Sawyer Patricia, Lillis J Porter, Bodner Eric V, Allman Richard M
Center for Aging, University of Alabama, Birmingham, AL 35294-2041, USA.
J Am Med Dir Assoc. 2007 Mar;8(3):158-65. doi: 10.1016/j.jamda.2006.12.030.
To evaluate the prevalence of substantial daily pain among nursing home residents aged 65 and older.
DESIGN, SETTING, AND METHODS: The Minimum Data Set (MDS) annual or admission assessment, available September 2002, for Alabama nursing home residents was used. Logistic regression was used to examine the association of such pain with nursing home characteristics as well as resident-specific factors.
The analysis is based on 27,628 nursing home residents 65 and older with mean age of 82.8 years; 20% African American; 25% male. Seventeen percent had substantial daily pain. By nursing home, reported substantial daily pain prevalence ranged from 0% to 54.7%. The prevalence of pain was less in smaller nursing homes (P < .001). Bivariate correlations were significant for all sociodemographic and mental status variables; number of medications; dementia; thyroid, musculoskeletal, neurological, pulmonary, and sensory disorders; allergies; anemia; and cancer. Factors independently correlated with substantial daily pain included (odds ratio, 95% confidence interval) sociodemographic characteristics: white race (1.5, 1.3-1.7), female (1.3, 1.2-1.5), married (1.1, 1.0-1.2), admission within year (2.0, 1.8-2.1); nursing home characteristics: nonprofit or government financing (1.3, 1.2-1.5), greater number of residents (1.4, 1.3-1.5); subject-specific conditions: no cognitive impairment (1.6, 1.5-1.7), communication ability (1.4, 1.2-1.5), sad mood/depression (1.5, 1.4-1.6), taking 10 or more medications (2.0, 1.9-2.2), musculoskeletal disease (1.9, 1.7-2.0), anemia (1.1, 1.0-1.2), and cancer (1.6, 1.4-1.8). Lower odds of substantial daily pain were associated with older age, rural locale, dementia, and thyroid, neurological, pulmonary, and sensory disorders.
This study highlights within-state variation in MDS reporting by nursing home as well as resident-specific factors associated with daily substantial pain. Rural, for-profit, and low-occupancy nursing homes had less documented pain. Communication ability and not having cognitive impairment were important factors in having such pain reported.
评估65岁及以上养老院居民中每日存在严重疼痛的患病率。
设计、研究地点和方法：使用了2002年9月可获取的阿拉巴马州养老院居民的最低数据集（MDS）年度评估或入院评估数据。采用逻辑回归分析此类疼痛与养老院特征以及居民个体因素之间的关联。
分析基于27628名65岁及以上的养老院居民，平均年龄为82.8岁；20%为非裔美国人；25%为男性。17%的居民每日存在严重疼痛。不同养老院报告的每日严重疼痛患病率从0%至54.7%不等。规模较小的养老院疼痛患病率较低（P <.001）。所有社会人口统计学和精神状态变量、用药数量、痴呆、甲状腺疾病、肌肉骨骼疾病、神经系统疾病、肺部疾病、感觉障碍、过敏、贫血和癌症的双变量相关性均具有统计学意义。与每日严重疼痛独立相关的因素包括（比值比，95%置信区间）社会人口统计学特征：白人种族（1.5，1.3 - 1.7）、女性（1.3，1.2 - 1.5）、已婚（1.1，1.0 - 1.2）、年内入院（2.0，1.8 - 2.1）；养老院特征：非营利或政府资助（1.3，1.2 - 1.5）、居民数量较多（1.4，1.3 - 1.5）；个体状况：无认知障碍（1.6，1.5 - 1.7）、沟通能力（1.4，1.2 - 1.5）、情绪低落/抑郁（1.5，1.4 - 1.6）、服用10种或更多药物（2.0，1.9 - 2.2）、肌肉骨骼疾病（1.9，1.7 - 2.0）、贫血（1.1，1.0 - 1.2）和癌症（1.6，1.4 - 1.8）。年龄较大、居住在农村地区、患有痴呆以及甲状腺疾病、神经系统疾病、肺部疾病和感觉障碍与每日严重疼痛的发生几率较低相关。
本研究突出了养老院在MDS报告方面的州内差异以及与每日严重疼痛相关的居民个体因素。农村地区、营利性和入住率低的养老院记录的疼痛较少。沟通能力和无认知障碍是报告此类疼痛的重要因素。
