To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management.
Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only.
One hundred fifty-nine NHs located in France.
A subgroup of 3722 residents.
Information on pain complaint and pain-related covariates at the resident-related and at the NH level were recorded by NH staff at baseline and 18 months later. These covariates were included in a mixed-effects logistic regression on resident's pain complaint. Pain management was compared between intervention groups by chi-square tests.
A greater reduction of residents with a pain complaint after the strong intervention (odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management (47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls.
Combining educational and organizational measures, evaluating pain as a patient-reported outcome and as a process endpoint, and implementing a broad-spectrum intervention were original approaches to improve quality of care in NHs. Our results support nonspecific, collaborative, educational, and organizational interventions in NHs to decrease residents' pain complaint and improve pain management.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Prevalence of pain and pharmacological pain treatment among old people in nursing homes in 2007 and 2013.Eur J Clin Pharmacol. 2018; 74: 483-488
- Pain and pharmacologic pain management in long-stay nursing home residents.Pain. 2017; 158: 1091-1099
- Prevalence of pain in nursing home residents: The role of dementia stage and dementia subtypes.J Am Med Dir Assoc. 2017; 18: 522-527
- Pain treatment for nursing home residents differs according to cognitive state—a cross-sectional study.BMC Geriatr. 2016; 16: 124
- Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study.Pain. 2013; 154: 2427-2431
- Pain in European long-term care facilities: Cross-national study in Finland, Italy and The Netherlands.Pain. 2010; 148: 70-74
- The association between pain and measures of well-being among nursing home residents.J Am Med Dir Assoc. 2012; 13: 344-349
- Health-related profile and quality of life among nursing home residents: Does pain matter?.Pain Manag Nurs. 2013; 14: e173-e184
- Chronic pain in a sample of nursing home residents: Prevalence, characteristics, influence on quality of life (QoL).Arch Gerontol Geriatr. 2008; 47: 121-128
- Nursing sensitive quality indicators for nursing home care: International review of literature, policy and practice.Int J Nurs Stud. 2009; 46: 848-857
- Impact of revisions to the F-Tag 309 surveyors' interpretive guidelines on pain management among nursing home residents.Drugs Aging. 2012; 29: 385-393
- Implementation of a nursing home quality improvement project to reduce resident pain: A qualitative case study.J Nurs Care Qual. 2015; 30: 261-268
- Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.Geriatr Gerontol Int. 2017; 17: 1534-1543
- Translation research in long-term care: Improving pain management in nursing homes.Worldviews Evid Based Nurs. 2004; 1: S13-S20
- Interventions to address deficits of pharmacological pain management in nursing home residents—a cluster-randomized trial.Eur J Pain. 2015; 19: 1331-1341
- Pain in cognitively impaired nursing home residents: How well are physicians diagnosing it?.J Am Geriatr Soc. 2002; 50: 1039-1044
- Systematic pain assessment in nursing homes: A cluster-randomized trial using mixed-methods approach.BMC Geriatr. 2017; 17: 61
- Pain management interventions in the nursing home: A structured review of the literature.J Am Geriatr Soc. 2009; 57: 1258-1267
- Effects on pain of a stepwise multidisciplinary intervention (STA OP!) that targets pain and behavior in advanced dementia: A cluster randomized controlled trial.Palliat Med. 2018; 32: 682-692
- Pain in severe dementia: Self-assessment or observational scales?.J Am Geriatr Soc. 2006; 54: 1040-1045
- Improving palliative care through teamwork (IMPACTT) in nursing homes: Study design and baseline findings.Contemp Clin Trials. 2017; 56: 1-8
- Implementation of observational pain management protocol for residents with dementia: A cluster-RCT.J Am Geriatr Soc. 2017; 65: e56-e63
- A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: Research protocol and baseline data of the IQUARE study.J Nutr Health Aging. 2013; 17: 173-178
- Potentially inappropriate drug prescribing and associated factors in nursing homes.J Am Med Dir Assoc. 2014; 15: 850.e1-850.e9
- Organizational factors associated with inappropriate neuroleptic drug prescribing in nursing homes: A multilevel approach.J Am Med Dir Assoc. 2015; 16: 590-597
- Improving the quality of care of long-stay nursing home residents in France.J Am Geriatr Soc. 2016; 64: 193-199
- Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation.Br J Clin Pharmacol. 2016; 81: 759-767
- Mortality and antipsychotic drug use in elderly patients with Parkinson disease in nursing homes.J Am Med Dir Assoc. 2017; 18: 791-796
- The relationship between pain and disruptive behaviors in nursing home resident with dementia.BMC Geriatr. 2013; 13: 14
- Bodily pain intensity in nursing home residents with pressure ulcers: Analysis of National Minimum Data Set 3.0.Res Nurs Health. 2015; 38: 207-212
- Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes: A cross-sectional study.BMC Geriatr. 2016; 16: 154
- The quality of advanced dementia care in the nursing home: The role of special care units.Med Care. 2012; 50: 856-862
- The utility of pain assessment for analgesic use in persons with dementia.Pain. 2008; 134: 16-23
- Associations between pain and depression in nursing home patients at different stages of dementia.J Affect Disord. 2017; 218: 8-14
- Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.J Am Geriatr Soc. 2017; 65: 286-293
- Patient-reported pressure ulcer pain: A mixed-methods systematic review.J Pain Symptom Manage. 2011; 42: 443-459
- Hospice use and pain management in elderly nursing home residents with cancer.J Pain Symptom Manage. 2017; 53: 561-570
- Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: A longitudinal cohort study.Pain. 2015; 156: 675-683
- Pain trajectories of nursing home residents nearing death.J Am Med Dir Assoc. 2017; 18: 700-706
- Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: Results from the SHELTER study.Pain. 2012; 153: 305-310
- Nursing home medical staff organization: Correlates with quality indicators.J Am Med Dir Assoc. 2011; 12: 655-659
- Nursing home quality, cost, staffing, and staff mix.Gerontologist. 2004; 44: 24-38
- End-of-life care in nursing homes: A qualitative interpretive meta-synthesis.J Palliat Med. 2018; 21: 503-512
- Systematic pain assessment using an observational scale in nursing home residents with dementia: Exploring feasibility and applied interventions.J Clin Nurs. 2012; 21: 3009-3017
- Quality improvement initiative for chronic pain assessment and management in the nursing home: A pilot study.J Am Med Dir Assoc. 2006; 7: 246-253
- A quality improvement intervention to improve pain assessment and management in the nursing home setting.Gerontologist. 2011; 51: 315
- Ameliorating pain in nursing homes: A collaborative quality-improvement project.J Am Geriatr Soc. 2004; 52: 1988-1995
- A quality improvement intervention to increase palliative care in nursing homes.J Palliat Med. 2005; 8: 576-584
- Interventions for the treatment of pain in nursing home residents: A systematic review and meta-analysis.J Am Med Dir Assoc. 2016; 17: 1163.e19-1163.e28
- Pain and its treatment in older nursing home hospice/palliative care residents.J Am Med Dir Assoc. 2010; 11: 579-583
The authors declare no conflicts of interest.
The IQUARE study was funded by a grant from the Regional Agency of Health of the Midi-Pyrénées region (Agence Régionale de Santé–Midi-Pyrénées). The funder contributed to data collection. The funder had no influence on the analysis and interpretation of data, or on the preparation, review, or approval of the manuscript.
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.