How Do Nursing Homes Manage Their Residents' Pain? Not Very Well

Preparation of a monograph on the prevalence and management of pain in nursing homes

In 1999, investigators at Brown University Center for Gerontology and Health Care Research prepared a monograph describing the prevalence of pain and the variation in its treatment among nursing home residents in 11 states. Using 1996 data, Vincent Mor, PhD, and Joan M. Teno, MD, MS, and a team of investigators evaluated three groups of nursing home residents:

  • All nursing home residents in the 11 states in mid-1996 (total 350,084).
  • New admissions to nursing homes in 1996 (total 127,426).
  • Residents who had died in nursing facilities in 1996 (total 43,117).

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Targeted End-of-Life Projects Initiative.

Key Findings

  • Among the investigators' findings:

    • One in six nursing home residents was in daily pain.
    • Among those residents who had been diagnosed with cancer, slightly more than one in five was in daily pain.
    • Nearly one in five residents who had died was in pain at last assessment.
    • One quarter of those with daily pain received no analgesia.
    • The data may underestimate the prevalence of pain by one-third because patients with severe cognitive impairment reported daily pain at one-half the rate of those with no impairment or mild impairment.

Key Recommendations

  • Among the investigators' recommendations to improve pain assessment and treatment:

    • Nursing home staff should undertake more complete and comprehensive assessments of pain.
    • The nursing home industry should develop organizational strategies to improve pain assessment and treatment, and adopt continuous quality improvement approaches to improve pain assessment and management among residents with substantial cognitive impairment.
    • States should assess whether their laws and regulations inadvertently act as barriers to pain management by discouraging the use of opiates.

An analysis of this data has been published as a research letter in the Journal of the American Medical Association (April 25, 2001).

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