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Published in: BMC Geriatrics 1/2018

Open Access 01-12-2018 | Research article

Pain perception of older adults in nursing home and home care settings: evidence from China

Authors: Yuebin Xu, Nan Jiang, Yean Wang, Qiang Zhang, Lin Chen, Shuang Ma

Published in: BMC Geriatrics | Issue 1/2018

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Abstract

Background

In the past decade, the number of long-term care (LTC) services for older adults in China has grown annually by an average of 10%. Older adults, their family members, and policymakers in China are concerned about patient outcomes in different care settings because older adults who have a similar functional status and LTC needs may choose either nursing home care or home care. The aim of this study was to compare pain perception in nursing home care and home care settings for physically dependent older adults in China.

Methods

Multi-stage sampling method was used to recruit respondents aged 65 and older from Yichang City, China, in 2015. The researchers employed a two-step analytical strategy—zero-inflated ordered probit regression followed by propensity score matching method—to model the effect of contrasting residence types on pain perception.

Results

Zero-inflated ordered probit regression analysis with participants unmatched (n = 484) showed that compared with older adults who received home care, those who received nursing home care did not have more severe pain (β = 0.088, SE = 0.196, p = 0.655). After propensity-score matching, the research found that older adults in the home care group perceived less pain compared with the nursing home group (β = 0.489, SE = 0.169, p = 0.004).

Conclusions

The older adults who received home care perceived significantly less pain than the nursing home residents. The pain of older adults may differ based on the type of LTC services and therapy intensity they received, and home care might lead to less pain and better comfort than nursing home care.
Literature
1.
go back to reference Jackson T, et al. Prevalence and correlates of chronic pain in a random population study of adults in Chongqing, China. Clin J Pain. 2014;30(4):346–52.CrossRefPubMed Jackson T, et al. Prevalence and correlates of chronic pain in a random population study of adults in Chongqing, China. Clin J Pain. 2014;30(4):346–52.CrossRefPubMed
2.
go back to reference Li L, Liu X, Herr K. Postoperative pain intensity assessment: a comparison of four scales in Chinese adults. Pain Med. 2007;8(3):223–34.CrossRefPubMed Li L, Liu X, Herr K. Postoperative pain intensity assessment: a comparison of four scales in Chinese adults. Pain Med. 2007;8(3):223–34.CrossRefPubMed
3.
go back to reference Stubbs B, et al. Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis. Pain Med. 2014;15(7):1115–28.CrossRefPubMed Stubbs B, et al. Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis. Pain Med. 2014;15(7):1115–28.CrossRefPubMed
4.
go back to reference Chen X, et al. Depression symptoms and chronic pain in the community population in Beijing, China. Psychiatry Res. 2012;200(2):313–7.CrossRefPubMed Chen X, et al. Depression symptoms and chronic pain in the community population in Beijing, China. Psychiatry Res. 2012;200(2):313–7.CrossRefPubMed
5.
go back to reference Chou KL, Chi I. Reciprocal relationship between pain and depression in elderly Chinese primary care patients. Int J Geriatr Psychiatry. 2005;20(10):945–52.CrossRefPubMed Chou KL, Chi I. Reciprocal relationship between pain and depression in elderly Chinese primary care patients. Int J Geriatr Psychiatry. 2005;20(10):945–52.CrossRefPubMed
7.
go back to reference China National Committe on Aging. The 2010 report on China ageing population (in Chinese). Beijing: China National Committee on Ageing; 2012. China National Committe on Aging. The 2010 report on China ageing population (in Chinese). Beijing: China National Committee on Ageing; 2012.
9.
go back to reference Hadjistavropoulos T, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain. 2007;23:S1–S43.CrossRefPubMed Hadjistavropoulos T, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain. 2007;23:S1–S43.CrossRefPubMed
10.
go back to reference Życzkowska J, et al. Pain among the oldest old in community and institutional settings. Pain. 2007;129(1):167–76.CrossRefPubMed Życzkowska J, et al. Pain among the oldest old in community and institutional settings. Pain. 2007;129(1):167–76.CrossRefPubMed
11.
go back to reference Phillips DR, et al. Informal social support and older persons’ psychological well-being in Hong Kong. J Cross-Cult Gerontol. 2008;23(1):39–55.CrossRefPubMed Phillips DR, et al. Informal social support and older persons’ psychological well-being in Hong Kong. J Cross-Cult Gerontol. 2008;23(1):39–55.CrossRefPubMed
12.
go back to reference Rustøen T, et al. Predictors of quality of life in oncology outpatients with pain from bone metastasis. J Pain Symptom Manag. 2005;30(3):234–42.CrossRef Rustøen T, et al. Predictors of quality of life in oncology outpatients with pain from bone metastasis. J Pain Symptom Manag. 2005;30(3):234–42.CrossRef
13.
go back to reference Clarke A, et al. “I feel so stupid because I can’t give a proper answer…” how older adults describe chronic pain: a qualitative study. BMC Geriatr. 2012;12(1):78.CrossRefPubMedPubMedCentral Clarke A, et al. “I feel so stupid because I can’t give a proper answer…” how older adults describe chronic pain: a qualitative study. BMC Geriatr. 2012;12(1):78.CrossRefPubMedPubMedCentral
14.
go back to reference Eggermont LH, et al. Depressive symptoms, chronic pain, and falls in older community-dwelling adults: the MOBILIZE Boston study. J Am Geriatr Soc. 2012;60(2):230–7.CrossRefPubMedPubMedCentral Eggermont LH, et al. Depressive symptoms, chronic pain, and falls in older community-dwelling adults: the MOBILIZE Boston study. J Am Geriatr Soc. 2012;60(2):230–7.CrossRefPubMedPubMedCentral
15.
16.
go back to reference Torvik K, et al. Pain and quality of life among residents of Norwegian nursing homes. Pain Management Nursing. 2010;11(1):35–44.CrossRefPubMed Torvik K, et al. Pain and quality of life among residents of Norwegian nursing homes. Pain Management Nursing. 2010;11(1):35–44.CrossRefPubMed
17.
go back to reference Takai Y, et al. Literature review of pain prevalence among older residents of nursing homes. Pain Management Nursing. 2010;11(4):209–23.CrossRefPubMed Takai Y, et al. Literature review of pain prevalence among older residents of nursing homes. Pain Management Nursing. 2010;11(4):209–23.CrossRefPubMed
18.
go back to reference Smalbrugge M, et al. Pain among nursing home patients in the Netherlands: prevalence, course, clinical correlates, recognition and analgesic treatment–an observational cohort study. BMC Geriatr. 2007;7(1):3.CrossRefPubMedPubMedCentral Smalbrugge M, et al. Pain among nursing home patients in the Netherlands: prevalence, course, clinical correlates, recognition and analgesic treatment–an observational cohort study. BMC Geriatr. 2007;7(1):3.CrossRefPubMedPubMedCentral
19.
go back to reference Kane RL, et al. Do rehabilitative nursing homes improve the outcomes of care? J Am Geriatr Soc. 1996;44(5):545–54.CrossRefPubMed Kane RL, et al. Do rehabilitative nursing homes improve the outcomes of care? J Am Geriatr Soc. 1996;44(5):545–54.CrossRefPubMed
20.
go back to reference Lee TW, et al. Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services. J Am Geriatr Soc. 2014;62(8):1467–75.CrossRefPubMed Lee TW, et al. Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services. J Am Geriatr Soc. 2014;62(8):1467–75.CrossRefPubMed
21.
go back to reference Maxwell CJ, et al. The prevalence and management of current daily pain among older home care clients. Pain. 2008;138(1):208–16.CrossRefPubMed Maxwell CJ, et al. The prevalence and management of current daily pain among older home care clients. Pain. 2008;138(1):208–16.CrossRefPubMed
22.
go back to reference Tsai Y-F, et al. Pain prevalence, experiences and management strategies among the elderly in Taiwanese nursing homes. J Pain Symptom Manag. 2004;28(6):579–84.CrossRef Tsai Y-F, et al. Pain prevalence, experiences and management strategies among the elderly in Taiwanese nursing homes. J Pain Symptom Manag. 2004;28(6):579–84.CrossRef
23.
go back to reference Jiang N, Lou VW, Lu N. Does social capital influence preferences for aging in place? Evidence from urban China. Aging Ment Health. 2016:1–7. Jiang N, Lou VW, Lu N. Does social capital influence preferences for aging in place? Evidence from urban China. Aging Ment Health. 2016:1–7.
24.
go back to reference Zhang NJ, Guo M, Zheng X. China: awakening giant developing solutions to population aging. Gerontologist. 2012:gns105. Zhang NJ, Guo M, Zheng X. China: awakening giant developing solutions to population aging. Gerontologist. 2012:gns105.
27.
go back to reference Ministry of Civil Affairs of the People’s Republic of China. Guiding opinions of the Ministry of Civil Affairs on promoting elderly service evaluation. Beijing: Ministry of Civil Affairs of the People’s Republic of China; 2016. Ministry of Civil Affairs of the People’s Republic of China. Guiding opinions of the Ministry of Civil Affairs on promoting elderly service evaluation. Beijing: Ministry of Civil Affairs of the People’s Republic of China; 2016.
28.
go back to reference Shum MH, et al. The “leap forward” in nursing home development in urban China: future policy directions. J Am Med Dir Assoc. 2015;16(9):784–9.CrossRefPubMed Shum MH, et al. The “leap forward” in nursing home development in urban China: future policy directions. J Am Med Dir Assoc. 2015;16(9):784–9.CrossRefPubMed
29.
go back to reference Yang W, et al. Financing institutional long-term care for the elderly in China: a policy evaluation of new models. Health Policy Plan. 2016;31(10):1391–401.CrossRefPubMed Yang W, et al. Financing institutional long-term care for the elderly in China: a policy evaluation of new models. Health Policy Plan. 2016;31(10):1391–401.CrossRefPubMed
30.
go back to reference Hao Q, et al. Current dilemmas of nursing homes in Chengdu: a cross-sectional survey. J Am Med Dir Assoc. 2012;13(4):406. e409–12.CrossRef Hao Q, et al. Current dilemmas of nursing homes in Chengdu: a cross-sectional survey. J Am Med Dir Assoc. 2012;13(4):406. e409–12.CrossRef
32.
go back to reference Wysocki A, et al. Long-term services and supports for older adults: a review of home and community-based services versus institutional care. J Aging Soc Policy. 2015;27(3):255–79.PubMed Wysocki A, et al. Long-term services and supports for older adults: a review of home and community-based services versus institutional care. J Aging Soc Policy. 2015;27(3):255–79.PubMed
33.
go back to reference Frytak JR, et al. Outcome trajectories for assisted living and nursing facility residents in Oregon. Health Serv Res. 2001;36(1 Pt 1):91.PubMedPubMedCentral Frytak JR, et al. Outcome trajectories for assisted living and nursing facility residents in Oregon. Health Serv Res. 2001;36(1 Pt 1):91.PubMedPubMedCentral
34.
go back to reference Mitchell SL, et al. Terminal care for persons with advanced dementia in the nursing home and home care settings. J Palliat Med. 2004;7(6):808–16.CrossRefPubMed Mitchell SL, et al. Terminal care for persons with advanced dementia in the nursing home and home care settings. J Palliat Med. 2004;7(6):808–16.CrossRefPubMed
36.
go back to reference Blackburn J, Locher JL, Kilgore ML. Comparison of long-term care in nursing homes versus home health: costs and outcomes in Alabama. The Gerontologist. 2014;56(2):215–21.CrossRefPubMed Blackburn J, Locher JL, Kilgore ML. Comparison of long-term care in nursing homes versus home health: costs and outcomes in Alabama. The Gerontologist. 2014;56(2):215–21.CrossRefPubMed
37.
go back to reference Tian X, et al. Association between pain and frailty among Chinese community-dwelling older adults: depression as a mediator and its interaction with pain. Pain. 2018;159(2):306–13.CrossRefPubMed Tian X, et al. Association between pain and frailty among Chinese community-dwelling older adults: depression as a mediator and its interaction with pain. Pain. 2018;159(2):306–13.CrossRefPubMed
38.
go back to reference Li J, et al. Chronic pain and its association with obesity among older adults in China. Arch Gerontol Geriatr. 2018;76:12–8.CrossRefPubMed Li J, et al. Chronic pain and its association with obesity among older adults in China. Arch Gerontol Geriatr. 2018;76:12–8.CrossRefPubMed
40.
go back to reference Miu D, Chan K. Under-detection of pain in elderly nursing home residents with moderate to severe dementia. J Clin Gerontol Geriatr. 2014;5(1):23–7.CrossRef Miu D, Chan K. Under-detection of pain in elderly nursing home residents with moderate to severe dementia. J Clin Gerontol Geriatr. 2014;5(1):23–7.CrossRef
41.
go back to reference Morris JN, Fries BE, Bernabei R, Steel K, Ikegami N, Carpenter I, Gilgen R, DuPasquier JN, Fritjers D, Henrard JC, Hirdes JP, Belleville-Taylor P. Home care (HC) assessment form and user’s manual, 9.1. Washington, DC: interRAI; 2009. Morris JN, Fries BE, Bernabei R, Steel K, Ikegami N, Carpenter I, Gilgen R, DuPasquier JN, Fritjers D, Henrard JC, Hirdes JP, Belleville-Taylor P. Home care (HC) assessment form and user’s manual, 9.1. Washington, DC: interRAI; 2009.
42.
go back to reference Morris J, Belleville-Taylor P, Fries B, et al. interRAI long-term care Facil- ities (LTCF) assessment form and User’s manual, 9.1. Washington, DC: interRAI; 2011. Morris J, Belleville-Taylor P, Fries B, et al. interRAI long-term care Facil- ities (LTCF) assessment form and User’s manual, 9.1. Washington, DC: interRAI; 2011.
43.
go back to reference Glenny C, Stolee P. Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature. BMC Geriatr. 2009;9(1):52.CrossRefPubMedPubMedCentral Glenny C, Stolee P. Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature. BMC Geriatr. 2009;9(1):52.CrossRefPubMedPubMedCentral
44.
go back to reference Hirdes JP, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8(1):277.CrossRefPubMedPubMedCentral Hirdes JP, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8(1):277.CrossRefPubMedPubMedCentral
45.
go back to reference Gray LC, et al. Standardizing assessment of elderly people in acute care: the interRAI acute care instrument. J Am Geriatr Soc. 2008;56(3):536–41.CrossRefPubMed Gray LC, et al. Standardizing assessment of elderly people in acute care: the interRAI acute care instrument. J Am Geriatr Soc. 2008;56(3):536–41.CrossRefPubMed
46.
go back to reference Leung AC-t, Tsui LL, Yau DC. The use of the minimum data set: home care in a case management project in Hong Kong. Care Manag J. 2001;3(1):8.CrossRef Leung AC-t, Tsui LL, Yau DC. The use of the minimum data set: home care in a case management project in Hong Kong. Care Manag J. 2001;3(1):8.CrossRef
47.
go back to reference Chan CL, Lai CK, Chi I. Initial validation of the Chinese interRAI mental health in people with psychiatric illness. Int J Psychiatry Clin Pract. 2014;18(3):182–9.CrossRefPubMed Chan CL, Lai CK, Chi I. Initial validation of the Chinese interRAI mental health in people with psychiatric illness. Int J Psychiatry Clin Pract. 2014;18(3):182–9.CrossRefPubMed
48.
go back to reference Liu JY, et al. The reliability and validity of the pain items of the Hong Kong version interRAI community health assessment for community-dwelling elders in Hong Kong. J Clin Nurs. 2015;15(24):2352–4.CrossRef Liu JY, et al. The reliability and validity of the pain items of the Hong Kong version interRAI community health assessment for community-dwelling elders in Hong Kong. J Clin Nurs. 2015;15(24):2352–4.CrossRef
49.
go back to reference Fries BE, et al. Pain in US nursing homes: validating a pain scale for the minimum data set. Gerontologist. 2001;41(2):173–9.CrossRefPubMed Fries BE, et al. Pain in US nursing homes: validating a pain scale for the minimum data set. Gerontologist. 2001;41(2):173–9.CrossRefPubMed
50.
go back to reference Doran DM, et al. Nursing-sensitive outcomes data collection in acute care and long-term-care settings. Nurs Res. 2006;55(2):S75–81.CrossRefPubMed Doran DM, et al. Nursing-sensitive outcomes data collection in acute care and long-term-care settings. Nurs Res. 2006;55(2):S75–81.CrossRefPubMed
51.
go back to reference Onder G, et al. Association between pain and depression among older adults in Europe: results from the aged in home care (AdHOC) project: a cross-sectional study. J Clin Psychiatry. 2005;66(8):982–8.CrossRefPubMed Onder G, et al. Association between pain and depression among older adults in Europe: results from the aged in home care (AdHOC) project: a cross-sectional study. J Clin Psychiatry. 2005;66(8):982–8.CrossRefPubMed
52.
go back to reference Wu N, et al. Impact of cognitive function on assessments of nursing home residents' pain. Med Care. 2005:934–9. Wu N, et al. Impact of cognitive function on assessments of nursing home residents' pain. Med Care. 2005:934–9.
53.
go back to reference Long JS, Freese J: Regression models for categorical dependent variables using Stata. Stata press; 2006. Long JS, Freese J: Regression models for categorical dependent variables using Stata. Stata press; 2006.
54.
go back to reference Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41–55.CrossRef Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41–55.CrossRef
55.
go back to reference Guo S, Fraser M. Propensity score analysis: statistical methods and analysis. Thousand Oaks: Sage; 2010. Guo S, Fraser M. Propensity score analysis: statistical methods and analysis. Thousand Oaks: Sage; 2010.
58.
go back to reference Greene WH: Accounting for excess zeros and sample selection in Poisson and negative binomial regression models. 1994. Greene WH: Accounting for excess zeros and sample selection in Poisson and negative binomial regression models. 1994.
60.
go back to reference Wilson P. The misuse of the Vuong test for non-nested models to test for zero-inflation. Econ Lett. 2015;127:51–3.CrossRef Wilson P. The misuse of the Vuong test for non-nested models to test for zero-inflation. Econ Lett. 2015;127:51–3.CrossRef
61.
go back to reference Harrington C, et al. Nursing home staffing and its relationship to deficiencies. J Gerontol Ser B Psychol Sci Soc Sci. 2000;55(5):S278–87.CrossRef Harrington C, et al. Nursing home staffing and its relationship to deficiencies. J Gerontol Ser B Psychol Sci Soc Sci. 2000;55(5):S278–87.CrossRef
62.
go back to reference Jette DU, Warren RL, Wirtalla C. Rehabilitation in skilled nursing facilities: effect of nursing staff level and therapy intensity on outcomes. Am J Phys Medi Rehabil. 2004;83(9):704–12.CrossRef Jette DU, Warren RL, Wirtalla C. Rehabilitation in skilled nursing facilities: effect of nursing staff level and therapy intensity on outcomes. Am J Phys Medi Rehabil. 2004;83(9):704–12.CrossRef
64.
go back to reference Pruchno RA, Rose MS. The effect of long-term care environments on health outcomes. Gerontologist. 2000;40(4):422–8.CrossRefPubMed Pruchno RA, Rose MS. The effect of long-term care environments on health outcomes. Gerontologist. 2000;40(4):422–8.CrossRefPubMed
65.
go back to reference Mattimore TJ, et al. Surrogate and physician understanding of patients' preferences for living permanently in a nursing home. J Am Geriatr Soc. 1997;45(7):818–24.CrossRefPubMed Mattimore TJ, et al. Surrogate and physician understanding of patients' preferences for living permanently in a nursing home. J Am Geriatr Soc. 1997;45(7):818–24.CrossRefPubMed
Metadata
Title
Pain perception of older adults in nursing home and home care settings: evidence from China
Authors
Yuebin Xu
Nan Jiang
Yean Wang
Qiang Zhang
Lin Chen
Shuang Ma
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2018
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-018-0841-0

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