title: Urban and rural differences in end-of-life pain and treatment status on admission to a nursing facility.
abstract: Individuals receiving end-of-life (EOL) care may have needs that are unrecognized or treated inappropriately. Yet, very little is known about differences in pain and special-care needs of EOL patients admitted to rural nursing facilities compared with urban nursing facilities, and whether the differing payer mix in urban and rural facilities affects the treatment ordered on admission. We examine a nationally representative sample of 6084 EOL patients upon admission to nursing homes to examine differences in diseases, pain assessments, and treatment orders. We found that rural EOL residents have higher rates of congestive heart failure, cancer, renal failure, and emphysema than urban EOL residents and are significantly more likely to report frequent pain, however, they are less likely to receive treatments such as IV medications, dialysis, and wound care.
authors.affiliation: Department of Health Policy and Management, Texas A & M University School of Rural Public Health, Bryan, Texas, USA.
authors.forename: Jane Nelson
authors.initials: JN
authors.lastname: Bolin
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
authors.forename: Catherine
authors.initials: C
authors.lastname: Hawes
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D010166:Palliative Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*