Daily pain, its associates and impact on work load in institutional long-term care

The objective of this study was to investigate the occurrence of daily pain, its associates and impact on work load in institutional long-term care (LTC) in a geriatric hospital responsible for all the hospital-based LTC-services in one health district (population 71 000) in Helsinki, Finland. All LTC-patients (n=656, females 81%, mean age=83 years) treated during 1 week were examined. Minimum Data Set (MDS 1.0), measurement of patient-related time according to Resource Utilization Groups (RUG-III)-studies, and Mini-Mental State Examination test (MMSE) were performed. If the patients complained or showed verbal or non-verbal evidence of pain at least once per day, they were considered to suffer from daily pain. Daily pain was present in 23% of the patients studied and its occurrence associated significantly with severity of illnesses, dehydration, vomiting, swallowing problems, weight loss, dyspnea, edema and terminal prognosis. It also related to frailty, poor functional capacity, contracture and the lack of body control. The occurrence of pain was increased in patients needing wound care, pressure relieving tools and mechanically altered diet. According to multivariate analysis dehydration, dyspnea, edema, diabetes mellitus, depression, wound care and dependency in locomotion emerged as independent associates of pain. The distribution of daily pain is heterogenic, even though it is accumulated in the sickest and frailest patients. The nursing staff addressed 14% more time to patients with pain than to those with out pain (P<0.05).