Woods Ashley, Farmer Matthew, Popescu Mihail, Powell Kimberly
Sinclair School of Nursing, School of Nursing, University of Missouri, Columbia, MO.
Sinclair School of Nursing, School of Nursing, University of Missouri, Columbia, MO.
Pain Manag Nurs. 2025 May 5. doi: 10.1016/j.pmn.2025.04.001.
This study aimed to explore the difference between the representation of pain assessment and management among older adults with and without Alzheimer's Disease and Related Dementias (ADRD) residing in nursing homes (NH) using interdisciplinary text messages (TMs) exchanged prior to hospital transfer.
A retrospective cohort study and secondary data analysis of (n = 21,000) TMs exchanged among interdisciplinary healthcare team members and survey data about NH residents who transferred to the hospital from 2016 to 2020.
The study analyzed TMs using natural language processing tools to identify mentions of pain assessment, management, and pain medications. We used a two-sample independent t-test and a negative binomial generalized linear model to assess the association between pain mentions and various resident characteristics, including ADRD status.
The analysis included 694 transfer events involving 414 residents, 39% of whom had ADRD. Significant differences were found in pain mentions, with ADRD residents having fewer mentions (t = 2.38, p = .02) than those without ADRD. The generalized linear model identified statistically significant predictors (age, race, and specific comorbidities) of the number of TMs exchanged with pain mentions about NH residents. Dementia stage and avoidable transfers were not significant.
Our findings indicate pain is underrepresented in communications about Black residents and those with ADRD, potentially contributing to disparities in pain assessment and management in these populations.
This study indicates a need for more equitable pain practices with improved pain assessment tools and pain assessment and management, particularly with TM communication in healthcare settings.
本研究旨在利用住院前跨学科团队交流的短信，探讨入住养老院的患有和未患有阿尔茨海默病及相关痴呆症（ADRD）的老年人在疼痛评估与管理方面的差异。
一项回顾性队列研究及对2016年至2020年期间跨学科医疗团队成员之间交流的（n = 21,000条）短信进行二次数据分析，并收集有关转院至医院的养老院居民的调查数据。
该研究使用自然语言处理工具分析短信，以识别疼痛评估、管理及止痛药物的提及情况。我们采用双样本独立t检验和负二项广义线性模型来评估疼痛提及与包括ADRD状态在内的各种居民特征之间的关联。
分析包括涉及414名居民的694次转院事件，其中39%的居民患有ADRD。在疼痛提及方面发现了显著差异，患有ADRD的居民提及次数（t = 2.38，p = .02）少于未患有ADRD的居民。广义线性模型确定了与养老院居民疼痛提及相关的短信交流次数的统计学显著预测因素（年龄、种族和特定合并症）。痴呆阶段和可避免的转院不具有显著性。
我们的研究结果表明，在关于黑人居民和患有ADRD的居民的交流中，疼痛的呈现不足，这可能导致这些人群在疼痛评估和管理方面存在差异。
本研究表明需要采用更公平的疼痛处理方法，改进疼痛评估工具以及疼痛评估与管理，特别是在医疗环境中的短信交流方面。
