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Using the Minimum Data Set to Select Nursing Home Residents for Interview About Pain

Authors

  • Lily Chu MD,

    1. From the *Department of Medicine, Division of Geriatrics, Borun Center for Gerontological Research, Los Angeles Jewish Home for the Aging, School of Medicine, and School of Nursing, University of California at Los Angeles, Los Angeles, California§Veterans Administration Hospital, Sepulveda, California.
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  • John F. Schnelle PhD,

    1. From the *Department of Medicine, Division of Geriatrics, Borun Center for Gerontological Research, Los Angeles Jewish Home for the Aging, School of Medicine, and School of Nursing, University of California at Los Angeles, Los Angeles, California§Veterans Administration Hospital, Sepulveda, California.
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  • Mary P. Cadogan RN, DrPH, GNP,

    1. From the *Department of Medicine, Division of Geriatrics, Borun Center for Gerontological Research, Los Angeles Jewish Home for the Aging, School of Medicine, and School of Nursing, University of California at Los Angeles, Los Angeles, California§Veterans Administration Hospital, Sepulveda, California.
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  • Sandra F. Simmons PhD

    1. From the *Department of Medicine, Division of Geriatrics, Borun Center for Gerontological Research, Los Angeles Jewish Home for the Aging, School of Medicine, and School of Nursing, University of California at Los Angeles, Los Angeles, California§Veterans Administration Hospital, Sepulveda, California.
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  • Funded by the Bureau of Health Professions, U.S. Department of Health and Human Services, California Healthcare Foundation, UCLA Claude Pepper Center, and Commonwealth Fund. Some results were presented at the Presidential Poster Session, American Geriatrics Society Annual Scientific Meeting, Baltimore, Maryland, May 16, 2003

Lily Chu, MD, Home Health/Continuing Care, The Permanente Medical Group, 1200 El Camino Real, South San Francisco, CA 94080. E-mail: ChuRainier@aol.com

Abstract

Objectives: To determine how many nursing home residents can provide stable responses to a simple pain interview and whether a Minimum Data Set (MDS) cognitive performance measure can be used to identify these residents.

Design: Cross-sectional descriptive study.

Setting: Thirty-three community-based nursing homes.

Participants: Eight hundred ninety-five nursing home residents.

Measurements: Resident completion rate, stability, and interrater reliability of a four-item interview derived from the Geriatric Pain Measure were calculated. Demographic data and MDS items concerning pain and memory were obtained from medical records.

Results: Overall, 835 residents were able to answer all four interview questions. At the lowest MDS recall score of 0, 52.7% of residents were able to complete all questions. All residents able to respond to the interview achieved high stability (kappa=0.633, P<.001). Overall, 62.8% of residents with daily pain or activity-limiting pain on interview did not have daily or moderate to severe pain recorded on the MDS. Residents who had lower MDS recall scores were significantly less likely (P=.004) to be appropriately identified on the MDS.

Conclusion: Residents with a low MDS recall score were significantly less likely to be noted on the MDS as having serious pain despite being able to complete a simple yes/no interview about pain in a stable fashion. Nursing staff should attempt to ask all residents direct questions about pain. Surveyors may restrict direct questioning to those residents with an MDS recall score of 1 or higher if time is an important consideration. Adjustment for MDS-derived prevalence of pain based on residents' cognitive status is questionable.

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