Underreporting of Pain for Short-Stay Nursing Home Residents in the Minimum Data Set 3.0?: Staff-Report, Self-Report, and the Role of Cognitive Impairment and Racial/Ethnic Identity
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Tetyana P Shippee1, Xuanzi Qin2, Rebecca Vick1
1Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
Objectives:
Previous studies examining biases in pain reporting among nursing home (NH) residents have excluded short-stay residents (NH stay <100 days). This study of short-stay NH residents in the United States estimates pain prevalence under self-reported and staff-reported assessment in the Minimum Data Set (MDS) 3.0 and estimates whether there are differences by dementia/cognitive status, and racial/ethnic identity.
Design:
Cross-sectional study.
Setting And Participants:
Short-stay NH residents in the United States with pain assessments from MDS 3.0 in the first two quarters of 2019, shortly after new pain measures were introduced.
Methods:
In 2 independent samples of short-stay residents with either self-reported pain assessment (n = 858,646 residents) or staff-reported pain assessment (n = 29,538 residents), we calculated the odds of reporting significant pain using mixed effects logistic models adjusted for key resident and facility characteristics.
Results:
Overall, 9.60% of short-stay residents self-reported moderate to severe pain and 34.04% of staff-reported residents. In both samples, in the fully adjusted model, the odds of reporting pain were significantly lower among residents with (vs without) diagnosed dementia, with moderate to severe cognitive impairment (vs cognitively intact), and with minoritized racial/ethnic identities (vs White) [odds ratios ranging from 0.37 to 0.93; P < .001], after adjusting for the ability to understand, unclear speech, poor hearing, length of stay, functional capacity, mental illness, other comorbidities, age, and facility characteristics.
Conclusions And Implications:
Among short-stay NH residents, disparities in pain reporting for residents with cognitive impairment, dementia, and minoritized racial/ethnic identity exist in both self-reported and staff-reported samples. Our study identifies potential underreporting of pain by cognitive status and racial/ethnic identity. Future work should explore whether lower rates of reporting pain reflect actual differences in experienced pain or bias due to measurement error.
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