Many Seniors Get 'Woefully Inadequate' Pain Treatment, Study Says
Andre Picard, Public Health Reporter
Originally published in The Globe and Mail, April 25, 2001
Pain among elderly nursing-home residents is prevalent, persistent and poorly treated, according to a new study.
More than two in five people in institutions are living daily in pain, and that figure probably underestimates the breadth of the problem, researchers report in today's edition of the Journal of the American Medical Association.
"Our findings demonstrate woefully inadequate pain management among a frail, old and vulnerable population," said Vince Mor, director of the department of community health at Brown University in Providence, R.I. He said the situation is wholly unacceptable because there have been many medical advances in pain management in the last decade, but nursing home residents are not benefiting from them.
Joan Teno, associate director of gerontology and health-care research at Brown University, said that regulators should consider pain as an indicator of quality, and assess pain management when they do annual inspections of nursing homes. She said the data should be reported publicly so consumers can consider pain management when choosing a nursing home.
Dr. Teno also urged patients and family members to question their caregivers about what is being done to alleviate pain rather than accept the tired old notion that pain is inevitable in the elderly.
"Ask if they regularly assess pain as the 'fifth vital sign.' Also ask what efforts has the home taken to be more aware of and to improve pain management," she said.
More than 2.2 million people live in nursing homes in the United States, and another 180,000 in Canada. More than half of people who live past the age of 80 will live in a nursing home in their final years.
To conduct their study, the Brown University researchers analyzed data from the Minimum Data Set, a national databank that collects details on all individuals admitted to U.S. nursing homes, including information on the frequency and severity of pain.
The percentage of residents living with moderate to excruciating pain ranged from 40-50 per cent on any given day. More than 40 per cent of residents reported that their pain persisted for periods of as long as 180 days.
Even among residents who were in nursing homes for less than six months, one in seven reported persistent pain. Because MDS data are based on staff perception, it probably underestimates the pain burden of patients, Dr. Teno said.
She said the fear that the elderly could become addicted to prescription painkillers is often cited as a reason why pain is untreated, but said that was not justified. "Fears about opiate-drug prescription abuse should not be a reason for leaving a vulnerable population in persistent, severe pain," she said.
