Dr. Teigland said the findings have important implications for residents with dementia, who could receive better pain treatment and thus have a better quality of life if more caregivers were to use the new model to assess pain.
For residents with dementia, improved pain assessment and treatment have been shown to be associated with less depression, fewer negative behaviors, and slower functional decline, she said. The result for nursing homes could be more accurate reporting on quality of care measures, including those reported to Nursing Home Compare, the Centers for Medicare and Medicaid (CMS) Web site for the public.
Scores on quality measures can be skewed by the underdiagnosis and undertreatment of pain in dementia residents, Dr. Teigland noted. The findings in the current study reveal that CMS quality measures offer “a highly skewed snapshot of facility pain rates,” she said in an interview.
These hidden problems with quality measures tend to multiply, Dr. Teigland added. Dementia residents are up to 5 times as likely as others to have pain-related outcomes such as agitation and depression, which lead to higher use of antipsychotics in a facility, she explained. Better quality measures would ensure that serious quality of life issues are not missed for the growing dementia population, she said.
The study indicates that these problems can be circumvented by using the wealth of resident information readily available in every nursing home's MDS, Dr. Teigland concluded. Such data on medial conditions and behavioral issues can identify cognitively impaired residents who are suffering from undetected or undertreated pain.
The New York Association of Homes & Services for the Aging, a nonprofit association, has incorporated Dr. Teigland's model into a Web-based informatics software tool, EQUIP for Quality. The decision-support tool includes other MDS-based predictive risk assessment models. It is available to nursing homes nationwide and is already being used by more than 400 facilities in 22 states. More information is available at www.equipforquality.com
Predicting PainIn the Elderly
Dr. Christie Teigland noted that men and older residents are less likely to report pain; obese individuals and those with arthritis are more likely to experience pain. Fractures increase the risk of pain by 100%.
Numerous risk factors related to incontinence are related to pain. For example, residents on bladder training were more than 50% more likely to have pain, and those with a scheduled toileting plan were less likely to have pain. Surgical wounds increased the likelihood of pain by more than 100%.
Dr. Teigland's study assessed the following risk factors for their association with pain in residents without dementia in New York nursing homes. For each factor, the odds ratio indicates the likelihood that a patient has pain.