Advertisement

Prevalence and Factors Associated with Pain in Nursing Home Residents: A Systematic Review of the Literature

Published:September 23, 2022DOI:https://doi.org/10.1016/j.jamda.2022.08.008

      Abstract

      Objectives

      To describe the pain prevalence in nursing home (NH) residents and the factors associated with the experience of pain.

      Design

      Systematic review of descriptive studies.

      Setting and Participants

      Three electronic databases were searched from 2010 to September 2020 in English. Descriptive studies that examined pain in NH residents, reported pain prevalence, and/or associated factors were included. Studies that focused exclusively on a specific disease or type of care such as cancer or hospice were excluded.

      Methods

      Two reviewers independently screened, selected, extracted data, and assessed risk of bias from included studies; narrative synthesis was performed. The review was guided by the Biopsychosocial Model of Chronic Pain for Older Adults.

      Results

      Twenty-six studies met our inclusion criteria. Overall, the prevalence of current pain ranged from 22.2% to 85.0%, the prevalence of persistent pain ranged from 19.5% to 58.5%, and the prevalence of chronic pain ranged from 55.9% to 58.1%. A variety of pain scales were used reporting higher pain prevalence for those using self-report measures (31.8% to 78.8%) or proxy measures (29.5% to 85.0%) compared with using chart review (22.2% to 29.3%) as the source of pain information. The studies reviewed provide support that certain diseases and clinical conditions are associated with pain. Impairment in activities of daily living (ADL) (12 studies), cognition (9 studies), depression (9 studies), and arthritis (9 studies) are the most widely studied factors, whereas depression, ADL impairment, arthritis, dementia, and cognitive impairment present the strongest association with pain.

      Conclusion and Implications

      This review highlights the complexities of pain in NH residents and has implications for both clinical practice and future research. Understanding the factors that underlie the experience of pain, such as depression, is useful for clinicians evaluating pain and tailoring management therapies. In addition, the gaps in knowledge uncovered in this review are important areas for future research.

      Keywords

      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
      Institutional Access: Sign in to ScienceDirect

      References

        • Tse M.M.Y.
        • Wan V.T.C.
        • Vong S.K.S.
        Health-related profile and quality of life among nursing home residents: does pain matter?.
        Pain Manag Nurs. 2013; 14: e173-e184
        • Lapane K.L.
        • Quilliam B.J.
        • Chow W.
        • Kim M.
        The association between pain and measures of well-being among nursing home residents.
        J Am Med Dir Assoc. 2012; 13: 344-349
        • Tarakcı E.
        • Zenginler Y.
        • Kaya Mutlu E.
        Chronic pain, depression symptoms and daily living independency level among geriatrics in nursing home.
        Agri. 2015; 27: 35-41
        • Achterberg W.P.
        • Gambassi G.
        • Finne-Soveri H.
        • et al.
        Pain in European long-term care facilities: cross-national study in Finland, Italy and the Netherlands.
        Pain. 2010; 148: 70-74
        • Horgas A.L.
        Pain assessment in older adults.
        Nurs Clin North Am. 2017; 52: 375-385
        • Torvik K.
        • Kaasa S.
        • Kirkevold O.
        • Rustøen T.
        Pain and quality of life among residents of Norwegian nursing homes.
        Pain Manag Nurs. 2010; 11: 35-44
        • Patel K.V.
        • Guralnik J.M.
        • Dansie E.J.
        • Turk D.C.
        Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study.
        Pain. 2013; 154: 2649-2657
        • Harris-Kojetin L.D.
        • Sengupta M.
        • Lendon J.
        • Rome V.
        • Valverde R.
        • Caffrey C.
        Series 3, Number 43, Long-term care providers and service users in the United States, 2015–2016.
        National Center for Health Statistics, Vital and Health Statistics, 2019
        • Centers for Medicare and Medicaid Services
        Nursing Home Data Compendium 2015 Edition.
        Department of Health and Human Services, 2015: 1-251
        • Institute of Medicine
        Relieving pain in America: a blueprint for transforming prevention, care, education, and research.
        National Academies Press, 2011
        • Scher C.
        • Meador L.
        • Van Cleave J.H.
        • Reid M.C.
        Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st century.
        Pain Manag Nurs. 2018; 19: 125-129
        • Kang Y.
        • Demiris G.
        Self-report pain assessment tools for cognitively intact older adults: integrative review.
        Int J Older People Nurs. 2018; 13: e12170
        • Booker S.Q.
        • Herr K.A.
        • Horgas A.L.
        A paradigm shift for movement-based pain assessment in older adults: practice, policy and regulatory drivers.
        Pain Manag Nurs. 2021; 22: 21-27
        • Herr K.
        • Sefcik J.S.
        • Neradilek M.B.
        • Hilgeman M.M.
        • Nash P.
        • Ersek M.
        Psychometric Evaluation of the MOBID Dementia Pain Scale in U.S. Nursing Homes.
        Pain Manag Nurs. 2019; 20: 253-260
        • Herr K.
        • Coyne P.J.
        • Ely E.
        • Gélinas C.
        • Manworren R.C.B.
        Pain assessment in the patient unable to self-report: clinical practice recommendations in support of the ASPMN 2019 position statement.
        Pain Manag Nurs. 2019; 20: 404-417
        • Centers for Medicare and Medicaid Services
        MDS 3.0 Quality Measures User’s Manual.
        Department of Health and Human Services, 2016
        • Boerlage A.A.
        • Masman A.D.
        • Hagoort J.
        • Tibboel D.
        • Baar F.P.M.
        • van Dijk M.
        Is pain assessment feasible as a performance indicator for Dutch nursing homes? A cross-sectional approach.
        Pain Manag Nurs. 2013; 14: 36-40
        • Saliba D.
        • Jones M.
        • Streim J.
        • Ouslander J.
        • Berlowitz D.
        • Buchanan J.
        Overview of significant changes in the Minimum Data Set for nursing homes version 3.0.
        J Am Med Dir Assoc. 2012; 13: 595-601
        • Centers for Medicare and Medicaid Services
        State Operations Manual: Appendix PP - Guidance to Surveyors for Long Term Care.
        Department of Health and Human Services, 2017
        • Lapane K.L.
        • Quilliam B.J.
        • Chow W.
        • Kim M.S.
        Impact of revisions to the F-Tag 309 surveyors' interpretive guidelines on pain management among nursing home residents.
        Drugs Aging. 2012; 29: 385-393
        • Centers for Medicare and Medicaid Services
        Revised quality of care guidance at F309, including pain management as part of appendix PP SOM.
        • Centers for Medicare and Medicaid Services
        List of revised FTags.
        • Takai Y.
        • Yamamoto-Mitani N.
        • Okamoto Y.
        • Koyama K.
        • Honda A.
        Literature review of pain prevalence among older residents of nursing homes.
        Pain Manag Nurs. 2010; 11: 209-223
        • Page M.J.
        • Moher D.
        • Bossuyt P.M.
        • et al.
        PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews.
        BMJ. 2021; 372: n160
        • Munn Z.
        • Moola S.
        • Lisy K.
        • Riitano D.
        • Tufanaru C.
        Methodological guidance for systematic reviews of observational epidemiological studies reporting revalence and incidence data.
        Int J Evid Based Healthc. 2015; 13: 147-153
        • Miaskowski C.
        • Blyth F.
        • Nicosia F.
        • et al.
        A biopsychosocial model of chronic pain for older adults.
        Pain Med. 2020; 21: 1793-1805
        • Tse M.M.Y.
        • Wan V.T.C.
        • Ho S.S.K.
        Profile of pain and use of pharmacological and non-pharmacological methods for relieving pain in older persons in nursing homes.
        J Pain Manag. 2010; 3: 309-317
        • Tse M.
        • Leung R.
        • Ho S.
        Pain and psychological well-being of older persons living in nursing homes: an exploratory study in planning patient-centred intervention.
        J Adv Nurs. 2012; 68: 312-321
        • Tse M.M.Y.
        • Vong S.K.S.
        Pain beliefs and pain-related profiles of older persons living in nursing homes.
        J Pain Manag. 2012; 5: 141-151
        • Lukas A.
        • Mayer B.
        • Fialová D.
        • et al.
        Pain characteristics and pain control in European nursing homes: cross-sectional and longitudinal results from the Services and Health for Elderly in Long TERm care (SHELTER) study.
        J Am Med Dir Assoc. 2013; 14: 421-428
        • Takai Y.
        • Yamamoto-Mitani N.
        • Chiba Y.
        • Nishikawa Y.
        • Sugai Y.
        • Hayashi K.
        Prevalence of pain among residents in Japanese nursing homes: a descriptive study.
        Pain Manag Nurs. 2013; 14: e1-e9
        • Barbosa M.H.
        • Bolina A.F.
        • Tavares J.L.
        • de Carvalho Cordeiro A.L.P.
        • Luiz R.B.
        • de Oliveira K.F.
        Sociodemographic and health factors associated with chronic pain in institutionalized elderly.
        Rev Lat Am Enfermagem. 2014; 22: 1009-1016
        • Takai Y.
        • Yamamoto-Mitani N.
        • Ko A.
        Prevalence of and factors related to pain among elderly Japanese residents in long-term healthcare facilities.
        Geriatr Gerontol Int. 2014; 14: 481-489
        • Shen X.
        • Zuckerman I.H.
        • Palmer J.B.
        • Stuart B.
        Trends in prevalence for moderate-to-severe pain and persistent pain among Medicare beneficiaries in nursing homes, 2006–2009.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 598-603
        • Bauer U.
        • Pitzer S.
        • Schreier M.M.
        • Osterbrink J.
        • Alzner R.
        • Iglseder B.
        Pain treatment for nursing home residents differs according to cognitive state - a cross-sectional study.
        BMC Geriatr. 2016; 16: 124
        • Björk S.
        • Juthberg C.
        • Lindkvist M.
        • et al.
        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
        • Tan E.C.
        • Visvanathan R.
        • Hilmer S.N.
        • et al.
        Analgesic use and pain in residents with and without dementia in aged care facilities: a cross-sectional study.
        Australas J Ageing. 2016; 35: 180-187
        • Tse M.M.Y.
        • Lai C.
        • Lui J.Y.W.
        • Kwong E.
        • Yeung S.Y.
        Frailty, pain and psychological variables among older adults living in Hong Kong nursing homes: can we do better to address multimorbidities?.
        J Psychiatr Ment Health Nurs. 2016; 23: 303-311
        • Hunnicutt J.N.
        • Ulbricht C.M.
        • Tjia J.
        • Lapane K.L.
        Pain and pharmacologic pain management in long-stay nursing home residents.
        Pain. 2017; 158: 1091-1099
        • Xu Y.
        • Jiang N.
        • Wang Y.
        • Zhang Q.
        • Chen L.
        • Ma S.
        Pain perception of older adults in nursing home and home care settings: evidence from China.
        BMC Geriatr. 2018; 18: 152
        • Altintas H.K.
        • Aslan G.K.
        • Sısman N.Y.
        • Kesgin M.T.
        Effects of pain and sleep quality on falls among nursing home residents in Turkey.
        Res Gerontol Nurs. 2018; 11: 257-264
        • Auer S.R.
        • Linsmayer E.
        • Prieschl D.
        • et al.
        Cross-sectional study of prevalence of dementia, behavioural symptoms, mobility, pain and other health parameters in nursing homes in Austria and the Czech Republic: results from the DEMDATA project.
        BMC Geriatr. 2018; 18: 1-13
        • Hemmingsson E.S.
        • Gustafsson M.
        • Isaksson U.
        • et al.
        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
        • Brennan P.L.
        • Greenbaum M.A.
        • Lemke S.
        • Schutte K.K.
        Mental health disorder, pain, and pain treatment among long-term care residents: evidence from the Minimum Data Set 30.
        Aging Ment Health. 2019; 23: 1146-1155
        • Bae S.H.
        • Lee S.
        • Kim H.
        Extent of and factors associated with pain among older residents in nursing homes in South Korea: a nationwide survey study.
        Geriatr Gerontol Int. 2020; 20: 118-124
        • Hoedl M.
        • Bauer S.
        The relationship between care dependency and pain in nursing home residents.
        Arch Gerontol Geriatr. 2020; 90: 104166
        • Warden V.
        • Hurley A.C.
        • Volicer L.
        Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale.
        J Am Med Dir Assoc. 2003; 4: 9-15
        • Closs S.J.
        • Barr B.
        • Briggs M.
        • Cash K.
        • Seers K.
        A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment.
        J Pain Symptom Manag. 2004; 27: 196-205
        • Hawker G.A.
        • Mian S.
        • Kendzerska T.
        • French M.
        Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).
        Arthritis Care Res. 2011; 63: S240-S252
        • Morris J.N.
        • Hawes C.
        • Fries B.E.
        • et al.
        Designing the national resident assessment instrument for nursing homes.
        Gerontologist. 1990; 30: 293-307
        • Morris J.
        • Murphy K.
        • Nonemaker S.
        Long term care facility Reident Assessment Instrument (RAI) user's manual version 2.0.
        HCFA, 1995
        • Onder G.
        • Carpenter I.
        • Finne-Soveri H.
        • et al.
        Assessment of nursing home residents in Europe: the Services and Health for Elderly in Long TERm care (SHELTER) study.
        BMC Health Serv Res. 2012; 12: 5
        • Saliba D.
        • Buchanan J.
        Making the investment count: revision of the Minimum Data Set for nursing homes, MDS 3.0.
        J Am Med Dir Assoc. 2012; 13: 602-610
        • Herr K.
        • Spratt K.F.
        • Garand L.
        • Li L.
        Evaluation of the Iowa pain thermometer and other selected pain intensity scales in younger and older adult cohorts using controlled clinical pain: a preliminary study.
        Pain Med. 2007; 8: 585-600
        • Abbey J.
        • Piller N.
        • De Bellis A.
        • et al.
        The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia.
        Int J Palliat Nurs. 2004; 10: 6-13
        • Herr K.A.
        • Mobily P.R.
        • Kohout F.J.
        • Wagenaar D.
        Evaluation of the Faces Pain Scale for use with the elderly.
        Clin J Pain. 1998; 14: 29-38
        • Cadogan M.P.
        • Schnelle J.F.
        • Yamamoto-Mitani N.
        • Cabrera G.
        • Simmons S.F.
        A minimum data set prevalence of pain quality indicator: is it accurate and does it reflect differences in care processes?.
        J Gerontol A Biol Sci Med Sci. 2004; 59: 281-285
        • Taylor L.J.
        • Harris J.
        • Epps C.D.
        • Herr K.
        Psychometric evaluation of selected pain intensity scales for use with cognitively impaired and cognitively intact older adults.
        Rehabil Nurs. 2005; 30: 55-61
        • Kim H.
        • Jung Y.I.
        • Sung M.
        • Lee J.Y.
        • Yoon J.Y.
        • Yoon J.L.
        Reliability of the interRAI Long Term Care Facilities (LTCF) and interRAI Home Care (HC).
        Geriatr Gerontol Int. 2015; 15: 220-228
        • Poss J.W.
        • Jutan N.M.
        • Hirdes J.P.
        • et al.
        A review of evidence on the reliability and validity of Minimum Data Set data.
        Healthc Manage Forum. 2008; 21: 33-39
        • Nekovarova T.
        • Yamamotova A.
        • Vales K.
        • Stuchlik A.
        • Fricova J.
        • Rokyta R.
        Common mechanisms of pain and depression: are antidepressants also analgesics?.
        Front Behav Neurosci. 2014; 8: 99
        • Arnstein P.
        • Herr K.A.
        • Butcher H.K.
        Evidence-based practice guideline: persistent pain management in older adults.
        J Gerontol Nurs. 2017; 43: 20-31
        • Fine P.G.
        Treatment guidelines for the pharmacological management of pain in older persons.
        Pain Med. 2012; 13: S57-S66
        • Wu N.
        • Miller S.C.
        • Lapane K.
        • Roy J.
        • Mor V.
        Impact of cognitive function on assessments of nursing home residents' pain.
        Med Care. 2005; 43: 934-939
        • Ersek M.
        • Nash P.V.
        • Hilgeman M.M.
        • et al.
        Pain patterns and treatment among nursing home residents with moderate-severe cognitive impairment.
        J Am Geriatr Soc. 2020; 68: 794-802
        • Dube C.E.
        • Morrison R.A.
        • Mack D.S.
        • et al.
        Prevalence of pain on admission by level of cognitive impairment in nursing homes.
        J Pain Res. 2020; 13: 2663-2672