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COHORT STUDY OF PAIN BEHAVIORS IN THE ELDERLY RESIDING IN SKILLED NURSING CARE
Title
COHORT STUDY OF PAIN BEHAVIORS IN THE ELDERLY RESIDING IN SKILLED NURSING CARE.
Creator
Burfield, Allison, Sole, Mary Lou, University of Central Florida
Abstract / Description
An integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the...
Show moreAn integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the elderly residing in skilled nursing care, especially those with cognitive-impairment. The specific aims of this study were to: 1) Determine the magnitude of the relationship between pain behaviors and a measurement model hypothesized for pain; 2) Test the construct validity of a pain measurement model; 3) Examine the concomitance of pain and cognition in a three-year longitudinal analysis. The research questions answered: 1) Is there a difference in the prevalence of pain in cognitively intact versus cognitively-impaired residents; 2) Can a theoretically derived model of pain aid in detecting pain across all cognitive levels; and 3) Do pain and cognitive status concomitantly correlate? The goal was to examine the covariance model of concomitance of pain and cognition to more accurately construct theoretical models of pain to then include additional resident care factors in future research. Traditional self-reports of pain are often under-assessed and under-treated in the cognitively-impaired (CI) elderly resident. Having additional measures to detect pain beyond self-reports of pain intensity and frequency increases the likelihood of detecting pain in populations with complex symptom presentation. Data collected from skilled nursing facilities offer exceptional opportunities to study resident demographics, characteristics, symptoms, medication use, quality indicators, and care outcomes. The Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0, a nationally required resident assessment tool, must be completed on every resident in a Medicare LTC facility within 14 days of admission, quarterly, annually and with significant changes in resident status. Because the MDS is widely used and recognized in LTC settings, core items from MDS [i.e., pain frequency (J2a) and pain intensity (J2b)] along with additional MDS items hypothesized to signify pain were analyzed in the pilot measurement model. Ten core items from MDS were used: 1) Inappropriate behavior frequency (E4da); 2) Repetitive physical movements; 3) Repetitive verbalizations (E1c); 4) Sad facial expressions (E1l); 5) Crying (E1m); 6) Change in mood (E3); 7) Negative statements (E1a); 8) Pain frequency (J2a); 9) Pain intensity (J2b); and 10) Cumulative pain sites scores. All indicators of pain were significant at the p<.01 level. A longitudinal cohort design was used to answer if a concomitance exists between pain and cognition. Data were collected from MDS annual assessments from 2001, 2002 and 2003 for residents across the United States. The sample consisted of 56,494 residents age 65 years and older with an average age of 83 ±8.2 years. Descriptive statistics, ANOVA and a covariance model were used to evaluate cognition and pain at the three time intervals. ANOVA indicated a significant effect (p<.01) for pain and cognition with protected t-tests indicating scores decreased significantly over time with resident measures of pain and cognition. Results from this study suggest that: 1) Using only pain intensity and frequency, pain prevalence was found in 30% of the pilot population, while 47.7% of cognitively intact residents had documented pain and only 18.2% of the severely CI had documented pain, supporting previous research that pain is potentially under-reported in the CI; 2) Parsimonious measurements models of pain should include dimensions beyond self-reports of pain (i.e., cognitive, affective, behavioral and inferred pain indicators); 3) Model fit was improved by using specific MDS items in the pain construct; 4) Longitudinal analysis revealed relative stability for pain and cognition measures over time (e.g., larger stability or consistency was found in cognitive measures than the measures of pain over the three-year period); 5) Crossed-legged effects between pain and cognition were not consistent; 6) A concomitant relationship was not found between pain and cognition. The relationship was significant (p<.01), but associations were weak (r=0.03 to 0. 08). Pain or cognition should not be used as a predictor of the other in theoretical models for similar populations. The MDS is a reliable instrument to follow resident attributes, quality of care, and patient outcomes over time. The development of more accurate assessments of pain may improve resident care outcomes. Ineffectively intervening on the pain cycle is posited to cause secondary unmet needs that affect the resident's quality of life. Findings support the importance of improving clinical outcomes in the management of pain in the elderly residing in long-term care. Deficits in the treatment of pain highlight the impetus to support health policy change that includes pain treatment as a top health priority and a quality indicator for federally funded programs supporting eldercare.
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Date Issued
2009
Identifier
CFE0002533, ucf:47660
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0002533
Field Theoretic Lagrangian Stencils from Off-Shell Supermultiplet Gauge Quotients
Title
Field Theoretic Lagrangian Stencils from Off-Shell Supermultiplet Gauge Quotients.
Creator
Katona, Gregory, Klemm, Richard, Hubsch, Tristan, Peale, Robert, Shivamoggi, Bhimsen, University of Central Florida
Abstract / Description
Recent efforts to classify off-shell representations of supersymmetry without a central charge have focused upon directed, supermultiplet graphs of hypercubic topology known as Adinkras. These encodings of Super Poincare algebras, depict every generator of a chosen supersymmetry as a node-pair transformtion between fermionic / bosonic componentfields. This research thesis is a culmination of investigating novel diagrammatic sums of gauge quotients by supersymmetric images of other Adinkras,...
Show moreRecent efforts to classify off-shell representations of supersymmetry without a central charge have focused upon directed, supermultiplet graphs of hypercubic topology known as Adinkras. These encodings of Super Poincare algebras, depict every generator of a chosen supersymmetry as a node-pair transformtion between fermionic / bosonic componentfields. This research thesis is a culmination of investigating novel diagrammatic sums of gauge quotients by supersymmetric images of other Adinkras, and the correlated building of field theoretic worldline Lagrangians to accommodate both classical and quantum venues. We find Ref [40], that such gauge quotients do not yield other stand alone or (")proper(") Adinkras as afore sighted, nor can they be decomposed into supermultiplet sums, but are rather a connected (")Adinkraic network("). Their iteration, analogous to Weyl's construction for producing all finite-dimensional unitary representations in Lie algebras, sets off chains of algebraic paradigms in discrete-graph and continuous-field variables, the links of which feature distinct, supersymmetric Lagrangian templates. Collectively, these Adiankraic series air new symbolic genera for equation to phase moments in Feynman path integrals. Guided in this light, we proceed by constructing Lagrangians actions for the N = 3 supermultiplet YI /(iDI X) for I = 1, 2, 3, where YI and X are standard, Salam-Strathdee superfields: YI fermionic and X bosonic. The system, bilinear in the component fields exhibits a total of thirteen free parameters, seven of which specify Zeeman-like coupling to external background (magnetic) fluxes. All but special subsets of this parameter space describe aperiodic oscillatory responses, some of which are found to be surprisingly controlled by the golden ratio, ? ? 1.61803, Ref [52]. It is further determined that these Lagrangians allow an N = 3 ? 4 supersymmetric extension to the Chiral-Chiral and Chiral-twisted-Chiral multiplet, while a subset admits two inequivalent such extensions. In a natural progression, a continuum of observably and usefully inequivalent, finite-dimensional off-shellrepresentations of worldline N = 4 extended supersymmetry are explored, that are variatefrom one another but in the value of a tuning parameter, Ref [53]. Their dynamics turnsout to be nontrivial already when restricting to just bilinear Lagrangians. In particular, wefind a 34-parameter family of bilinear Lagrangians that couple two differently tuned supermultiplets to each other and to external magnetic fluxes, where the explicit parameter dependence is unremovable by any field redefinition and is therefore observable. This offers the evaluation of X-phase sensitive, off-shell path integrals with promising correlationsto group product decompositions and to deriving source emergences of higher-order background flux-forms on 2-dimensional manifolds, the stacks of which comprise space-time volumes. Application to nonlinear sigma models would naturally follow, having potential use in M- and F- string theories.
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Date Issued
2013
Identifier
CFE0005011, ucf:50004
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005011