ABSTRACT PAIN AND PAIN MANANAGEMENT IN A MEDICAID WAIVER PROGRAMByElizabeth Annette BymaBackground/Purpose: Poor older adults are a vulnerable population at increased risk for cancer, pain, poor pain management and pain management outcomes. There is no known research that has examined the differences in pain, pain management and pain management outcomes or the transfer of HCBWP participants to nursing homes between persons with and without a diagnosis of cancer among Medicaid-enrolled, older adults participating in Home and Community-Based Waiver programs (HCBWP). Research examining pain, pain management and pain management outcomes among older adults has been cross-sectional. Longitudinal research would be better able to examine the associations among pain, pain management and pain management outcomes overtime and how pain, pain management and pain management outcomes associate with the admission of older adult HCBWP participants to nursing homes. Conceptual Model: Based on the Symptom Management Theory, the pain experience, pain management strategies and pain management outcomes are associated with the domains of person and health and illness. The pain experience, pain management strategies, pain management outcomes and domains of person and health and illness are conceptualized as impacting the admission of older adult HCBWP participants to nursing homes. Methods: The study was a secondary analysis of data from the Minimum Data Set Home Care (MDS-HC), the State of Michigan Cancer Surveillance Data and Michigan Medicaid paid claims files and was of a longitudinal design. The sample was comprised of 4054 older adult HCBWP participants Generalized Estimating Equations, logistic regression and survival analysis methods were used. Results: Older adult HCBWP participants who were female, had a higher comorbid conditions score or higher score for behaviors indicative of depression were more likely to experience daily pain over time. Older adult HCBWP participants who were African American, older age, or cognitively impaired were less likely to report daily pain over time. Cancer was not associated with daily pain over assessment time points. Older adult HCBWP participants with daily pain and in the initial phase of diagnosis of cancer were less likely to be prescribed non-opioid pain medications and adjuvant pain medications than older adult HCBWP participants without daily pain. Pain, age, race, sex, cognitive functioning, behaviors indicative of depression and comorbid conditions were associated over time with prescribed pain medications and physical functions. Behaviors indicative of depression was significantly associated with perceived pain control, such that as the measure of behaviors indicative of depression increased, the likelihood of pain control occurring decreased. Finally, diagnosis of cancer was not significantly associated with admission to a nursing home. Older adult HCBWP participants with daily pain were less likely to be admitted to a nursing home. Older adult HCBWP participants who had a higher measure of comorbid conditions, were cognitively impaired or were white had an increased hazard of being admitted to a nursing home. Conclusion: Diagnosis of cancer was not significantly associated with the pain experience, pain management outcomes and admission to a nursing home among older adult HCBWP participants and a limited association with prescribed pain medications. The prescription of pain medication was most consistently associated with the measure of pain. Pain had a negative association with the admission of older adult HCBWP participants to a nursing home and a positive association with physical functioning over time.
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