Effects of Mental Health Disorders on Nursing Home Residents' Nine-Month Pain Trajectories.

Abstract

To determine the key classes of nursing home residents' nine-month pain trajectories, the influence of residents' mental health disorders on membership in these classes, and nine-month health-related outcomes associated with pain trajectory class membership. Four times over a nine-month period, the MDS 3.0 resident assessment instrument was used to record the demographic characteristics, mental health disorder diagnoses, pain characteristics, and health and functioning outcomes of 2,539 Department of Veterans Affairs Community Living Center (VA CLC) residents. Growth mixture modeling was used to estimate the key classes of residents' nine-month pain trajectories, the influence of residents' mental health disorders on their pain trajectory class membership, and the associations of class membership with residents' health and functioning outcomes at nine-month follow-up. Four-class solutions best described nursing home residents' nine-month trajectories of pain frequency, severity, and interference. Residents with dementia and severe mental illness diagnoses were less likely, and those with depressive disorder, PTSD, and substance use disorder diagnoses more likely, to belong to adverse nine-month pain trajectory classes. Membership in adverse pain frequency and pain severity trajectory classes, and in trajectory classes characterized by initially high but steeply declining pain interference, portended more depressive symptoms but better cognitive and physical functioning at nine-month follow-up. Nursing home residents' mental health disorder diagnoses help predict their subsequent pain frequency, severity, and interference trajectories. This may be clinically useful information for improving pain assessment and treatment approaches for nursing home residents.