Assessing and Managing Pain in Dementias: Insights From Interdisciplinary Text Message Communications.

Abstract

Purpose: This study aimed to explore the difference between the representation of pain assessment and management among older adults with and without Alzheimer's Disease and Related Dementias (ADRD) residing in nursing homes (NH) using interdisciplinary text messages (TMs) exchanged prior to hospital transfer.

Design: A retrospective cohort study and secondary data analysis of (n = 21,000) TMs exchanged among interdisciplinary healthcare team members and survey data about NH residents who transferred to the hospital from 2016 to 2020.

Methods: The study analyzed TMs using natural language processing tools to identify mentions of pain assessment, management, and pain medications. We used a two-sample independent t-test and a negative binomial generalized linear model to assess the association between pain mentions and various resident characteristics, including ADRD status.

Results: The analysis included 694 transfer events involving 414 residents, 39% of whom had ADRD. Significant differences were found in pain mentions, with ADRD residents having fewer mentions (t = 2.38, p = .02) than those without ADRD. The generalized linear model identified statistically significant predictors (age, race, and specific comorbidities) of the number of TMs exchanged with pain mentions about NH residents. Dementia stage and avoidable transfers were not significant.

Conclusions: Our findings indicate pain is underrepresented in communications about Black residents and those with ADRD, potentially contributing to disparities in pain assessment and management in these populations.

Clinical implications: This study indicates a need for more equitable pain practices with improved pain assessment tools and pain assessment and management, particularly with TM communication in healthcare settings.