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Pain in cognitively impaired nursing home patients
Ferrell BA, Ferrell BR, Rivera L.. Journal of pain and symptom management, 1995-11-01
Topic: Risk, prevention and care in population studies
Pain is an understudied problem in frail elderly patients, especially those with cognitive impairment, delirium, or dementia. The focus of this study was to describe the pain experienced by patients in skilled nursing homes, which have a high prevalence of cognitive impairment. A random sample of 325 subjects was selected from ten community skilled nursing homes. Subjects underwent a cross-sectional interview and chart review for the prevalence of pain complaints, etiology, and pain management strategies. Pain was assessed using the McGill Pain Questionnaire and four unidimensional scales previously utilized in younger adults. Thirty-three percent (33%) of subjects were excluded because they were either comatose (21%), non-English speaking (3.7%), temporarily away (sick in hospital) (4.3%), or refused to participate (3.7%). Of 217 subjects in the final analysis, the mean age was 84.9 years, 85% were women, and most were dependent in all activities of daily living. Subjects demonstrated substantial cognitive impairment (mean Folstein Mini-Mental State exam score was 12.1 +/- 7.9), typically having deficits in memory, orientation, and visual spatial skills. Sixty-two percent reported pain complaints, mostly related to musculoskeletal and neuropathic causes. Pain was not consistently documented in records, and pain management strategies appeared to be limited in scope and only partially successful in controlling pain. None of the four unidimensional pain-intensity scales studied in this investigation had a higher completion rate than the Present Pain Intensity Scale of the McGill Pain Questionnaire (65% completion rate). However, 83% of subjects who had pain could complete at least one of the scales. We conclude that cognitive impairment among elderly nursing home residents present a substantial barrier to pain assessment and management. Nonetheless, most patients with mild to moderate cognitive impairment can be assessed using at least one of the available bedside assessment scales.
Key findings
- Subjects demonstrated substantial cognitive impairment (mean Folstein Mini-Mental State exam score was 12.1 +/- 7.9), typically having deficits in memory, orientation, and visual spatial skills.
- We conclude that cognitive impairment among elderly nursing home residents present a substantial barrier to pain assessment and management.
Why it matters
This cross-sectional study of nursing home patients found that 62% reported pain complaints, mostly musculoskeletal and neuropathic, but pain was not consistently documented and management strategies appeared limited. It concludes that cognitive impairment among elderly nursing home residents presents a substantial barrier to pain assessment and management.
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Study details
- Study designcross-sectional
- Participants325
- Effect size3.7%; 4.3%
- Evidence strengthLow
How this study scored 53/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of pain and symptom management) |
| Journal's citation record | 2 / 4 | Journal of Pain and Symptom Management: journal h-index 213 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1995 — older than 20 years, still counted |
| Sample size | 2 / 4 | 325 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 636 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 19.3 citations a year over 33 year(s) since 1995 |
| Impact for its field and year | 4 / 6 | Cited 12.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 1 / 4 | Cited 8 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Lynne M. Rivera: h-index 10 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, Los Angeles: institution h-index 1,923 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 8594119) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 53 / 100 | — |
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Read the original
- DOI: 10.1016/0885-3924(95)00121-2
- PubMed: 8594119
- Original source →
- Free full text: Journal of Pain and Symptom Management →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Ferrell, B. A., Ferrell, B. R., & Rivera, L. (1995). Pain in cognitively impaired nursing home patients. Journal of pain and symptom management. https://doi.org/10.1016/0885-3924(95)00121-2
Vancouver
Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. Journal of pain and symptom management. 1995. doi:10.1016/0885-3924(95)00121-2. PMID: 8594119.
BibTeX
@article{ferrell1995-8594119,
author = {Ferrell, B. A. and Ferrell, B. R. and Rivera, L.},
title = {{Pain in cognitively impaired nursing home patients}},
journal = {Journal of pain and symptom management},
year = {1995},
doi = {10.1016/0885-3924(95)00121-2},
pmid = {8594119},
url = {https://doi.org/10.1016/0885-3924(95)00121-2}
}
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