Pain in cognitively impaired nursing home residents: how well are physicians diagnosing it?
Abstract
Objectives This study examined the reliability and validity of geriatricians' assessments of pain in cognitively impaired nursing home residents. Design Cross-sectional analysis. Setting A large suburban nursing home. Participants Seventy-nine nursing home residents participated in the study. Of these, 31 had mild/moderate cognitive impairment (average Mini-Mental State Examination (MMSE) = 16.04) and 48 were severely cognitively impaired (average MMSE = 1.91). More than 80% of the participants were female, and the average age was 87. Measurements Two geriatricians from outside the nursing home examined laboratory results, performed a physical examination, and completed a detailed assessment of pain. The personal geriatricians of 42 of the participants also completed the same assessment. Results Intergeriatrician agreement rates were statistically significant and moderate in magnitude. When examined by subgroup, the correlations were significant only for those with mild/moderate impairment. Some of the geriatricians' ratings of pain correlated significantly with residents' self-reports. All relationships were weaker in the severely cognitively impaired group. Ratings of greater pain were significantly correlated with higher cognitive functioning. Conclusions The results validate geriatricians' evaluations of pain during a medical examination for moderately impaired persons and question their ability to evaluate pain in the severely cognitively impaired. There is a need for in…
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Raters in this study were likely subject to the same bias found in most studies of pain in dementia: residents who can express pain are likely identified, while those who cannot remain underdiagnosed.
“Regarding pain, the finding that pain was significantly related to cognitive function led us to believe that the raters of the present study were subject to the same bias found in most studies of pain in persons with dementia; that is, those who can express pain are likely to be identified, whereas those who cannot express pain remain under diagnosed (Cohen-Mansfield, 2005; Cohen-Mansfield and Lip”
From Which unmet needs contribute to behavior problems in persons with advanced dementia? (2015) · cites this paper as Cohen-Mansfield and Lipson, 2002
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Which unmet needs contribute to behavior problems in persons with advanced dementia?
Cohen-Mansfield, J., Dakheel-Ali, M., Marx, M. S., Thein, K., & Regier, N. G. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.03.043 · Cited by 287 · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript (Cohen-Mansfield, 2005; Cohen-Mansfield and Lipson, 2002).”
BackgroundSelf-citationNursing staff members assessments of pain in cognitively impaired nursing home residents
Cohen-Mansfield, J. (2005) · Pain Management Nursing · doi:10.1016/j.pmn.2005.05.002 · Cited by 32 · see citing works
Self-citationBiobehavioral measures as outcomes: A cautionary Tale
Kovach, C. R., Woods, D. L., Devine, E. C., Logan, B. R., & Raff, H. (2014) · Research in Gerontological Nursing · doi:10.3928/19404921-20131018-01 · Cited by 4 · see citing works
- Authors
- Cohen‐Mansfield, J., & Lipson, S.
- Affiliations
- George Washington University (US)
- Hebrew Home of Greater Washington (US)
- Corresponding author
- Cohen‐Mansfield, Jiska
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2002-06
- Volume
- 50
- Issue
- 6
- Pages
- 1039-1044
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2061526772
- Cited by
- 92
- References
- 0
- Citations by year
- 2025: 2 · 2024: 1 · 2022: 1 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 1 · 2016: 1 · 2015: 3 · 2014: 4 · 2013: 4 · 2012: 3
- FWCI
- 7.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- National Institute of Nursing Research (1R55 NR/OD 04365-01A)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- pain assessment, cognitive impairment, nursing home residents, geriatricians, interobserver agreement, severe cognitive impairment, self-reported pain, reliability and validity, older adults
- MeSH terms
- Aged, Aged, 80 and over, Cross-Sectional Studies, Dementia, Female, Geriatrics, Homes for the Aged, Humans, Inpatients, Male, Middle Aged, Nursing Homes, Pain, Pain Measurement, Reproducibility of Results, Observer Variation
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