A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain

Figures & data

Figure 1 Flowchart of the construction of the analytic sample.

Table 1 Descriptive Characteristics of Nursing Home Residents with Staff Assessed Pain, 2011–2016, by Change in Cognitive Status

Admission	Sample (n = 26,816)	Stable, Severe Cognitive Impairment or Worsened in 6 Months (n = 5035)	Stable, Mild/Moderate Cognitive Impairment or Improved in 6 Months (n = 21,781)
Age, years
65–74	17.7	17.0	17.9
75–84	38.0	37.9	38.0
≥85	44.3	45.1	44.0
Women	72.4	72.3	72.4
Marital Status
Married	32.6	33.9	32.3
Race
Non-White	22.4	20.5	22.9
Symptoms (Yes)
Pain	35.9	38.7	35.3
Dependent in Activities of Daily Living^a	47.2	44.1	48.0
ARBS^b	35.4	38.1	34.9
Little interest or pleasure in doing things^c	18.3	17.2	18.3
Feeling down, depressed^c	20.9	23.6	20.2
Trouble falling or staying asleep^c	19.4	20.4	19.2
Feeling tired, having little energy^c	28.7	30.2	28.4
Decreased/increased appetite^c	20.4	20.1	20.4
Trouble concentrating^c	35.0	34.5	35.2
Being short tempered/easily annoyed^c	20.8	24.4	20.2

Notes: ^aActivities of Daily Living measured by the ADL Hierarchy Scale (dependent and totally dependent versus all others); ^bAgitated and Reactive Behavior Scale (any behavioral symptom); ^cDepression symptoms measured by Patient Health Questionnaire (PHQ-9) Depression Scale (self-assessed and staff assessed).

Figure 2 Item response probabilities for four-class solution.

Table 2 Estimated Class Membership Across Time Points by 6-Month Change in Cognitive Impairment Among US Nursing Home Residents with Staff-Assessed Pain (2011–2016)

	Behavioral and Severe Depression	Functional	Physical	Behavioral	Low
Stable, Severe Cognitive Impairment or Worsened in 6 Months Since Admission
Admission	11%	21%	22%	23%	23%
Three Months	15%	21%	22%	21%	23%
Six Months	15%	21%	22%	21%	22%
Stable, Mild/Moderate Cognitive Impairment or Improved in 6 Months Since Admission
Admission	10%	25%	23%	19%	24%
Three Months	14%	24%	23%	19%	24%
Six Months	14%	24%	23%	19%	23%

Table 3 Latent Transition Probabilities from Nursing Home Admission to 3 Months and 3 Months to 6 Months, by Cognitive Change Status

	Behavioral and Severe Depression	Functional	Physical	Behavioral	Low	Behavioral and Severe Depression	Functional	Physical	Behavioral	Low
Stable, Severe Cognitive Impairment or Worsened	Admission to 3 Months					Three Months to 6 Months
Behavioral and Severe Depression	0.69	0.03	0.13	0.12	0.03	0.90	0.01	0.06	0.03	0.01
Functional	0.00	0.82	0.09	0.02	0.06	0.00	0.93	0.05	0.01	0.01
Physical	0.02	0.18	0.68	0.03	0.08	0.03	0.08	0.85	0.01	0.03
Behavioral	0.11	0.04	0.05	0.70	0.10	0.07	0.02	0.04	0.84	0.03
Low	0.03	0.06	0.05	0.07	0.79	0.02	0.09	0.04	0.02	0.83
Stable, Mild/Moderate Cognitive Impairment or Improved	Admission to 3 Months					Three Months to 6 Months
Behavioral and Severe Depression	0.72	0.02	0.11	0.12	0.05	0.91	0.02	0.01	0.04	0.02
Functional	0.01	0.84	0.04	0.01	0.10	0.00	0.96	0.03	0.00	0.01
Physical	0.02	0.11	0.74	0.04	0.09	0.00	0.06	0.91	0.01	0.03
Behavioral	0.04	0.03	0.02	0.81	0.12	0.02	0.02	0.01	0.93	0.02
Low	0.01	0.05	0.03	0.02	0.89	0.05	0.05	0.02	0.00	0.91