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Pain in U.S. Nursing Homes

Validating a Pain Scale for the Minimum Data Set

^a Institute of Gerontology and School of Public Health, University of Michigan, and Ann Arbor VA Medical Center
^b Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, MA
^c Department of Biostatistics, University of Michigan, Ann Arbor

Correspondence: Brant E. Fries, PhD, Institute of Gerontology, University of Michigan, 300 North Ingalls, Ann Arbor, MI 48109-2007. E-mail: bfries{at}umich.edu.

Laurence G. Branch, PhD

Purpose: The aim of this study was to validate a pain scale for the Minimum Data Set (MDS) assessment instrument and examine prevalence of pain in major nursing home subpopulations, including type of admission and cognitive status. Design and Methods: This study considered validation of the MDS pain items and derivation of scale performed against the Visual Analogue Scale (VAS), using Automatic Interaction Detection. The derivation data describe 95 postacute care nursing home patients who are able to communicate. The scale is then used in retrospective analysis of 34,675 Michigan nursing home residents. Results: A four-group scale was highly predictive of VAS pain scores (variance explanation 56%) and therefore quite valid in detecting pain. In the prevalence sample, only 47% of postacute patients compared to 63% of postadmission patients reported no pain, and these percentages rose with increasing cognitive impairment. Implications: Pain is prevalent in nursing home residents, especially in those with cognitive dysfunction, and often untreated.

Key Words: Care planning • Comprehensive assessment • Long-term care

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