[Chronic pain in nursing home residents--patients' self-report and nurses' assessment].
BACKGROUND
Nursing home patients who have difficulties communicating are often under-treated for painful conditions. We assessed the agreement between nurses and patients regarding pain. Furthermore, we studied nurses' assessment of pain in non-communicative patients.


METHODS
Cross-sectional study, including 157 patients from four nursing homes. Demographic data, diagnoses and clinical information were collected. A study nurse interviewed patients and nurses with regard to pain over the last seven days. Patients who answered this question were regarded as communicative, the others as non-communicative. Cognitive function was assessed by means of the Abbreviated Mental Test.


RESULTS
A total of 109 patients (69%) were capable of answering the question of whether they had felt pain: 42% of the severely, 68% of the slightly or moderately cognitively impaired, and 97% of the cognitively intact patients. 53% of the patients indicated pain. There was agreement between nurses and patients in 77% of the cases (kappa = 0.54), among the severely impaired 33%, among the slightly or moderately impaired 69%, and among of 78% of those cognitively intact. Nurses considered pain to be less prevalent in non-communicative than in communicative patients (44% versus 52%, p = 0.39). Nurses' pain assessment was significantly related to the presence of pain-related diagnoses.


CONCLUSIONS
With regard to communicative patients, there was a fairly good/good agreement between patients' report and nurses' assessment of pain. A substantial proportion of the cognitively severely impaired are able to communicate their pain problems.
Nygaard
Harald A
HA
Seksjon for geriatri, Institutt for samfunnsmedisinske fag, Universitetet i Bergen, og NKS Olaviken Alderspsykiatriske sykehus 5306 Erdal. harald.nygaard@isf.uib.no
Jarland
Marit
M
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003072:Cognition Disorders / Q000150:complications; D003142:Communication; D003430:Cross-Sectional Studies; D006801:Humans; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods* / Q000523:psychology; D010361:Patients / Q000523:psychology; D011795:Surveys and Questionnaires