Pain, delirium, and physical function in skilled nursing home patients with dementia

Abstract

Objective: Skilled nursing facilities (SNFs) are major sites of postacute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are suboptimal because of poor-quality treatment, including the failure to provide needed care. Pain is frequently unrecognized and untreated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined.

Design: Secondary analysis of data from an on-going randomized clinical trial.

Setting: Eight SNFs located in central and northeast Pennsylvania.

Participants: A total of 103 SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were women (66%) and white (98%).

Measurements: Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge.

Results: On days when participants experienced greater than their average level of pain, they also experienced more delirium symptoms (P < .001) and lower physical function (P < .001). Participants with higher levels of average daily pain were more likely to die (odds ratio [OR] 6.306, 95% confidence interval [CI] 1.914-20.771, P = .003) or be placed in a nursing home (OR 4.77, 95% CI 1.7-13.2, P = .003) compared with returning to the community at 3-month follow-up.

Conclusion: Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs.

Keywords: Pain; delirium; physical function; skilled nursing facilities.