Table 1.
Baseline* Demographic and Clinical Characteristics of Long-term Care Residents with or without Pain Control† in the Depression and Behavioral Symptoms Cohorts
| Depression cohort (n=27,131) | Behavioral symptoms cohort (n=15,657) | |||||||
|---|---|---|---|---|---|---|---|---|
| Baseline characteristic* | Residents with uncontrolled pain, %* | Residents with controlled pain, %* | Adjusted OR (95% CI) | P-value | Residents with uncontrolled pain, %* | Residents with controlled pain, %* | Adjusted OR (95% CI) | P-value |
| Total, No. | 4087 | 23,044 | 3192 | 12,465 | ||||
| Age group, y | ||||||||
| 50–64 | 6.0 | 5.2 | Reference | 8.2 | 6.2 | Reference | ||
| 65–74 | 12.4 | 10.2 | 0.91 (0.75–1.11) | .34 | 14.9 | 11.5 | 0.92 (0.74–1.13) | .42 |
| 75–84 | 28.0 | 24.8 | 0.86 (0.72–1.03) | .10 | 28.4 | 24.3 | 0.84 (0.70–1.03) | .09 |
| ≥85 | 53.7 | 59.7 | 0.72 (0.60–0.86) | <.001 | 48.4 | 58.0 | 0.71 (0.59–0.86) | <.001 |
| Sex | ||||||||
| Male | 20.6 | 26.5 | Reference | 19.1 | 24.2 | Reference | ||
| Female | 79.4 | 73.5 | 1.23 (1.12–1.37) | <.001 | 80.9 | 75.8 | 1.24 (1.10–1.40) | <.001 |
| Race/ethnicity | ||||||||
| White | 82.2 | 75.4 | Reference | 84.5 | 77.8 | Reference | ||
| Black | 12.0 | 16.0 | 0.75 (0.66–0.84) | <.001 | 9.6 | 13.4 | 0.74 (0.64–0.87) | <.001 |
| Other‡ | 5.8 | 8.6 | 0.77 (0.65–0.90) | .002 | 5.9 | 8.8 | 0.76 (0.63–0.93) | .006 |
| Region of United States | ||||||||
| Northeast | 17.6 | 24.0 | Reference | 17.0 | 22.8 | Reference | ||
| Northcentral | 30.7 | 25.6 | 1.27 (1.13–1.42) | <.001 | 30.8 | 26.0 | 1.30 (1.13–1.50) | <.001 |
| West | 11.6 | 11.0 | 1.41 (1.22–1.63) | <.001 | 11.6 | 11.2 | 1.41 (1.18–1.67) | <.001 |
| South | 40.1 | 39.4 | 1.28 (1.14–1.42) | <.001 | 40.6 | 40.0 | 1.26 (1.10–1.43) | <.001 |
| Receipt of low-income subsidy | ||||||||
| No | 18.5 | 16.8 | Reference | 16.5 | 16.2 | Reference | ||
| Yes | 81.5 | 83.2 | 0.88 (0.79–0.97) | .01 | 83.5 | 83.8 | 0.94 (0.83–1.07) | 0.37 |
| Body mass index | ||||||||
| Normal | 34.7 | 41.0 | Reference | 31.3 | 37.1 | Reference | ||
| Underweight | 8.4 | 8.6 | 1.02 (0.88–1.18) | .77 | 6.0 | 7.6 | 0.86 (0.71–1.04) | 0.13 |
| Overweight | 27.7 | 28.8 | 1.05 (0.96–1.16) | .26 | 26.4 | 28.8 | 1.06 (0.94–1.19) | 0.34 |
| Obese | 29.2 | 21.72 | 1.09 (0.99–1.21) | .09 | 36.4 | 26.5 | 1.13 (1.00–1.27) | 0.04 |
| Pain reporting | ||||||||
| Staff-observed | 8.5 | 16.1 | Reference | 3.5 | 11.8 | Reference | ||
| Self-reported | 91.5 | 83.9 | 1.01 (0.87–1.18) | .89 | 96.5 | 88.2 | 1.44 (1.12–1.85) | 0.005 |
| ADL dependence | ||||||||
| No | 28.4 | 25.6 | Reference | 33.2 | 28.8 | Reference | ||
| Mild | 32.6 | 32.5 | 0.92 (0.83–1.01) | .09 | 33.5 | 32.9 | 0.87 (0.78–0.98) | .02 |
| Moderate | 26.6 | 26.7 | 0.98 (0.88–1.10) | .75 | 24.4 | 25.8 | 0.86 (0.76–0.98) | .02 |
| Severe | 12.4 | 15.2 | 1.00 (0.87–1.15) | .99 | 9.0 | 12.5 | 0.90 (0.75–1.08) | .27 |
| Comorbidity | ||||||||
| 0–2 | 21.6 | 29.6 | Reference | 17.2 | 24.9 | Reference | ||
| 3–4 | 34.4 | 36.5 | 1.10 (0.99–1.21) | .09 | 33.0 | 36.9 | 1.01 (0.89–1.15) | .88 |
| 5–6 | 25.2 | 21.7 | 1.18 (1.05–1.31) | .006 | 28.8 | 23.9 | 1.13 (0.99–1.31) | .07 |
| ≥7 | 18.9 | 12.2 | 1.30 (1.15–1.48) | <.001 | 21.0 | 12.3 | 1.14 (0.98–1.34) | .09 |
| Dementia severity | ||||||||
| Mild | 67.7 | 41.0 | Reference | 82.7 | 57.1 | Reference | ||
| Moderate | 26.3 | 44.8 | 0.50 (0.45–0.54) | <.001 | 14.9 | 32.8 | 0.55 (0.49–0.62) | <.001 |
| Severe | 6.0 | 14.3 | 0.43 (0.36–0.52) | <.001 | 2.4 | 10.1 | 0.47 (0.35–0.64) | <.001 |
| Pain management (yes vs. no as reference) | ||||||||
| Receipt of prescription pain medication | 78.8 | 46.4 | 1.94 (1.76–2.13) | <.001 | 83.8 | 52.5 | 1.87 (1.65–2.11) | <.001 |
| Use of PRN pain medication | 76.4 | 23.4 | 4.98 (4.52–5.49) | <.001 | 78.0 | 26.6 | 4.70 (4.19–5.26) | <.001 |
| Use of scheduled pain medication | 61.4 | 35.6 | 1.47 (1.34–1.62) | <.001 | 67.6 | 39.8 | 1.69 (1.51–1.89) | <.001 |
| Use of pain management | 94.9 | 51.5 | 3.55 (2.97–4.24) | <.001 | 96.4 | 56.3 | 3.73 (2.96–4.70) | <.001 |
| Use of psychotropic medication | 62.0 | 58.2 | 0.93 (0.86–1.02) | .11 | 71.2 | 61.3 | 0.96 (0.86–1.07) | .42 |
| Polypharmacy | 91.7 | 84.3 | 0.97 (0.84–1.12) | .70 | 93.6 | 86.2 | 0.97 (0.80–1.17) | 0.75 |
| Healthcare utilization | ||||||||
| Any hospitalization | 43.3 | 34.4 | 1.19 (1.06–1.33) | .003 | 39.3 | 24.5 | 1.43 (1.24–1.65) | <.001 |
| Any ED visit | 55.7 | 44.8 | 1.34 (1.20–1.50) | <.001 | 49.6 | 33.0 | 1.36 (1.19–1.65) | <.001 |
| Depression (PHQ-9 ≥10) | N/A | N/A | N/A | N/A | 9.4 | 5.5 | 1.56 (1.31–1.84) | <.001 |
| Behavioral symptoms | 23.8 | 27.4 | 0.98 (0.90–1.08) | .74 | N/A | N/A | N/A | N/A |
Abbreviations: ADL, activities of daily living; ED, emergency department; N/A, not available; OR, odds ratio; PHQ-9, Patient Health Questionnaire (PHQ)-9; PRN, pro re nata.
*
Baseline was defined as 6 months before the index Minimum Data Set (MDS) 3.0 assessment;
†
Uncontrolled pain was defined based on pain assessment of the index MDS 3.0.
‡
Included Hispanic, Asian, Pacific Islander, and Native American individuals.