Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions.
Jinjiao Wang, Todd B Monroe, Adam Simning and 8 others
PMID 32680825WHAT IT FOUND
Home health patients with dementia or cognitive impairment had severe interfering pain recorded less often than those without such impairment.
Recorded severe pain raised unplanned facility admission risk overall, but not in these patients.
Key findings
01Patients with ADRD had severe interfering pain recorded less often than others (16.4% versus 23.6%), and after adjustment were 28% less likely to have it.
02Severe interfering pain was associated with a 35% higher risk of unplanned facility admission among home health recipients.
03In patients with ADRD, severe pain was not significantly associated with unplanned facility admission, while in patients without ADRD it was.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data came from one home health agency in New York, so pain recording and admission patterns may differ elsewhere. ADRD was identified from claims and OASIS items, not detailed dementia severity, so mild and advanced cases were mixed. Severe pain was based on OASIS documentation, not a research pain assessment, and the paper notes the OASIS pain items had an accuracy rate of 54.3%. This was an observational study, so it cannot prove that ADRD causes lower pain recording or that severe pain causes facility admission. Analgesic use and non-pharmacological pain treatments were not controlled, and other unmeasured factors may explain the associations. The non-significant pain-admission finding in ADRD may reflect under-recording, not evidence that pain is harmless in dementia.
The easy way to misread this
Do not conclude that patients with dementia or cognitive impairment have less severe pain or that pain does not increase admission risk in them. The study measured recorded pain, not true pain, and the non-significant finding in ADRD may reflect under-assessment or documentation gaps rather than a lack of effect.