2.50
Hdl Handle:
http://hdl.handle.net/10755/158311
Type:
Presentation
Title:
Characterizing pain in cognitively impaired nursing home residents
Abstract:
Characterizing pain in cognitively impaired nursing home residents
Conference Sponsor:Western Institute of Nursing
Conference Year:2003
Author:Mentes, Janet
P.I. Institution Name:University of California-Los Angeles, School of Nursing
Title:Assistant Professor
Contact Address:5-940 Factor Building, Box 956919, Provo, UT, 90095-6919, USA
Contact Telephone:310.794.7609
Co-Authors:Cadogan, M.; Teer, J.
Problem: Pain is a frequent problem among older adults. In a recent study 76% of nursing home residents had one or more pain causing diagnoses. Nursing home (NH) residents are particularly vulnerable to having pain misdiagnosed and inadequately treated because approximately 60% to 75% of nursing home residents may have cognitive impairment that can decrease their ability to effectively communicate subjective aspects of the pain experience. The purposes of this study were to ascertain the etiologies of pain in cognitively impaired (CI) nursing home (NH) residents, to identify individualized behavioral indicators of pain in CI residents, and to evaluate whether information about life-long pain behavior/expression from family members/significant others improves pain detection in CI residents. Methods: We used a descriptive observational approach to characterize the pain experience in cognitively impaired NH residents over a four month time period. Chart reviews, daily morning care observations, agitation measurements and interviews with formal caregivers (Certified nursing assistants, CNAs) and family members/significant others served as sources of data. Sample: Twenty nursing home residents, 11 Certified Nursing Assistants (CNAs) who were primarily responsible for the care of the 20 residents, and 16 family members of the residents comprised the sample for this study. NH residents had a mean age of 82 years, were 65% female, and represented the following ethnic groups: 5% Asian/Pacific Islander, 25% African American, 15% Latino, and 55% Caucasian. The CNAs had a mean 2.7 years of work experience and were 55% Latino and 45% African American. Results: Residents were extremely cognitively impaired (Mean MMSE= 8) and physically frail (90% had >3 ADL limitations). Chart review revealed that despite 95% of residents having a pain related medical diagnosis, only 55% had pain documented in a recent Minimum Data Set (MDS) or received scheduled pain medication. Conversely, 25% of residents had pain at rest and 100% had pain with movement during observations of AM care. The most frequent nonverbal indicators of pain observed during AM care included facial expressions such as grimacing (94%) and vocalizations (69%). Interviews with CNAs revealed that they most frequently use facial expression, focusing on the resident’s eyes for pain assessment. They use a multi-level approach to dealing with a resident’s pain. Family interviews uncovered residents’ previous modes of pain expression. Many family members indicated that prior to NH admission, their relative did not complain of pain or were stoic, making it hard to understand when they were in pain. Families ranged in their satisfaction with the pain management their relative received, and concurred with the CNAs that the best way to improve pain assessment was to know the resident. Implications: Results from this study indicate that pain in CI residents is still under detected. The descriptive interview data will be helpful in constructing a pain assessment guide for CI residents and lends support for the necessity of interviewing family members of residents at admission to better understand a resident’s previous mode of pain expression.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCharacterizing pain in cognitively impaired nursing home residentsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158311-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Characterizing pain in cognitively impaired nursing home residents </td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2003</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Mentes, Janet</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of California-Los Angeles, School of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">5-940 Factor Building, Box 956919, Provo, UT, 90095-6919, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">310.794.7609</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jmentes@sonnet.ucla.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Cadogan, M.; Teer, J. </td></tr><tr><td colspan="2" class="item-abstract">Problem: Pain is a frequent problem among older adults. In a recent study 76% of nursing home residents had one or more pain causing diagnoses. Nursing home (NH) residents are particularly vulnerable to having pain misdiagnosed and inadequately treated because approximately 60% to 75% of nursing home residents may have cognitive impairment that can decrease their ability to effectively communicate subjective aspects of the pain experience. The purposes of this study were to ascertain the etiologies of pain in cognitively impaired (CI) nursing home (NH) residents, to identify individualized behavioral indicators of pain in CI residents, and to evaluate whether information about life-long pain behavior/expression from family members/significant others improves pain detection in CI residents. Methods: We used a descriptive observational approach to characterize the pain experience in cognitively impaired NH residents over a four month time period. Chart reviews, daily morning care observations, agitation measurements and interviews with formal caregivers (Certified nursing assistants, CNAs) and family members/significant others served as sources of data. Sample: Twenty nursing home residents, 11 Certified Nursing Assistants (CNAs) who were primarily responsible for the care of the 20 residents, and 16 family members of the residents comprised the sample for this study. NH residents had a mean age of 82 years, were 65% female, and represented the following ethnic groups: 5% Asian/Pacific Islander, 25% African American, 15% Latino, and 55% Caucasian. The CNAs had a mean 2.7 years of work experience and were 55% Latino and 45% African American. Results: Residents were extremely cognitively impaired (Mean MMSE= 8) and physically frail (90% had &gt;3 ADL limitations). Chart review revealed that despite 95% of residents having a pain related medical diagnosis, only 55% had pain documented in a recent Minimum Data Set (MDS) or received scheduled pain medication. Conversely, 25% of residents had pain at rest and 100% had pain with movement during observations of AM care. The most frequent nonverbal indicators of pain observed during AM care included facial expressions such as grimacing (94%) and vocalizations (69%). Interviews with CNAs revealed that they most frequently use facial expression, focusing on the resident&rsquo;s eyes for pain assessment. They use a multi-level approach to dealing with a resident&rsquo;s pain. Family interviews uncovered residents&rsquo; previous modes of pain expression. Many family members indicated that prior to NH admission, their relative did not complain of pain or were stoic, making it hard to understand when they were in pain. Families ranged in their satisfaction with the pain management their relative received, and concurred with the CNAs that the best way to improve pain assessment was to know the resident. Implications: Results from this study indicate that pain in CI residents is still under detected. The descriptive interview data will be helpful in constructing a pain assessment guide for CI residents and lends support for the necessity of interviewing family members of residents at admission to better understand a resident&rsquo;s previous mode of pain expression. </td></tr></table>en_GB
dc.date.available2011-10-26T20:43:11Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:43:11Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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