Pain in nursing home residents: An exploration of prevalence, staff perspectives, and practical aspects of measurement

Objective: To help rectify the underdiagnosis of chronic pain in frail nurs ing home residents by developing a new feasible pain self-report instrument , the structured pain interview; to use this new tool to estimate pain prev alence and staff's knowledge of residents' pain in two nursing homes; and t o compare the performance differences of the structured pain interview and the commonly used 0-10 stale. Design: Cross-sectional survey. Setting: One 120-bed VA-affiliated and one 125-bed university-affiliated, c ommunity-based nursing home in Durham, North Carolina. Patients: One hundred fifty-eight chronic care nursing home residents witho ut aphasia, acute illness, persistent vegetative status, or severe hearing impairment and 31 nursing home nurses. Outcome Measures: Pain prevalence according to resident self-report and nur se report; stability of response to the structured pain interview and 0-10 scale over 1 month; agreement between residents and nurses on the structure d pain interview and 0-10 scale. Results: Fifty-eight percent of the VA and 45% of the community nursing hom e residents reported pain. Forty-two percent at the VA and 20% at the commu nity home were unable to respond to the 0-10 scale, compared with 7.5% and 14% using the structured pain interview. Stability of response to the struc tured pain interview at I month was 0.56 at the VA (nurse-resident agreemen t 0.38) and 0.72 in the community (nurse-resident agreement 0.07), which wa s very comparable to the 0-10 scale. Conclusions: We have developed a highly feasible tool for examining pain pr evalence in nursing homes. This tool uncovered considerable miscommunicatio n regarding pain between residents and staff. Improvement in pain communica tion between nursing home residents and staff is needed, so that more effec tive pain treatment programs can be developed for this vulnerable populatio n.