Disparities in Pain Among Nursing Home Residents - Race, Cognitive Impairment, and Nursing Home Racial Composition

Sep 29, 2026

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Pain is common among nursing home residents and can significantly shape end-of-life experiences, yet inequities in pain assessment and treatment persist and remain less studied among racial groups with smaller populations. This longitudinal, multi-level logistic regression study assessed associations between resident race, cognitive impairment, and nursing home racial composition with any pain recorded in the last five days. Analyses used resident data (including n=617,922 decedents in 2018–2019) and stratified by staff- and self-reported pain, adjusting for key demographic and facility factors, revealing race- and cognition-related disparities in pain documentation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Background

Study Design and Data

Key Findings

Implications and Future Research

484 Innovation in Aging, 2025, Vol. 9, No. S2 Abstract citation ID: igaf122.1655 DISPARITIES IN PAIN AMONG NURSING HOME RESIDENTS: RACE, COGNITIVE IMPAIRMENT, AND NURSING HOME RACIAL COMPOSITION Cassandra Dictus1, Matthias Hoben2, Kali Thomas3, Tamara A. Baker4, Baiming Zou4, Ruth Anderson1, Ashley Leak Bryant4, and Anna Beeber3, 1. Duke University, Durham, North Carolina, United States, 2. York University, Toronto, Ontario, Canada, 3. Johns Hopkins University, Baltimore, Maryland, United States, 4. The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States Pain is common among nursing home (NH) residents and can significantly impact quality of end-of-life experiences, yet Innovation in Aging, 2025, Vol. 9, No. S2 485 inequities in pain assessment and treatment persist and are less studied among racial groups with smaller population sizes. This study examined associations between resident race, cognitive impairment, and NH racial composition with any pain documented in the last five days. We conducted a longitudinal multi-level logistic regression using MDS 3.0, LTCFocus, and MBSF data. We focused on residents who died in 2018 or 2019, regardless of place of death (n = 617,922) . Analyses were stratified by staff-and self-reported pain, controlling for resident age, function, comorbidity, gender, and NH percent Medicaid, bed number, staffing, ownership, and rurality. In the initial adjusted models, both staff-and self-reported pain increased over the year before death. Staff-and self-reported pain decreased as cognitive impairment increased, and this was more dramatic in the self-reported model. In both models, pain varied by race, with American Indian or Alaskan Native residents having the highest rates, followed by Hispanic and White residents at similar rates; Black residents had slightly lower rates, followed by Asian residents, and Native Hawaiian or other Pacific Islander residents at the lowest. Pain was more frequently reported in predominately White NHs than in more racially diverse NHs, especially in the staff-reported model. Disparities may reflect underassessment of pain and inappropriate pain assessment methods, particularly at the NH-level in facilities that included more racially minoritized residents. Further research is needed to clarify these disparities and ensure equitable pain management.

FAQs

What does the study examine regarding pain in nursing homes?

It examines how resident race, cognitive impairment, and nursing home racial composition relate to any pain documented within the last five days.

How were the analyses conducted?

The study used longitudinal multi-level logistic regression and analyzed outcomes stratified by staff-reported and self-reported pain, adjusting for resident and nursing home characteristics.

What racial and cognitive patterns were observed in pain reporting?

Pain rates varied by race, with American Indian/Alaskan Native residents showing the highest rates, followed by Hispanic and White residents at similar levels. Pain decreased as cognitive impairment increased, more noticeably in the self-reported model.

Sep 29, 2026

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