(P62) Examining Relationships Between Nursing Home Facility Factors, Pain, and Race

Introduction/

Objective: Pain is highly prevalent among nursing home (NH) residents with dementia with estimates suggesting that 35-80% of residents experience pain. There are a number of factors that are associated with pain in NH residents with dementia including age, gender, race, comorbidities, and psychosocial factors. Moreover, racial disparities have been observed in the identification, assessment, and treatment of pain in NH residents. Limited evidence exists about whether NH facility factors such as size, staffing levels, star rating, and profit status are associated with pain and whether racial disparities exist in NH residents with dementia. Controlling for residents’ age, gender, comorbidities, and physical function, the purpose of this study was to examine differences in the relationship between NH facility factors and pain by race in a sample of NH residents with dementia. We hypothesized that there would be racial differences between NH facility factors and pain.

Design/Methodology: This was a secondary analysis using baseline data from the Testing the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study. Measures included residents’ demographic and health information from medical charts, facility characteristics collected from the NH and NH Compare website, and pain was evaluated based on the Pain Assessment in Advanced Dementia (PAINAD) Scale. Linear mixed models were used to examine the association between NH facility factors (size, profit status, staffing levels, star rating, health citations, and number of federal fines) and residents’ pain level and interactions by race, controlling for residents’ age, gender, function, and comorbidities.

Results: The sample included 553 residents from 55 NH facilities. Nursing homes in the sample ranged in size from 45 to 412 beds. The majority of NH were for-profit (n=34, 60.7%) and not part of a retirement community (n=38, 67.9%). Most residents in the sample were female (n = 398, 72%), White (n = 419, 76%), and mean age was 83 years old (SD=10.4). On average, NH residents had 7 comorbidities (SD = 2.2), minimal pain (M = .7, SD = 1.5), and functional impairment (M=36.5, SD=30.2). After adjusting for residents’ demographic and health characteristics, there were no significant associations between NH facility factors and pain and no significant interactions by race (p > 0.05).

Conclusion/

Discussion: Findings from this study suggest that NH facility characteristics were not associated with pain and no racial differences in these associations were found. Participants in this study were observed to have minimal pain based on the PAINAD measure. This study was limited in that it was only conducted in two states in a single region of the country and the sample was relatively homogenous. Further research is needed in a more diverse sample across geographic regions to better understand whether racial differences exist in the associations between NH facility factors and pain among residents with dementia.