Aging Clinical and Experimental Research

, Volume 10, Issue 5, pp 411–420 | Cite as

Predictors of pain self-report in nursing home residents

  • D. K. Weiner
  • B. L. Peterson
  • P. Logue
  • F. J. Keefe


The purpose of this study was to examine the influence of cognitive function and other biopsychosocial factors on test-retest agreement, four-week variability, and intensity of self-reported pain using the verbal 0 to 10 scale and a pain thermometer in 115 nursing home residents over four weeks. Pain was assessed twice on three days during week 1, and once each during weeks 2, 3 and 4. A forward stepwise regression procedure was used to examine the influence of biopsychosocial parameters (age, race, gender, educational status, marital status, comorbidity, cognitive function, depression, social support, physical function and self-rated health) on pain intensity, test-retest agreement and variability. There was a quadratic association between cognitive function and test-retest agreement with the 0–10 scale; residents with Folstein scores of 22–26 were more likely to show disagreement (50% of 34) than residents with scores <22 or >26 (7% of 71). Hi gher Folstein scores were also associated with greater pain intensity for both pain scales (p<0.001). Baseline pain intensity was significantly related to pain variability (0–10 scale only). The clinician should be cognizant of these relationships when interpreting verbalizations of pain in long-term care facilities.

Key words

Elderly nursing home pain pain measurement 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gordon R.S.: Pain in the elderly — patterns change with age. JAMA 241: 2491–2492, 1979.CrossRefGoogle Scholar
  2. 2.
    Roy R., Thomas M.: A survey of chronic pain in an elderly population. Can. Fam. Physician 32: 513–516, 1986.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Fordyce W.E.: Environmental factors in the genesis of low back pain. In: Bonica J.J., Liebeskind J.E., Albe-Fessard D.G. (Eds.), Advances in Pain Research and Therapy. Raven Press, New York, 1979, Vol. 3.Google Scholar
  4. 4.
    Harkins S.W., Kwentus J., Price D.D.: Pain and the elderly. In: Benedetti et al. (Eds.), Advances in Pain Research and Therapy. Raven Press, New York, 1984, Vol. 7, pp. 103–212.Google Scholar
  5. 5.
    Herr K.A., Mobily P.R.: Complexities of pain assessment in the elderly — clinical considerations. J. Gerontol. Nurs. 17: 12–19, 1991.PubMedGoogle Scholar
  6. 6.
    Marzinski L.R.: The tragedy of dementia: clinically assessing pain in the confused, nonverbal elderly. J. Gerontol. Nurs. 17: 25–28, 1991.PubMedGoogle Scholar
  7. 7.
    Melding P.S.: Is there such a thing as geriatric pain? Pain 46: 119–121, 1991.PubMedCrossRefGoogle Scholar
  8. 8.
    Parmelee P.A.: Pain in cognitively impaired older persons. Clin. Geriatr. Med. 12: 473–487, 1996.PubMedGoogle Scholar
  9. 9.
    Hardy J.D.: The nature of pain. J. Chronic Dis. 4: 22–51, 1956.PubMedCrossRefGoogle Scholar
  10. 10.
    Wiener C.L.: Pain assessment on an orthopedic ward. Nurs. Outlook 23: 508–516, 1975.PubMedGoogle Scholar
  11. 11.
    Fordyce W.E.: Behavioral Methods for Chronic Pain and Illness. Mosby, St. Louis, 1976.Google Scholar
  12. 12.
    Melzack R., Wall P.D.: Pain mechanisms: a new theory. Science 150: 971–979, 1965.PubMedCrossRefGoogle Scholar
  13. 13.
    McGrath P.A., Brigham M.C.: The assessment of pain in children and adolescents. In: Turk D.D., Melzack R. (Eds.), Handbook of Pain Assessment. The Guilford Press, New York/London, 1992, pp. 295–314.Google Scholar
  14. 14.
    Parmelee P.A., Smith B., Katz I.R.: Pain complaints and cognitive status among elderly institution residents. J. Am. Geriatr. Soc. 41: 517–522, 1993.PubMedGoogle Scholar
  15. 15.
    Blessed G., Tominson B.E., Roth M.: The association between quantitative measures of dementia and of senile change in the cerebral gray matter. Br. J. Psychiatry 114: 797–811, 1968.PubMedCrossRefGoogle Scholar
  16. 16.
    Parmelee P.A.: Assessment of pain in the elderly. In: Lawton M.P., Teresi J. (Eds.), Annual Review of Gerontology and Geriatrics. Springer, New York, 1994, pp. 281–301.Google Scholar
  17. 17.
    Guyatt G., Walter S., Norman G.: Measuring change over time: assessing the usefulness of evaluative instruments. J. Chronic Dis. 40: 171–178, 1987.PubMedCrossRefGoogle Scholar
  18. 18.
    Cleeland C.S.: Measurement of pain by subjective report. In: Chapman C.R., Loeser J.D. (Eds.), Advances in Pain Research and Therapy: Issues in Pain Measurement. Raven Press, New York, 1989, pp. 391–404.Google Scholar
  19. 19.
    Turk D.C., Melzack R.: The measurement of pain and the assessment of people experiencing pain. In: Turk D.C., Melzack R. (Eds.), Handbook of Pain Assessment. The Guilford Press, New York/London, 1992, pp. 3–14.Google Scholar
  20. 20.
    Jensen M.P., Karoly P.: Self-report scales and procedures for assessing pain in adults. In: Turk D.C., Melzack R. (Eds.), Handbook of Pain Assessment. The Guildford Press, New York/London, 1992, pp. 135–151.Google Scholar
  21. 21.
    Roland M., Morris R.: A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low-back pain. Spine 8: 141–144, 1983.PubMedCrossRefGoogle Scholar
  22. 22.
    Herr K.A., Mobily P.R.: Comparison of selected pain assessment tools for use with the elderly. Appl. Nurs. Res. 6: 39–46, 1993.PubMedCrossRefGoogle Scholar
  23. 23.
    Folstein M.F., Folstein S., McHugh P.R.: Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.PubMedCrossRefGoogle Scholar
  24. 24.
    Parmelee P.A., Thuras P.D., Katz I.R., Lawton M.P.: Validation of the cumulative illness rating scale in a geriatric residential population. J. Am. Geriatr. Soc. 43: 130–137, 1995.PubMedGoogle Scholar
  25. 25.
    Yesavage J.A., Brink T.L., Rose T.L., Lum O.: Development and validation of a geriatric depression screening scale: a preliminary report. J. Psychiatr. Res. 17: 37–49, 1983.CrossRefGoogle Scholar
  26. 26.
    McGivney S.A., Mulvihill M., Taylor B.: Validating the GDS depression screen in the nursing home. J. Am. Geriatr. Soc. 42: 490–492, 1994.PubMedGoogle Scholar
  27. 27.
    Barthel D., Mahoney F.: Functional evaluation: the Barthel index. Md. State Med. J. 2: 61–65, 1965.Google Scholar
  28. 28.
    Cohen-Mansfield J., Marx M.S.: The social network of the agi -tated nursing home resident. Res. Aging 14: 110–123, 1992.CrossRefGoogle Scholar
  29. 29.
    Fillenbaum G.G.: Social context and self-assessments of health among the elderly. J. Health Soc. Behav. 20: 45–51, 1979.PubMedCrossRefGoogle Scholar
  30. 30.
    Mossey J.M., Shapiro M.A.: Self-rated health: a predictor of mortality among the elderly. Am. J. Public Health 72: 800–808, 1982.PubMedCrossRefGoogle Scholar
  31. 31.
    Schoenfeld D.E., Malmrose L.C., Blazer D.G., Gold D.T., Seeman T.E.: Self-rated health and mortality in the high-functioning elderly — a closer look at healthy individuals: MacArthur field study of successful aging. J. Gerontol. Med. Sci. 49: M109–M115, 1994.Google Scholar
  32. 32.
    Shrout P.E., Fleiss J.L.: Intraclass correlations: uses in assessing rate reliability. Psychol. Bull. 93: 586–595, 1983.CrossRefGoogle Scholar
  33. 33.
    Forthofer R.N., Lehnen R.G.: Public Program Analysis. Lifetime Learning Publications, Belmont CA, 1981.CrossRefGoogle Scholar
  34. 34.
    Raskin R.: Partialing out the effects of depression and age on cognitive functions: experimental data and methodologic issues. In: Poon (Ed.), Handbook for Clinical Memory Assessment of Older Adults. American Psychological Association, Washington, D.C., 1986, pp. 218–225.Google Scholar
  35. 35.
    Ferrell B.A., Ferrell B.R., Osterweil D.: Pain in the nursing home. J. Am. Geriatr. Soc. 38: 409–414, 1990.PubMedGoogle Scholar
  36. 36.
    Ferrell B.A., Ferrell B.R., Rivera L.: Pain in cognitively impaired nursing home patients. J. Pain Symptom Manage. 10: 591–598, 1995.PubMedCrossRefGoogle Scholar
  37. 37.
    Encandela J.A.: Social science and the study of pain since Zborowski: a need for a new agenda. Soc. Sci. Med. 36: 783–791, 1993.PubMedCrossRefGoogle Scholar
  38. 38.
    Weiner D.K., Ladd K.E., Pieper C.F., Keefe F.J.: Pain in the nursing home: resident versus staff perceptions. J. Am. Geriatr. Soc. 43: SA2, 1995 (Abstract).Google Scholar
  39. 39.
    Dirks J.F., Wunder J., Kinsman R., McElhinny J., Jones N.F.: A pain rating scale and a pain behavior checklist for clini cal use: development, norms, and the consistency score. Psychother. Psychosom. 59: 41–49, 1993.PubMedCrossRefGoogle Scholar
  40. 40.
    Keefe F.J., Crisson J.E., Trainor M.: Observation methods for assessing pain: a practical guide. In: Blumenthal J.A., McKee D.C. (Eds.), Applications in Behavioral Medicine and Health Psychology: A Clinician’s Source Book. Professional Resource Exchange, Sarasota FL, 1987, pp. 67–94.Google Scholar
  41. 41.
    Kerns R.D., Haythornthwaite J., Rosenberg R., Southwick S., Giller E.L., Jacob M.C.: The pain behavior check list (PBCL): factor structure and psychometric properties. J. Behav. Med. 14: 155–167, 1991.PubMedCrossRefGoogle Scholar
  42. 42.
    Richards J.S., Nepomuceno C., Riles M., Suer Z.: Assessing pain behavior: the UAB pain behavior scale. Pain 14: 393–398, 1982.PubMedCrossRefGoogle Scholar
  43. 43.
    Weiner D., Pieper C., McConnell E., Martinez S., Keefe F.: Pain measurement in elders with chronic low back pain: traditional and alternative approaches. Pain 67: 461–467, 1996.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 1998

Authors and Affiliations

  • D. K. Weiner
    • 1
    • 2
    • 3
    • 6
    • 7
  • B. L. Peterson
    • 1
    • 4
  • P. Logue
    • 5
    • 6
  • F. J. Keefe
    • 3
    • 5
    • 6
  1. 1.Center for the Study of Aging and Human DevelopmentDurhamUSA
  2. 2.Department of MedicineDurhamUSA
  3. 3.Duke University Arthritis CenterDurhamUSA
  4. 4.Biometry Division, Department of Community and Family MedicineDurhamUSA
  5. 5.Department of Psychiatry and Behavioral SciencesDurhamUSA
  6. 6.Department of PsychologyDuke University Medical CenterDurhamUSA
  7. 7.Durham VA Medical Center Geriatric Research Education and Clinical CenterDurhamUSA

Personalised recommendations