Study
finds
persistent
and
severe
pain
among
nursing
home
residents
The
first
national
look
at
pain
among
the
frailest
nursing
home
residents
uncovers
“woe-fully
inadequate
pain
management,”
say
its
Brown
Medical
School
authors.
Their
study
appears
in
the
April
25
issue
of
the
Journal
of
the
American
Medical
Association.
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PROVIDENCE,
R.I.,
April
26,
2001
—
A
new
nationwide
study
shows
that
severe
pain
among
elderly
nursing
home
residents
is
prevalent,
persistent
and
poorly
treated.
The
authors
of
the
first
national
look
at
pain
management
among
this
frail
population
say
that
the
findings
underrate
the
true
pain
burden
experienced
by
the
patients.
They
call
untreated
pain
in
nursing
homes
“an
important
national
public
health
problem.”
The
study
reports
the
rate
of
persistent
severe
pain,
using
data
gathered
through
the
federally
required
Minimum
Data
Set
(MDS).
The
MDS
is
used
to
collect
details
on
individuals
admitted
to
U.S.
nursing
homes,
including
information
on
the
frequency
and
severity
of
pain.
“We
believe
the
findings
underestimate
the
actual
pain
burden,”
said
lead
author
Joan
Teno
M.D.
“MDS
data
is
collected
by
nursing
home
staff.
It
is
based
on
staff
perception,
and
staff
routinely
underestimate
the
pain
burden
of
patients.”
The
study
appears
in
the
April
25
issue
of
the
Journal
of
the
American
Medical
Association.
The
authors
used
the
MDS
to
examine
the
pain
experience
of
more
than
2.2
million
people
residing
in
U.S.
nursing
homes
on
or
about
April
1,
1999.
They
found
that
41.2
percent
of
elderly
nursing
home
residents
who
were
in
pain
around
April
1,
1999,
still
experienced
moderate
daily
pain
or
excruciating
pain
60
to
180
days
later.
Of
individuals
in
a
nursing
home
between
2
and
6
months,
one
in
seven
had
persistent
pain.
Nationwide,
rates
of
persistent
pain
varied,
with
most
states
between
39.5
percent
and
49.5
percent.
“Our
findings
demonstrate
woefully
inadequate
pain
management
among
a
frail,
old
and
vulnerable
population
of
Americans,”
said
co-author
Vince
Mor,
director
of
the
Department
of
Community
Health,
Brown
Medical
School.
“Important
ground
has
been
gained
in
the
last
decade
in
pain
management,
but
these
results
highlight
the
urgent
work
yet
to
be
done.”
There
is
an
urgent
need
for
balance
in
public
policy
on
pain
management
given
that
recent
public
attention
and
policy
have
focused
on
the
dangers
of
opiate
prescription
abuse,
said
Teno,
associate
director
of
the
Brown
University
Center
for
Gerontology
and
Health
Care
Research.
“Recent
media
coverage
has
fed
fears
about
opiate
drug
prescription
abuse,”
she
said,
“but
that
should
not
be
a
reason
for
leaving
a
vulnerable
population
in
persistent
severe
pain.
The
focus
must
be
on
quality
medical
care
that
provides
competent,
compassionate
and
coordinated
medical
care
for
frail,
older
Americans
residing
in
nursing
homes
and
treats
drug
abuse
as
well.”
The
high
rate
of
persistent
severe
pain
has
important
policy
ramifications,
said
Karen
Kaplan,
National
Program
Director
for
Last
Acts,
a
coalition
of
more
than
600
organizations
united
to
improve
end
of
life
care.
“Current
regulations
need
to
change
to
make
pain
a
focus
at
all
state
and
federal
inspections
of
nursing
homes
to
comport
with
the
new
standard
of
the
Joint
Commission
on
the
Accreditation
of
Healthcare
Organizations,”
she
said.
That
standard
says
hospitals
and
nursing
homes
must
recognize
the
right
of
patients
to
the
appropriate
assessment
and
management
of
pain.
Teno
agrees.
“Persistent
pain
in
nursing
homes
should
be
considered
by
regulators
as
an
indicator
of
quality
and
reported
publicly
along
with
other
indicators,”
she
said.
“Federal
and
state
nursing
home
surveyors
should
assess
the
quality
of
pain
management
at
the
time
of
annual
inspection
of
nursing
homes.
We
call
on
local
Peer
Review
Organizations
of
the
Health
Care
Financing
Agency
to
work
with
nursing
homes
to
improve
pain
management
in
the
next
decade.”
In
addition,
there
is
a
need
to
enhance
education
of
nursing
home
staff
to
give
people
the
in-formation
and
tools
to
improve
their
behaviors
concerning
pain
management,
Teno
said.
She
suggests
that
patients
and
family
members
ask
a
nursing
home
about
its
pain-treatment
policy.
“Ask
if
it
regularly
assesses
pain
as
the
‘fifth
vital
sign.’
Also
ask
what
efforts
has
the
home
taken
to
be
more
aware
of
and
to
improve
pain
management.”
The
study’s
other
authors
are
Sherry
Weitzen,
a
Brown
doctoral
student,
and
Terrie
Wetle,
associate
dean
of
medicine
for
public
health
and
public
policy,
at
the
Brown
Medical
School.
The
study
was
funded
by
a
grant
from
the
Robert
Wood
Johnson
Foundation.
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