Pain in nursing home residents: an exploration of prevalence, staff perspectives, and practical aspects of measurement.
OBJECTIVE
To help rectify the underdiagnosis of chronic pain in frail nursing home residents by developing a new feasible pain self-report instrument, the structured pain interview; to use this new tool to estimate pain prevalence and staff's knowledge of residents' pain in two nursing homes; and to compare the performance differences of the structured pain interview and the commonly used 0-10 scale.


METHODS
Cross-sectional survey.


METHODS
One 120-bed VA-affiliated and one 125-bed university-affiliated, community-based nursing home in Durham, North Carolina.


METHODS
One hundred fifty-eight chronic care nursing home residents without aphasia, acute illness, persistent vegetative status, or severe hearing impairment and 3 1 nursing home nurses.


METHODS
Pain prevalence according to resident self-report and nurse report; stability of response to the structured pain interview and 0-10 scale over 1 month; agreement between residents and nurses on the structured pain interview and 0-10 scale.


RESULTS
Fifty-eight percent of the VA and 45% of the community nursing home residents reported pain. Forty-two percent at the VA and 20% at the community home were unable to respond to the 0-10 scale, compared with 7.5% and 14% using the structured pain interview. Stability of response to the structured pain interview at 1 month was 0.56 at the VA (nurse-resident agreement 0.38) and 0.72 in the community (nurse-resident agreement 0.07), which was very comparable to the 0-10 scale.


CONCLUSIONS
We have developed a highly feasible tool for examining pain prevalence in nursing homes. This tool uncovered considerable miscommunication regarding pain between residents and staff. Improvement in pain communication between nursing home residents and staff is needed, so that more effective pain treatment programs can be developed for this vulnerable population.
Weiner
D
D
Center for the Study of Aging and Human Development, Department of Medicine, Duke University Arthritis Center, Duke University Medical Center, Durham, North Carolina, USA.
Peterson
B
B
Ladd
K
K
McConnell
E
E
Keefe
F
F
D001291:Attitude of Health Personnel; D006801:Humans; D009735:Nursing Homes; D010146:Pain / Q000453:epidemiology* / Q000503:physiopathology*; D010147:Pain Measurement; D012650:Self Disclosure; D011795:Surveys and Questionnaires