Capacity Measures Explain Only a Small Part of Self-Reported Disability in Institutionalized Ambulatory Older Adults: An Observational Study

Pilot testing implementation of the pain management clinical practice guideline in nursing homes

Pain is a common symptom for older adults living with dementia in nursing homes. Unfortunately, there are many challenges to pain assessment, diagnosis and management for these individuals. The purpose of this study was to pilot test the implementation of the newly published Pain Management Clinical Practice Guideline from AMDA: The Society of Post Acute and Long-Term Care using our theoretically based Pain-CPG-EIT approach. Implementation was provided by a research nurse facilitator and included four components: Component I: Establishing and working with a stakeholder team monthly; Component II: Education of the staff; Component III: Mentoring and motivating the staff; and Component IV: Ongoing monitoring of pain assessment, diagnosis and management for residents. Findings provide some preliminary support for the feasibility and effectiveness of our implementation approach.

The Reciprocal Relationship of Physical Capacity and Mental Health: A Random Intercept Cross-Lagged Panel Model Analysis

This study investigates the mutual influence of mental health and physical capacity in older adults, considering potential gender differences. Data from 7,504 Medicare beneficiaries aged 65+ from the NHATS 2011-2015 surveys were analyzed using a random intercept cross-lagged panel model in Mplus. Results revealed moderate within-person effects of physical capacity on mental health (βt12 = -.19, βt23 = -.32, βt34 = -.42, βt45 = -.40), while the reverse relationship showed smaller effects (βt12 = -.02, βt23 = -.03, βt34 = -.03, βt45 = -.02). Gender differences emerged, with the influence of mental health on physical capacity being significant in men but not women. Additionally, correlations between changes in physical capacity and mental health were stronger for men. Lastly, lagged effects of physical capacity on mental health were notably stronger than the reverse. The findings suggest that enhancing physical capacity may alleviate depression and anxiety symptoms in older adults, particularly men.

The Relationship Between Pain, Function, Behavioral, and Psychological Symptoms of Dementia and Quality of Life

BACKGROUND

This study evaluated the association between age, sex, comorbidities, cognition, and administration of opioids with pain and the impact of all of these variables plus function, agitation, resistiveness to care, and depression on quality of life among residents in nursing home with severe dementia.

DESIGN

This was a descriptive study using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia implementation study.

METHODS

Model testing was done using structural equation modeling. The sample included 553 residents from 55 nursing homes with a mean age of 83.88 (standard deviation = 10.44) and mean Brief Interview of Mental Status of 4.30 (standard deviation = 3.50).

RESULTS

There were significant associations showing those who were older, male, had fewer comorbidities, better cognition, and were black were more likely to have pain. Pain, in combination with the demographic and descriptive variables, explained 32% of the variance in function, 75% of the variance in depression, 88% of the variance in agitation, 98% of the variance in resistiveness to care, and 92% of the variance in quality of life. The model however did not show a good fit to the data.

SETTING

The study was done in 55 nursing homes in Maryland and Pennsylvania.

PARTICIPANTS/SUBJECTS

A total of 553 residents were included in the study.

CONCLUSIONS

The model did not have a good fit with the data which likely was due to the lack of variance in outcomes. The hypothesized paths, with the exception of opioid use, were significant.

Test-Retest Reliability of Pain Measures in Institutionalized Older Adults: Number of Painful Body Sites, Pain Intensity, and Pain Extent

OBJECTIVE

The reliability of pain assessment in frail and older adults has seldom been assessed. This study aims to assess the test-retest reliability of (1) the number of painful body sites, (2) pain intensity, and (3) pain extent in institutionalized older adults.

METHODS

Seventy-four older adults who were institutionalized were assessed in 2 separate sessions, 2 days to 1 week apart, for pain intensity, number of painful body sites, and pain extent (in pixels) using a vertical pain numeric scale (0 to 10), a body chart divided into 50 body regions, and ImageJ, respectively. Intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable differences (MDDs) were calculated.

RESULTS

In session 1, the mean values (± standard deviation) were 5.54 ± 2.12 points for pain intensity, 4.47 ± 3.27 for number of painful body sites, and 2,726.00 ± 2,322.09 for pain extent. ICCs were 0.82 (95% confidence interval [CI] = 0.72 to 0.89) for pain intensity, 0.89 (95% CI = 0.83 to 0.93) for number of painful body sites, and 0.74 (95% CI = -0.07 to 0.91) for pain area. The MDDs were 2.46 for pain intensity, 3.14 for number of painful body sites, and 4,997.60 for pain extent.

CONCLUSIONS

The vertical pain rating scale and the body chart seem reliable to assess pain intensity and number of pain sites, respectively. The wide CI for the ICC found for pain area and the high measurement error compromise its potential clinical relevance.