Association between contextual isolation and self-reported pain among US nursing home residents

Despite living in congregate settings, residents may not feel a sense of belonging. Contextual isolation measures the extent to which a resident does not share socially salient characteristics with others in the nursing home (e.g., sex). Because the experience of pain may be impacted by emotional factors, we quantified the association between contextual isolation and five self-reported pain measures.

Using a cross-sectional study design, we identified long-stay residents without dementia using national 2022 Minimum Data Set 3.0. Five self-reported pain measures were used. Residents were categorized as being contextually isolated on multiple, one, or no characteristics. Poisson and ordinal multinomial models were used to estimate adjusted prevalence ratios (aPR) and odds ratios (aOR), respectively, with generalized estimating equations to account for clustering of residents within nursing homes.

Among the 255,462 residents, 22.5% were contextually isolated on multiple characteristics, with 32% reporting pain in the past five days. Relative to residents not contextually isolated, residents contextually isolated on multiple characteristics were less likely to report any pain (aPR: 0.98, 95% CI: 0.96-0.99) or pain that limits daily activities (aPR: 0.92, 95% CI: 0.88-0.96). Residents contextually isolated on multiple characteristics had decreased odds of higher pain frequency (aOR: 0.96, 95% CI: 0.93-0.98) and pain severity (aOR: 0.96, 95% CI: 0.93-0.99) than residents without contextual isolation.

Interventions to improve welcoming and inclusive nursing home environments may reduce the potential adverse effects of contextual isolation on pain underreporting among long-stay residents without dementia.