Abstract
Abstract
(350/350 words) Background Pain is common among nursing home (NH) residents and is associated with adverse physical, psychological, and social outcomes that may diminish their quality of life (QoL). Yet evidence regarding the association between pain and QoL remains inconclusive. Existing evidence mainly examined demographic and clinical variables, while the role of residents’ social determinants and NH organizational context in residents’ QoL remains underexplored. We examined (i) whether resident pain (at least moderate intensity of any frequency in the last 7 days) was associated with lower QoL, when adjusted for NH organizational context, resident social determinants, and clinical characteristics, and (ii) compared whether these associations differ between sub-samples of residents with or without pain. Methods We conducted a cross-sectional analysis of 2,950 residents from 67 publicly funded NHs across five Canadian provinces. QoL was assessed using the DEMQOL-CH completed by staff proxies. NH context variables, including NH characteristics, staffing hours, person-centered care, and proportion of visible minority residents, were collected using a facility survey completed by NH administrators. Social determinants were collected using staff surveys. Clinical data were obtained from Resident Assessment Instrument–Minimum Data Set 2.0 records. Utilizing generalized linear mixed models with staff-level random intercepts, we examined (i) associations between pain and QoL, when adjusting for NH context, resident social determinants, and clinical characteristics and (ii) the association of NH and resident variables with QoL stratified by pain status. Results A total of 314 (10.6%) residents experienced at least moderate pain. Mean DEMQOL-CH score was 92.9 (95% CI: 92.37-93.51). Residents with pain had significantly lower QoL scores (by 2.9%) compared to those without pain. Responsive behaviors, depressive symptoms, and health instability were associated with lower QoL, while cognitive impairment was associated with better staff-rated QoL among the total sample and residents without pain. NH context variables were not associated with QoL among residents with or without pain. Conclusions Pain was independently associated with poorer QoL, highlighting the importance of incorporating inclusive pain definition for early pain identification and management. Larger longitudinal and qualitative studies focusing on residents with pain are needed. Interventions targeting clinical symptoms may help improve residents’ QoL.