title: Pain and Satisfaction With Pain Management Among Older Patients During the Transition From Acute to Skilled Nursing Care.
abstract: Approximately 20% of hospitalized Medicare beneficiaries are discharged from the hospital to skilled nursing facilities (SNFs); and up to 23% of SNF patients return to the hospital within 30 days of hospital discharge, with pain as one of the most common symptoms precipitating hospital readmission. We sought to examine the prevalence of moderate to severe pain at hospital discharge to SNF, the incidence of new moderate to severe pain (relative to prehospitalization), and satisfaction with pain management among older acute care patients discharged to SNF.
  
  
  
  Structured patient interviews were conducted with 188 Medicare beneficiaries discharged to 23 area SNFs from an academic medical center. Pain level (0-10) and satisfaction with pain management were assessed upon hospital admission, discharge, and within 1 week after transition to SNF.
  
  
  
  There was a high prevalence of moderate to severe pain at each time point including prehospital (51%), hospital discharge (38%), and following SNF admission (53%). Twenty-eight percent of participants reported new moderate to severe pain at hospital discharge, whereas 44% reported new moderate to severe pain following SNF admission. Most participants reported being "satisfied" with their pain treatment, even in the context of moderate to severe pain.
  
  
  
  Moderate to severe pain is a common problem among hospitalized older adults discharged to SNF and continues during their SNF stay. Pain assessment and management should involve a specific, planned process between hospital and SNF clinicians at the point of care transition, even if patients express "satisfaction" with current pain management.
authors.affiliation: Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee. Sandra.Simmons@Vanderbilt.edu.|Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.|Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
authors.affiliation: Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.|Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.|Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.affiliation: Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Avantika A
authors.initials: AA
authors.lastname: Saraf
authors.affiliation: Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.|Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.
authors.forename: Chris
authors.initials: C
authors.lastname: Simon Coelho
authors.affiliation: Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.|Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.
authors.forename: J Mary Lou
authors.initials: JM
authors.lastname: Jacobsen
authors.affiliation: Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee.|Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Susan
authors.initials: S
authors.lastname: Bell
authors.affiliation: Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Amanda
authors.initials: A
authors.lastname: Mixon
authors.affiliation: Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010146:Pain; D059408:Pain Management; D010147:Pain Measurement; D010359:Patient Readmission; D017060:Patient Satisfaction; D010360:Patient Transfer; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D014481:United States
keywords: Acute care; Geriatrics; Pain assessment; Pain management; Postacute care