Aging, Pain and Cancer in Long-term Care

A recent  article in Cancer Pain Release, a publication of the World Health Organization Collaborating Center for Policy and Communications in Cancer Care, (Vol. 20, No. 3-- 2007) addressed “Aging, pain and long-term care”.  As the “boomers” age and their parents age, long-term care facilities are becoming the principal place of care for older adults with complex medical conditions and increasingly a place of death.

The article included an interview Joan M. Teno, MD, Professor of Community Health and Medicine and Associate Director of the Center for Gerontology and Health Care Research at Brown University and includes a section on “Pain Management in Long-term Care: Recent Resources” that lists educational resources, “Research in Pain Control and Palliative Care: Pain Management Issues in Nursing Homes”. It also lists recent research and abstracts from studies in nursing home populations. The entire issue of Cancer Pain Release can be accessed online. 

One research abstract is important to bring to the attention of SCCPI members. It reported that palliative care and pain control are inadequate for older cancer patients in nursing homes. A secondary analysis of the Minimum Data Set (MDS) of a sample of 190,769 nursing home residents found 8.8% had a cancer diagnosis. Among  patients with pain, half of those who survived to a second assessment had persistent, severe pain (51.3%) although this varied by state. Active treatment was rare; less than 5% received chemotherapy or radiotherapy. The authors concluded that there are opportunities to improve the quality of cancer care and pain management in older adult residents in long-term care.  This report underscores the fact that nursing home residents have complex medical needs, are often frail and many have cognitive impairments. The complete citation is Johnson VMP, Teno JM, Bourbonniere M, et al. Palliative care needs of cancer patients in US nursing homes. J Palliat Med 2005; 2(8): 273-279.

Also see  “News and Views” about Schedule II prescriptions in long-term care facilities.