Association Between Documented Severe Pain and Cognitive Impairment in Home Health Care Patients: Results from the National Outcome and Assessment Information Set Data.
Association Between Documented Severe Pain and Cognitive Impairment in Home Health Care Patients: Results from the National Outcome and Assessment Information Set Data.
复制标题
家庭保健患者记录的严重疼痛与认知障碍之间的关联：来自国家结果和评估信息集数据的结果。
DOI：
10.1089/jpm.2023.0016
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发表时间：
2023
影响因子：
2.8
通讯作者：
Reckrey,JenniferM
中科院分区：
文献类型：
--
作者：
Osakwe,ZainabToteh;Calixte,Rose;Bubu,OmonighoMichael;Reckrey,JenniferM
背景：尽管家庭医疗保健（HHC）在老年人认知障碍护理中的重要性日益增加，但有关接受HHC.Methods的老年人中记录的严重疼痛相关因素的证据有限：该二级数据分析使用了2017年国家结果和评估信息集（OASIS）数据的5%随机国家样本。多变量Poisson回归模型被用来研究记录的严重疼痛，认知功能障碍，和一系列的社会人口，临床和认知factors.Results：HHC患者（n= 183,038）的平均年龄79.7岁，61.7%的女性，和78.6%的非西班牙裔白色之间的关联。在多变量模型中，认知障碍与记录的重度疼痛的可能性较低相关（患病率[PR] = 0.96，置信区间[CI] = [0.94-0.98]）。与记录较少的严重疼痛独立相关的其他因素包括西班牙裔（PR = 0.92，CI = [0.89-0.95]），年龄最大（≥85岁）组（PR = 0.65，CI = [0.63-0.66]），男性患者（PR = 0.83，CI = [0.82-0.85]），正式诊断为阿尔茨海默病相关痴呆的患者（PR = 0.67，CI = [0.65-0.69]），以及言语和言语相关困难患者（PR = 0.83，CI = [0.80-0.86]）。有福尔斯史的患者（PR = 1.18，CI = [1.16-1.20]），患者健康问卷-2的阳性筛选（PR = 1.36，CI = [1.31-1.41]），呼吸短促（PR = 1.14，CI = [1.12-1.14]），每日焦虑（PR = 1.16，CI = [1.14-1.18]），每天或更频繁地焦虑（PR = 1.40，CI = [1.37-1.43]）更可能有记录的严重疼痛。即使考虑了一系列社会人口统计学、临床、功能和认知特征，认知障碍的HHC患者也不太可能记录到重度疼痛。这些发现可能反映了认知障碍之间的联系，错过了临床医生提供疼痛管理的机会。需要量身定制的干预措施，以更好地评估和管理HHC患者这一弱势群体的疼痛。
Background:Despite the growing importance of home health care (HHC) in the care of older adults with cognitive impairment, limited evidence exists about factors associated with documented severe pain among older adults receiving HHC.Methods:This secondary data analysis used a 5% random national sample of the 2017 national Outcome and Assessment Information Set (OASIS) data. Multivariable Poisson regression model was used to examine the association between documented severe pain, cognitive impairment, and a range of sociodemographic, clinical, and cognitive factors.Results:HHC patients (n= 183,038) were mean age 79.7 years, 61.7% female, and 78.6% non-Hispanic White. In multivariable models, cognitive impairment was associated with lower likelihood of documented severe pain (prevalence ratio [PR] = 0.96, confidence interval [CI] = [0.94–0.98]). Other factors independently associated with less documented severe pain included Hispanic ethnicity (PR = 0.92, CI = [0.89–0.95]), the oldest (≥85 years) groups (PR = 0.65, CI = [0.63–0.66]), male patients (PR = 0.83, CI = [0.82–0.85]), those with a formal diagnosis of Alzheimer's Disease Related Dementias (PR = 0.67, CI = [0.65–0.69]), and patients with verbal- and speech-related difficulty (PR = 0.83, CI = [0.80–0.86]). Patients with history of falls (PR = 1.18, CI = [1.16–1.20]), positive screen on the Patient Health Questionnaire-2 (PR = 1.36, CI = [1.31–1.41]), shortness of breath (PR = 1.14, CI = [1.12–1.14]), anxiety daily (PR = 1.16, CI = [1.14–1.18]), and anxiety daily or more often (PR = 1.40, CI = [1.37–1.43]) were more likely to have documented severe pain.Conclusions:HHC patients with cognitive impairment were less likely to have documented severe pain even with a range of sociodemographic, clinical, functional, and cognitive characteristics were considered. These findings may reflect a link between cognitive impairment missed opportunities for clinicians to provide pain management. Tailored interventions are needed to better assess and manage pain in this vulnerable group of HHC patients.