PAIN IN COGNITIVELY IMPAIRED NURSING-HOME PATIENTS

Pain is an understudied problem in frail elderly patients, especially those with cognitive impairment, delirium, or dementia. The focus of t his study was to describe the pain experienced by patients in. skilled nursing homes, which have a high prevalence of cognitive impairment. A random sample of 325 subjects was selected from ten community skille d nursing homes. Subjects underwent a moss-sectional inter-view and ch art review for the prevalence of pain complaints, etiology, and pain m anagement strategies. Pain was assessed using the McGill Pain Question naire and four unidimensional scales previously utilized in younger ad ults. Thirty-three percent (33%) of subjects were excluded because the y were either comatose (21%), non-English speaking (3.7%), temporarily away (sick in hospital) (4.3%), or refused to participate (3.7%). Of 217 subjects in the final analysis, the mean age was 84.9 years, 85% w ere women, and most were dependent in all activities of daily living. Subjects demonstrated substantial cognitive impairment (mean Folstein Mini-Mental State exam score was 12.1 +/- 7.9), typically having defic its in memory, orientation, and visual spatial skills. Sixty-two perce nt reported pain complaints, mostly related to musculoskeletal and neu ropathic causes. Pain was not consistently documented in records, and pain management strategies appeared to be limited in scope and only pa rtially successful in controlling pain. None of the four unidimensiona l pain-intensity scab studied in this investigation had a higher compl etion rate than the Present Pain Intensity Scale of the McGill Pain Qu estionnaire (65% completion rate). However, 83% of subjects who had pa in could complete at least one of the scales. We conclude that cogniti ve impairment among elderly nursing home residents presents a substant ial barrier to pain assessment and management. Nonetheless, most patie nts with mild to moderate cognitive impairment can be assessed using a t least one of the available bedside assessment scales.