Pain in cognitively impaired nursing home residents: how well are physicians diagnosing it?

J Am Geriatr Soc. 2002 Jun;50(6):1039-44. doi: 10.1046/j.1532-5415.2002.50258.x.

Abstract

Objectives: This study examined the reliability and validity of geriatricians' assessments of pain in cognitively impaired nursing home residents.

Design: Cross-sectional analysis.

Setting: A large suburban nursing home.

Participants: Seventy-nine nursing home residents participated in the study. Of these, 31 had mild/moderate cognitive impairment (average Mini-Mental State Examination (MMSE) = 16.04) and 48 were severely cognitively impaired (average MMSE = 1.91). More than 80% of the participants were female, and the average age was 87.

Measurements: Two geriatricians from outside the nursing home examined laboratory results, performed a physical examination, and completed a detailed assessment of pain. The personal geriatricians of 42 of the participants also completed the same assessment.

Results: Intergeriatrician agreement rates were statistically significant and moderate in magnitude. When examined by subgroup, the correlations were significant only for those with mild/moderate impairment. Some of the geriatricians' ratings of pain correlated significantly with residents' self-reports. All relationships were weaker in the severely cognitively impaired group. Ratings of greater pain were significantly correlated with higher cognitive functioning.

Conclusions: The results validate geriatricians' evaluations of pain during a medical examination for moderately impaired persons and question their ability to evaluate pain in the severely cognitively impaired. There is a need for increased awareness of pain in this population and a need for improved methodologies to identify it.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Dementia / complications*
  • Female
  • Geriatrics / standards
  • Homes for the Aged*
  • Humans
  • Inpatients
  • Male
  • Middle Aged
  • Nursing Homes*
  • Observer Variation
  • Pain / complications*
  • Pain / diagnosis*
  • Pain Measurement / methods
  • Pain Measurement / standards*
  • Reproducibility of Results