, severe, and very severe and horrible), a numeric rating scale (NRS; 0 = no pain to 10 = worst pain imaginable), or both. We used item response theory (IRT) methods to identify the correspondence between the VDS and the NRS response options by estimating item parameters for these and five additional pain items. RESULTS The sample reported moderate amounts of pain on average. Examination of the IRT location parameters for the pain intensity items indicated the following approximate correspondence: VDS mild approximately NRS 1-4, VDS moderate approximately NRS 5-7, VDS severe approximately NRS 8-9, and VDS very severe, horrible approximately NRS 10. CONCLUSION This IRT calibration provides a crosswalk between the two response scales so that either can be used in practice depending on the preference of the clinician and respondent.
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Abstract
BACKGROUND Although a variety of national organizations such as the Canadian Pain Society, the American Pain Society and the Joint Commission on Accreditation of Health Care Organizations have advanced the idea that pain should be assessed on a routine basis, there is little evidence that systematic pain assessment information is used routinely by clinicians even when it is readily available. OBJECTIVE To determine whether systematic pain assessment information alters medical practitioners' clinical practices. METHODS A population of seniors with complex medical problems who were evaluated by case coordinators was studied. Case coordinators were assigned to either an experimental or control patient assessment condition. Control condition patients were assessed as usual. In the experimental condition, a psychometrically valid pain assessment battery as well as the Geriatric Depression Scale - Short Form (because depression and chronic pain are frequently comorbid) were integrated into the routine case coordination assessment. A summary of the results of the depression and pain assessments was subsequently sent to physicians via mail and fax. Patients were also given copies of the assessment summaries and were asked to discuss these with their physicians. Physicians' medication prescriptions were monitored over time through the database of the provincial ministry of health. RESULTS At the end of the study, no significant differences between experimental and control patients were found with respect to medications prescribed or patient self-reports of pain. Nonetheless, there was a significant relationship between Geriatric Depression Scale -- Short Form scores and pain medications prescribed for patients in the experimental condition. Moreover, indexes of overall pain intensity did not change significantly over time. CONCLUSIONS The findings do not support the idea that the availability of systematic pain assessment information leads to change in clinician's medication practices. As such, educational interventions and public policy initiatives are needed to ensure that treatment providers do not only gather but also use pain assessment information.
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Ritchie CS, Wieland D. Advanced Illness Care in Older Adults: Many Lessons Yet To Be Learned. J Gerontol A Biol Sci Med Sci 2008; 63:949-50. [DOI: 10.1093/gerona/63.9.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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