PA-13-058 (Pain in Aging): The 2011 Institute of Medicine report entitled Relieving Pain in America noted that 62% of nursing home (NH) residents experience pain. Despite a decade of evidence, the introduction of quality indicators and the initiation of quality improvement programs, pain management in nursing homes is sub-optimal. Pain is seldom an isolated symptom and is often associated with/accompanied by other symptoms in common clusters. The proposed work seeks to use a novel analytic approach to characterize pain symptom clusters in NH residents using a contemporaneous dataset. We propose merging elements of the following existing databases: the Minimum Data Set (MDS), Medicare eligibility and claims data (Part A, B & D), and the Certification and Survey Provider Enhanced Reporting (CASPER) system.
The specific aims are to: 1) Identify the most common and burdensome pain symptom clusters among nursing home residents and describe correlates of pain symptom clusters; 2) Describe medication use by pain symptom clusters; 3) Evaluate trajectories of pain symptom clusters and corresponding medication use; and 4) Quantify the extent to which medications are associated with outcomes such as improvements in pain trajectories and adverse events (falls, fractures, constipation, and overall hospitalizations and hospitalizations for specific causes). State of the art statistical techniques including latent clas modeling and marginal structural models will be used. All analyses will be conducted by underlying diagnosis (e.g., those with and without a cancer diagnosis), sociodemographic (age, gender and race/ethnicity), and cognitive and functional impairment. Despite administrative initiatives including the inclusion of pain as a quality indicator and public reporting of measures and directives in surveyors' interpretive guidance documents regarding polypharmacy and pain, untreated, potentially undertreated and inappropriately treated pain remain common in the nursing home setting. No studies have attempted to characterize pain symptom clusters in nursing homes and to longitudinally explore the changes in pain, pharmacological pain treatments, and outcomes in a contemporaneous national dataset of nursing home residents. This is a novel area of exploration that will provide needed information to form the basis of strategies to improve pain management in NHs.
Pain in nursing home residents is common. This study will describe pain symptom clusters and the treatment of pain symptom clusters in nursing home residents. It will describe patterns of pain management, and quantify its risks and benefits in nursing home residents. This study will provide a novel area of exploration for future interventions to assure that nursing home residents in pain are identified and managed well.
| Hunnicutt, Jacob N; Hume, Anne L; Ulbricht, Christine M et al. (2018) Long-acting opioid initiation in US nursing homes. Pharmacoepidemiol Drug Saf : |
| Ulbricht, Christine M; Chrysanthopoulou, Stavroula A; Levin, Len et al. (2018) The use of latent class analysis for identifying subtypes of depression: A systematic review. Psychiatry Res 266:228-246 |
| Hunnicutt, Jacob N; Hume, Anne L; Liu, Shao-Hsien et al. (2018) Commonly Initiated Opioids and Risk of Fracture Hospitalizations in United States Nursing Homes. Drugs Aging 35:925-936 |
| Hunnicutt, Jacob N; Chrysanthopoulou, Stavroula A; Ulbricht, Christine M et al. (2018) Prevalence of Long-Term Opioid Use in Long-Stay Nursing Home Residents. J Am Geriatr Soc 66:48-55 |
| Wood, Mollie E; Chrysanthopoulou, Stavroula; Nordeng, Hedvig M E et al. (2018) The Impact of Nondifferential Exposure Misclassification on the Performance of Propensity Scores for Continuous and Binary Outcomes: A Simulation Study. Med Care 56:e46-e53 |
| Hunnicutt, Jacob N; Baek, Jonggyu; Alcusky, Matthew et al. (2018) Geographic Variation in the Initiation of Commonly Used Opioids and Dosage Strength in United States Nursing Homes. Med Care 56:847-854 |
| Hunnicutt, Jacob N; Ulbricht, Christine M; Tjia, Jennifer et al. (2017) Pain and pharmacologic pain management in long-stay nursing home residents. Pain 158:1091-1099 |
| Hunnicutt, Jacob N; Ulbricht, Christine M; Chrysanthopoulou, Stavroula A et al. (2016) Probabilistic bias analysis in pharmacoepidemiology and comparative effectiveness research: a systematic review. Pharmacoepidemiol Drug Saf 25:1343-1353 |
