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Jewish World Review April 27, 2001 / 5 Iyar, 5761

Lee Bowman

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Consumer Reports


Study finds many in nursing homes in pain

http://www.jewishworldreview.com -- PAIN is a persistent fact of life among nursing home residents, a new nationwide study suggests.

Researchers from Brown University Medical School report that four in 10 nursing home residents who were in pain around April 1, 1999, were still experiencing moderate or excruciating daily pain two to six months later. Fourteen percent had been in persistent pain.

"Our findings demonstrate woefully inadequate pain management among a frail, old and vulnerable population of Americans,'' said Vincent Mor, director of the Department of Community Health at Brown and a co-author of the study, which is briefly described in Wednesday's Journal of the American Medical Association.

"Important ground has been gained in the last decade in pain management, but these results highlight the urgent work yet to be done,'' Mor said.

Researchers used data from a federally mandated evaluation of nursing home patients that must be done by staff for each person admitted to a nursing home. The reports include information about the frequency and severity of pain the residents experience. Data was analyzed from more than 2.2 million people.

"We believe these findings underestimate the true pain burden experienced by nursing home residents,'' said Dr. Joan Teno, lead author of the study. "The assessments were based on the perceptions of nursing home staff, not the residents, and staff routinely underestimate the pain burden of patients.''

More than 1.5 million people in the United States are in a nursing home on any particular day. It's estimated that 43 percent of people 65 and older will enter a nursing home before they die.

The study found variations among the states in the percentage of patients experiencing pain between a first and second evaluation: the rate varied from a low of 37.7 percent in Mississippi to a high of 49.5 percent in Utah. Data for individual states can be found online at www.chcr.brown.edu/dying/factsondying.htm.

Pain management has only recently become an issue for nursing homes and other health-care institutions. Accreditation standards now require that hospitals and nursing homes recognize the right of patients to the appropriate assessment and management of pain.

Although nursing home patient evaluations now attempt to measure the extent of pain being experienced by patients, "regulations need to change to make pain a focus at all state and federal inspections of nursing homes to comport with the new standard of the Joint Commission on the Accreditation of Healthcare Organizations,'' said Karen Kaplan, national program director for Last Acts, a coalition of more than 600 organizations dedicated to improving end-of-life care.

"Persistent pain in nursing homes should be considered by regulators as an indicator of quality and publicly reported along with other indicators,'' Teno said. "Federal and state nursing home surveyors need to assess the quality of pain management at the time of annual inspections.''

While some nursing home physicians and administrators are wary of over prescribing painkillers, particularly opiates, Teno said "that should not be a reason for leaving a vulnerable population in persistent severe pain.

She suggests that patients and family members ask about a facility's pain treatment policies before committing to move in. "Ask if it regularly assesses pain as a 'fifth vital sign.' Also, ask what effort the home has taken to be more aware of and to improve pain management.''

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