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Non-malignant Pain in Nursing Home Residents

疗养院居民的非恶性疼痛

基本信息

批准号：
10204112
负责人：
Kate L Lapane
金额：
$ 51.72万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-25 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10204112
关键词：
Address Adverse effects Adverse event Affect Age-Years Aging Americas Analgesics Anxiety Area Arthritis Benefits and Risks Big Data Caring Characteristics Clinical Clinical Practice Guideline Clinical Trials Comparative Effectiveness Research Complex Constipation Data Data Set Databases Discipline of Nursing Disease Drug Prescriptions Drug Side Effects Elderly Eligibility Determination Ensure Event Fatigue Fracture Funding Future Geriatric Nursing Geriatrics Hand Health High Prevalence Home Hospitalization Impaired cognition Incidence Individual Institute of Medicine (U.S.)Intervention Knowledge Lead Literature Malignant Neoplasms Measurement Medical Medicare Medicare claim Medicare/Medicaid Medication Management Mental Depression Methodology Methods Modeling Musculoskeletal National Institute of Nursing Research Non-Malignant Nursing Homes Outcome Pain Pain Measurement Pain Research Pain management Patients Persons Pharmaceutical Preparations Pharmacology Pharmacy facility Population Public Health Quality of life Regimen Reporting Research Research Design Risk Science Sensory Sleep disturbances Source Statistical Methods Statistical Models Structural Models Subgroup Symptoms Techniques Technology Update Validation Work associated symptom base clinically relevant comorbidity comparative effectiveness comparative effectiveness study crosslink daily pain disability end of life care experience falls gastrointestinal improved individualized medicine insight multidisciplinary novel pain relief pain symptom personalized medicine pharmacokinetics and pharmacodynamics repository safety study symptom cluster symptom management symptom science

项目摘要

PROJECT SUMMARY/ABSTRACT This application responds to PA-16-188 "Mechanisms, Models, Measurement, & Management in Pain Research (R01)". Pain management in nursing homes is sub-optimal. Sixty-two percent of nursing home residents experience pain. Although cancer is an important reason for pain in nursing homes, arthritis and musculoskeletal problems affect over three quarters of persons over 65 years of age. Despite the high prevalence of painful conditions experienced by nursing home residents, non-malignant pain in nursing homes has not been thoroughly studied. Pain is seldom an isolated symptom and is often associated with/accompanied by other symptoms in common clusters. We do know that pain is under-reported in nursing homes and when documented, its treatment is often suboptimal. For nursing home residents, a “geriatric pharmacoparadox” exists – i.e., despite the growing population and the high burden of medication use, geriatric nursing home residents are systematically excluded from clinical trials. The resulting dearth of information requires rigorous non-experimental study designs to quantify the risks and benefits of medication use. This study extends the literature in two ways. First, it seeks to improve measurement of pain. Second, with improved measurement in hand, it seeks to expand knowledge on how best to relieve pain using pharmacologic approaches. This application builds on previous and ongoing work conducted by our team. We are currently working on characterizing non-malignant pain symptom clusters (cross-sectional and longitudinal) using latent variable modeling approaches. The work proposed in this application will further refine these models using a contemporaneous dataset. We will update our in-house data set to include the most recent data available (the Minimum Data Set 3.0 (MDS) and Medicare eligibility and claims data (Part A & D)). The specific aims are to: 1) Validate pain symptom clusters in current data; 2) Describe correlates of pain symptom clusters; 3) Describe analgesic use by pain symptom clusters; and 4) Quantify the extent to which medications are associated with outcomes such as improvements in pain and adverse events (e.g. falls/fractures, hospitalizations). Advanced statistical techniques including latent variable models, marginal structural models, and quantile regression will be used. Untreated, potentially undertreated and inappropriately treated non- malignant pain remains common in the nursing home setting. Non-malignant pain, and how best to relieve it, is understudied in the nursing home setting. This is a novel area of exploration that will provide needed information to form the basis of effective clinical strategies to improve non-malignant pain management in nursing homes.

项目概要/摘要该应用程序响应 PA-16-188“疼痛的机制、模型、测量和管理” 研究（R01）”。疗养院的疼痛管理效果不佳。62% 的疗养院居民经历痛苦。尽管癌症是疗养院疼痛的一个重要原因，但关节炎和肌肉骨骼问题影响超过四分之三的 65 岁以上老年人。尽管高疗养院居民经历的疼痛状况的发生率，疗养院中的非恶性疼痛还没有被彻底研究过。疼痛很少是一种孤立的症状，而且常常是相关的伴有/伴有常见集群中的其他症状。我们确实知道护理中疼痛的报告不足当有记录时，其治疗往往不是最理想的。对于疗养院居民来说，“老年病 “药物悖论”的存在——即，尽管人口不断增长且药物使用负担沉重，老年疗养院居民被系统地排除在临床试验之外。由此造成的缺乏信息需要严格的非实验研究设计来量化药物的风险和益处使用。这项研究以两种方式扩展了文献。首先，它寻求改进疼痛测量。第二，通过改进现有的测量方法，它旨在扩展有关如何最好地缓解疼痛的知识药理学方法。该应用程序建立在我们团队之前和正在进行的工作的基础上。我们目前正在研究非恶性疼痛症状群的特征（横截面和纵向）使用潜变量建模方法。本申请中提出的工作将进一步完善这些使用同期数据集的模型。我们将更新我们的内部数据集以包括最新的可用数据（最低数据集 3.0 (MDS) 以及 Medicare 资格和索赔数据（A 和 D 部分））。这具体目标是： 1) 验证当前数据中的疼痛症状群； 2) 描述疼痛症状的相关因素集群； 3) 描述按疼痛症状群使用的止痛药； 4) 量化药物治疗的程度与疼痛改善和不良事件（例如跌倒/骨折、住院治疗）。先进的统计技术，包括潜变量模型、边际结构模型、并将使用分位数回归。未经治疗、可能治疗不足和治疗不当的非恶性疼痛在疗养院环境中仍然很常见。非恶性疼痛以及如何最好地缓解它是在疗养院环境中学习。这是一个新的探索领域，将提供所需的信息构成有效临床策略的基础，以改善非恶性疼痛管理疗养院。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Nonmalignant Pain Symptom Subgroups in Nursing Home Residents.

疗养院居民的非恶性疼痛症状亚组。

DOI：
10.1016/j.jpainsymman.2018.11.023
发表时间：
2019
期刊：
Journal of pain and symptom management
影响因子：
4.7
作者：
Ulbricht,ChristineM;Hunnicutt,JacobN;Gambassi,Giovanni;Hume,AnneL;Lapane,KateL
通讯作者：
Lapane,KateL

Heart failure among US nursing home residents with diabetes mellitus.