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Using the minimum data set to select nursing home residents for interview about pain
Lily Chu1, John F Schnelle, Mary P Cadogan
1Department of Medicine, Division of Geriatrics, Los Angeles Jewish Home for the Aging, School of Medicine, CA, USA. ChuRainier@aol.com <ChuRainier@aol.com>
Journal of the American Geriatrics Society
|December 2, 2004
Summary
Many nursing home residents can stably answer simple pain questions, even with cognitive impairment. However, the Minimum Data Set (MDS) often fails to accurately record their pain, especially for those with lower cognitive performance.
Area of Science:
- Geriatric medicine
- Pain management
- Nursing home care
Background:
- Assessing pain in nursing home residents is crucial for quality care.
- Cognitive impairment can hinder accurate pain reporting.
- The Minimum Data Set (MDS) is a standard tool for resident assessment, including pain and cognitive function.
Purpose of the Study:
- To evaluate the response stability of nursing home residents to a simple pain interview.
- To determine if MDS cognitive performance measures can identify residents capable of providing stable pain responses.
Main Methods:
- Cross-sectional descriptive study in 33 community-based nursing homes.
- Interviewed 895 residents using a four-item pain interview derived from the Geriatric Pain Measure.
- Collected demographic data and MDS items on pain and memory from medical records.
Main Results:
- 835 residents (93.4%) could answer all four interview questions.
- 52.7% of residents with the lowest MDS recall score (0) completed the interview.
- High stability (kappa=0.633) was observed for residents who could respond.
- 62.8% of residents reporting daily or activity-limiting pain were under-recorded on the MDS.
- Lower MDS recall scores correlated with under-identification of pain on the MDS (P=.004).
Conclusions:
- Residents with low MDS recall scores are frequently misclassified regarding pain severity.
- Direct pain questioning by nursing staff is recommended for all residents.
- MDS cognitive status may inform targeted direct questioning by surveyors.
- Relying solely on MDS for pain prevalence in cognitively impaired residents is unreliable.