Nonmalignant Pain Symptom Subgroups in Nursing Home Residents.
Nonmalignant Pain Symptom Subgroups in Nursing Home Residents.
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疗养院居民的非恶性疼痛症状亚组。
DOI：
10.1016/j.jpainsymman.2018.11.023
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发表时间：
2019
影响因子：
4.7
通讯作者：
Lapane,KateL
中科院分区：
文献类型：
--
作者：
Ulbricht,ChristineM;Hunnicutt,JacobN;Gambassi,Giovanni;Hume,AnneL;Lapane,KateL
尽管许多养老院的居民经历疼痛，关于这些居民的非恶性疼痛的多维性质的研究是缺乏的。目的识别和描述疼痛症状亚组，并评估亚组是否存在性别差异。方法采用最小数据集3.0 （Minimum Data Set 3.0）数据（2011-2012年），选取报告疼痛的新入院养老院居民（n= 119,379）。潜在分类分析包括13个指标：疼痛标记（即严重程度、频率、影响睡眠和功能）和抑郁症状。性别作为分组变量进行评估。多项逻辑模型确定了潜在类别成员和协变量（包括年龄和认知障碍）之间的关联。结果发现4个潜在亚组：重度（15.2%）、中度频繁（26.4%）、中度偶发伴抑郁症状（26.4%）和中度偶发无抑郁症状（32.0%）。排除了性别的测量不变性。抑郁情绪、睡眠障碍和疲劳是不同的亚组。年龄≥75岁与属于重度、中度频繁或中度偶尔伴有抑郁症状亚组呈负相关。有严重认知障碍的住院医师加入严重疼痛亚组的几率降低（调整比值比[aOR]: 0.84； 95%可信区间[CI]: 0.78-0.90）和中度频繁疼痛亚组（aOR: 0.60; 95% CI: 0.56-0.64），但加入中度偶尔疼痛伴抑郁症状亚组的几率增加（aOR: 1.12; 95% CI: 1.06-1.18）。结论区分不同疼痛和抑郁症状模式的住院医师亚组，强调需要考虑疼痛的生理和心理因素。扩大疼痛症状亚群的知识可能为改善养老院居民的疼痛管理提供一个有希望的途径。
ContextDespite many nursing home residents experiencing pain, research about the multidimensional nature of nonmalignant pain in these residents is scant.ObjectivesTo identify and describe pain symptom subgroups and to evaluate whether subgroups differed by sex.MethodsUsing Minimum Data Set 3.0 data (2011-2012), we identified newly admitted nursing home residents reporting pain (n= 119,379). A latent class analysis included 13 indicators: markers for pain (i.e., severity, frequency, impacts sleep, and function) and depressive symptoms. Sex was evaluated as a grouping variable. Multinomial logistic models identified the association between latent class membership and covariates, including age and cognitive impairment.ResultsFour latent subgroups were identified: severe (15.2%), moderate frequent (26.4%), moderate occasional with depressive symptoms (26.4%), and moderate occasional without depressive symptoms (32.0%). Measurement invariance by sex was ruled out. Depressed mood, sleep disturbances, and fatigue distinguished subgroups. Age ≥75 years was inversely associated with belonging to the severe, moderate frequent, or moderate occasional with depressive symptoms subgroups. Residents with severe cognitive impairment had reduced odds of membership in the severe pain subgroup (adjusted odds ratio [aOR]: 0.84; 95% confidence interval [CI]: 0.78-0.90) and moderate frequent pain subgroup (aOR: 0.60; 95% CI: 0.56-0.64) but increased odds in the moderate occasional pain with depressive symptoms subgroup (aOR: 1.12; 95% CI: 1.06-1.18).ConclusionIdentifying subgroups of residents with different patterns of pain and depressive symptoms highlights the need to consider physical and psychological components of pain. Expanding knowledge about pain symptom subgroups may provide a promising avenue to improve pain management in nursing home residents.