Abstract
BackgroundWe tested for differences in direct health care costs among long-term care (LTC) residents age 65 and older with clinically significant pain (CSP) and with no pain or non-daily mild pain (NP/NDMP). We are not aware of any other large scale investigation that examined the cost of pain in LTC environments.MethodsPopulation-based administrative health data from Saskatchewan, Canada for 2004 to 2015 were used to compare direct health care costs for CSP and NP/NDMP groups up to one year after admission to LTC. Total accumulated costs for hospitalization, physician services, LTC, and prescription drugs were calculated in 2015 Canadian dollars. Group differences were tested using generalized linear models with generalized estimating equations.ResultsAmongst 24,870 LTC residents, 8289 (33.3%) were censored due to death or discharge in the 365-day study observation period. Of the 16,581 (66.7%) observed residents, 5683 (34.3%) had CSP at admission. Residents (66.3% female) had a mean age of 85 years (SD = 7.4). The mean annual total direct health care cost per resident was higher among the CSP group (CAD $8063) than the NP/NDMP group (CAD $6455). This difference was found even after including LTC costs, and for each cost component (i.e., CSP residents had higher hospitalization, physician, and prescription drug costs). Similar results were obtained after controlling for demographics, comorbidities, physical and cognitive impairment, prior health care costs, and facility characteristics.ConclusionThe higher costs incurred by CSP residents compared to NP/NDMP residents are likely underestimated because pain problems are often missed in residents with dementia, who comprise a large portion of the LTC population. Improved pain care can reduce such costs and improve quality of life.
Highlights
Prevalence estimates for pain in residents of long-term care (LTC) facilities range from 40 to 85% depending on study methods and the population under investigation [1]
Pain care in LTC can be improved with increased assessment focusing on well validated observational methods that focus on pain behaviours [6, 7], resource constraints are often cited as barriers to improving care and to conducting frequent pain assessments [8]
At the time of admission to LTC, 14.6% of residents with clinically significant pain (CSP) had moderate to very severe cognitive impairment, 10.1% had a CHESS scale of 3 to 5 and 14.5% had minimum level of functioning (ADL score of 22 to 28)
Summary
Prevalence estimates for pain in residents of long-term care (LTC) facilities range from 40 to 85% depending on study methods and the population under investigation [1]. Despite this high prevalence, pain is often undertreated among LTC residents, many of whom have cognitive impairments [1, 2]. For example, are less likely to receive analgesics than their cognitively intact counterparts [3, 4] This occurs, at least in part, because of limitations in ability to communicate subjective states such as pain due to cognitive decline [5] which affects a large portion of LTC residents. We are not aware of any other large scale investigation that examined the cost of pain in LTC environments
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