The Problems of Pain and Its Detection among Geriatric Nursing Home Residents

OBJECTIVE: To assess physicians' detection of pain among geriatric nursing home residents and to determine if there are factors that may interfere with their ability to do this. DESIGN: Chart review and patient interview. SETTING: Geriatric nursing home. PARTICIPANTS: One hundred nursing home residents age 65 or older. Seventy-six were communicative. MEASUREMENTS: Demographic information, diagnoses, and medication use were compared for several groups of residents to determine their effects on the detection of pain. RESULTS: Sixty-six percent of the communicative residents were identified as having chronic pain. Treating physicians did not detect this problem in 34% of these residents. Those whose pain was not so identified were more likely to have a neurologic disorder other than dementia. When non-communicative residents were compared with those who were communicative, the physicians were found to have identified pain less frequently in the former cohort. CONCLUSIONS: Chronic pain is a common problem among geriatric nursing home residents and is frequently undetected. Identification of this problem among communicative residents may be markedly improved by direct questioning about this problem at frequent intervals. New methods of assessing pain need to be created to assist in its detection among the non-communicative population.