Pain trajectories of nursing home residents.
Pain trajectories of nursing home residents.
复制标题
疗养院居民的疼痛轨迹。
DOI：
10.1111/jgs.18182
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发表时间：
2023
影响因子：
6.3
通讯作者：
Hickman,SusanE
中科院分区：
文献类型：
--
作者：
Cole,ConnieS;Carpenter,JanetS;Blackburn,Justin;Chen,ChenX;Jones,BobbyL;Hickman,SusanE
背景了解疗养院 (NH) 居民疼痛随时间的变化将提供更明智的视角，从而有机会改变病程、计划护理和确定优先事项。因此，本分析的目的是识别和描述 NH 住院医师有临床意义的动态疼痛轨迹。方法对住院时间 > 100 天的 NH 住院医师疼痛评分进行回顾性纵向分析 (N = 4864)。基于组的轨迹建模应用于最小数据集 3.0 评估，以识别疼痛轨迹。然后使用居民人口统计和临床特征与其疼痛轨迹之间未经调整和调整的横截面关联来表征轨迹。结果我们确定了四种不同的轨迹：（1）持续疼痛消失（48.9％），（2）疼痛减少-增加（21.8％），（3）疼痛增加-减少（15.3％），（4）持续性疼痛存在（14.0％）。年轻的人口统计数据和生活在农村地区与持续疼痛的存在轨迹相关。肥胖和完整认知的临床变量与持续疼痛存在轨迹相关。任何一个轨迹组中都有较小比例的中度或重度认知受损的居民出现疼痛。结论我们确定并描述了 NH 居民的四种疼痛轨迹，包括与人口特征（年轻、女性、农村）和临床因素（肥胖、骨折、挛缩）相关的持续性疼痛。此外，被诊断患有阿尔茨海默病或痴呆症的居民不太可能处于这三种疼痛轨迹中的任何一种，这可能代表了评估这些居民的疼痛的困难。重要的是，NH 工作人员了解、认识和应对与已确定的疼痛轨迹相关的因素，以改善潜在持续性疼痛（例如髋部骨折、挛缩）的缓解，或提高有疼痛报告不足风险的居民（例如阿尔茨海默病）的代理疼痛评估技能。
BackgroundUnderstanding changes in nursing home (NH) resident pain over time would provide a more informed perspective, allowing opportunities to alter the course of illness, plan care, and set priorities. Therefore, the purpose of this analysis was to identify and characterize clinically meaningful, dynamic pain trajectories in NH residents.MethodsRetrospective longitudinal analysis of NH resident pain scores with a length of stay >100 days (N= 4864). Group‐based trajectory modeling was applied to Minimum Data Set 3.0 assessments to identify pain trajectories. Trajectories were then characterized using unadjusted and adjusted cross‐sectional associations between residents' demographic and clinical characteristics and their pain trajectory.ResultsWe identified four distinct trajectories: (1) consistent pain absence (48.9%), (2) decreasing‐increasing pain presence (21.8%), (3) increasing‐decreasing pain presence (15.3%), and (4) persistent pain presence (14.0%). Demographics of younger age and living in a rural area were associated with the persistent pain presence trajectory. Clinical variables of obesity and intact cognition were associated with being in the persistent pain presence trajectory. A smaller proportion of residents with moderately or severely impaired cognition were in any of the trajectory groups with pain.ConclusionsWe identified and characterized four pain trajectories among NH residents, including persistent pain presence which was associated with demographic characteristics (younger, female, rural) and clinical factors (obese, fracture, contracture). Moreover, residents with a diagnosis of Alzheimer's disease or dementia were less likely to be in any of the three trajectories with pain, likely representing the difficulty in evaluating pain in these residents. It is important that NH staff understand, recognize, and respond to the factors associated with the identified pain trajectories to improve mitigation of potentially persistent pain (e.g., hip fracture, contracture) or improve proxy pain assessment skills for residents at risk for under reporting of pain (e.g., Alzheimer's Disease).