Pain Management in Nursing Home Residents with Cancer and Dementia with and without Hospice Services
type: CreativeWork
description: Aims: We sought to identify differences in pain management between two groups; nursing home residents with malignant cancer and dementia with and without hospice services. Methods: Decedent records from 2003-2009 were assessed for diagnosis of dementia and cause of death as cancer. Ten malignant cancer diagnoses were determined a priori from the CDC 2004 data on the top 10 malignant cancers for all races and genders. Fifty-five decedents from 10 nursing homes were included in the final sample. Four instruments were used: Minimum Data Set (MDS) a standardized assessment tool required of most U.S. nursing homes. A large comprehensive assessment is conducted yearly followed by smaller quarterly assessments. The MDS collects demographic and diagnostic variables, as well as clinical, functional, psychosocial, and cognitive assessments. Cognitive Performance Scale (CPS scored from 1 borderline-intact to 6 very severe impairment); Discomfort Behavior Scale (DBS scored from 0 no discomfort behavior identified to 102 maximum identifiable discomfort behavior); and Equivalent Dose Units (EDU’s) of opioid analgesic calculated and totaled over the last 2 weeks of life. We calculated the CPS score from the admission MDS because we believed cognitive levels were unlikely to improve over time. DBS scores were calculated from the last MDS prior to death in an effort to capture active cancer pain at the end-of-life. We realized the last MDS assessment might have been in the previous 90 days. The study received exempt status from the office of human protection. Results: Total EDU’s were significantly greater among hospice enrollees (U 226.5, p <.05). There is a significantly greater likelihood of being prescribed a scheduled narcotic analgesic (OR 5.5; 95% CI 1.8-18.8) and a PRN narcotic analgesic (OR 3.6; 95% CI 1.2-11.3) when enrolled in hospice. Nursing home residents not enrolled in hospice had a significantly (U 195.0, p < .01) lower CPS scores than those enrolled in hospice. Dec…
abstract: Aims: We sought to identify differences in pain management between two groups; nursing home residents with malignant cancer and dementia with and without hospice services. Methods: Decedent records from 2003-2009 were assessed for diagnosis of dementia and cause of death as cancer. Ten malignant cancer diagnoses were determined a priori from the CDC 2004 data on the top 10 malignant cancers for all races and genders. Fifty-five decedents from 10 nursing homes were included in the final sample. Four instruments were used: Minimum Data Set (MDS) a standardized assessment tool required of most U.S. nursing homes. A large comprehensive assessment is conducted yearly followed by smaller quarterly assessments. The MDS collects demographic and diagnostic variables, as well as clinical, functional, psychosocial, and cognitive assessments. Cognitive Performance Scale (CPS scored from 1 borderline-intact to 6 very severe impairment); Discomfort Behavior Scale (DBS scored from 0 no discomfort behavior identified to 102 maximum identifiable discomfort behavior); and Equivalent Dose Units (EDU’s) of opioid analgesic calculated and totaled over the last 2 weeks of life. We calculated the CPS score from the admission MDS because we believed cognitive levels were unlikely to improve over time. DBS scores were calculated from the last MDS prior to death in an effort to capture active cancer pain at the end-of-life. We realized the last MDS assessment might have been in the previous 90 days. The study received exempt status from the office of human protection. Results: Total EDU’s were significantly greater among hospice enrollees (U 226.5, p <.05). There is a significantly greater likelihood of being prescribed a scheduled narcotic analgesic (OR 5.5; 95% CI 1.8-18.8) and a PRN narcotic analgesic (OR 3.6; 95% CI 1.2-11.3) when enrolled in hospice. Nursing home residents not enrolled in hospice had a significantly (U 195.0, p < .01) lower CPS scores than those enrolled in hospice. Dec…
author: Monroe, Todd Bryant
keywords: Cancer, Dementia, End of Life, Nursing Home, Pain, Pain Assessment, Diseases, Health Services Research, Medicine and Health Sciences, Neoplasms, Nervous System Diseases
date published: 2010-05-01T07:00:00Z
date modified: 2026-07-24T05:00:11Z
provider: University of Tennessee Health Science Center
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Tennessee Health Science Center