Pain in older subacute care patients: associations with clinical status and treatment

To examine the relationship between patient pain levels and clinical status and treatment in older adults.

A correlational study involving patient and nurse ratings of pain and retrospective review of clinical records.

A subacute care inpatient facility.

Seventy-five older adults (mean age: 75.9 years) who met entry criteria for pain, age, and mental status.

Patients and nurses made independent ratings of pain over a 7-day period. Clinical data included measures of mental status, depression, behavioral signs of discomfort, functional independence, and analgesic medication use.

Nurse ratings of patient pain were uncorrelated with patient ratings and underestimated pain relative to patient reports. Nurse ratings correlated with levels of behavioral discomfort and with doses of opioid medication. Patient ratings were associated with functional limitations, depression, and behavioral signs of discomfort, but were minimally related to administration of opioids or other pain medication. Patient mental status did not appreciably moderate these relationships.

These findings support a growing literature indicating deficiencies in pain assessment of older patients and suggest inappropriate administration of analgesic medications for these patients. More systematic assessment of pain, including the use of instruments with established psychometric properties for older patients, may improve pain control and enhance functional rehabilitation in this group.