Effects of Mental Health Disorders on Pain Monitoring and Treatment in VA CLCs

描述（由申请人提供）： 本项目的目的是使用纵向最小数据集（MDS 3.0）居民评估数据，以确定老年人的心理健康障碍，特别是他们的抑郁症和临床显著抑郁症，对他们作为VA社区生活中心（VA CLC）居民接受疼痛治疗的类型和结果的影响。有效的疼痛治疗是整个VA医疗保健系统的关键目标，特别是在VA CLC中。CLC居民是一个弱势群体，他们的健康和功能特点限制了他们成功启动和持续努力，以获得有效治疗继承人疼痛的能力。有提示性证据表明，精神健康障碍，包括抑郁症和临床显著抑郁症，进一步阻碍VA CLC居民获得有效的疼痛治疗。然而，大多数证据是轶事或已在年轻和混合年龄患者人群的横断面研究中获得。来自新升级的最小数据集居民评估工具（MDS 3.0）的纵向数据提供了一个独特的机会，以促进了解老年人心理健康障碍对他们在VA CLC中接受疼痛治疗的类型和结果的影响。MDS评估调查首次包括疼痛治疗项目和通过居民自我报告获得的一组扩展的疼痛项目。VA CLC居民每3个月进行一次MDS 3.0评估;这些居民水平数据的跨时间链接允许对VA CLC居民中心理健康障碍、疼痛治疗和疼痛治疗结果之间的关系进行前瞻性和其他纵向分析。我们将对从诊断为肌肉骨骼疾病的老年VA CLC居民队列中获得的纵向MDS数据进行二次数据分析，以实现这些特定目标：（a）确定老年人的心理健康障碍，特别是抑郁症对疼痛治疗的短期影响，以及疼痛治疗结果，他们作为VA CLC居民的经验;（B）确定四种特定MDS评估的疼痛治疗建议是否在患有精神健康障碍，特别是抑郁障碍与较差的短期疼痛治疗结果之间起中介作用;以及（c）确定老年人的基线精神健康障碍，特别是抑郁症，影响随后12个月的疼痛治疗结果，以及这些12个月疼痛治疗结果轨迹与居民12个月身体、认知和行为功能轨迹的关系。

DESCRIPTION (provided by applicant): The purpose of this project is to use longitudinal Minimum Dataset (MDS 3.0) resident assessment data to determine the influence of older adults' mental health disorders, especially their depressive disorders and clinically significant depression, on the types and outcomes of pain treatment they receive as residents in VA Community Living Centers (VA CLCs). Effective pain treatment is a key objective throughout the VA health care system, but particularly in VA CLCs. CLC residents are a vulnerable population whose health and functioning characteristics limit their ability to successfully initiate and sustain efforts to obtain effective treatment for heir pain. There is suggestive evidence that mental health disorders, including depressive disorders and clinically significant depression, further impede VA CLC residents' access to effective pain treatment. However, most of this evidence is anecdotal or has been obtained in cross-sectional studies of younger and mixed-age patient populations. Longitudinal data from the newly upgraded Minimum Dataset resident assessment instrument (MDS 3.0) provide a unique opportunity to advance knowledge about the influence of older adults' mental health disorders on the types and outcomes of pain treatment they receive in VA CLCs. For the first time, the MDS assessment survey includes pain treatment items, and an expanded set of pain items, obtained through resident self-report. VA CLC residents are assessed with MDS 3.0 every 3 months; cross-temporal linking of these resident-level data permit prospective and other longitudinal analyses of relationships among mental health disorders, pain treatment, and pain treatment outcomes among VA CLC residents. We will conduct secondary data analyses of longitudinal MDS data obtained from a cohort of older VA CLC residents with diagnosed musculoskeletal disorders in order to achieve these specific aims: (a) to determine the short- term influence of older adults' mental health disorders, particularly depressive disorders, on the pain treatments, and pain treatment outcomes, they experience as VA CLC residents; (b) determine whether four specific MDS-assessed pain treatment recommendations mediate between having a mental health disorder, particularly depressive disorders, and poorer short- term pain treatment outcomes; and (c) ascertain how older adults' baseline mental health disorders, particularly depressive disorders, affect the subsequent 12-month course of their pain treatment outcomes, and the relationship of these 12-month pain treatment outcome trajectories to residents' 12-month physical, cognitive, and behavioral functioning trajectories.