Date of Award

8-2023

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Ling Shi

Second Advisor

Suzanne G. Leveille

Third Advisor

Janice B. Foust

Abstract

Pain management is particularly challenging among older adults with cognitive impairment. Self-efficacy for pain management can promote effective pain management; however, the interplay between cognitive performance and self-efficacy on pain management is complicated and not well understood. The aims were to examine the relationship between cognitive performance, self-efficacy for pain management and pain management. Secondary data analyses were performed in 511 participants aged ≥ 70 years, reporting chronic pain (BPI ≥ 1) and pain management information at baseline, from the MOBILIZE Boston study. Cognitive performance was assessed using the Clock in the Box Test (CBT), Letter Fluency Test (LFT), Trail Making Test (TMT) Part A and B, the Hopkins Verbal Learning Test (HVLT), and the WORLD test. Self-efficacy for pain management was measured by the Chronic Pain Self-Efficacy (CPSE) questionnaire. Pain management was assessed by recommended and self-reported effectiveness of pain management. Recommended pain management was defined as using the endorsement of pharmacological and non-pharmacological pain management, while effectiveness of pain management was defined by the self-reported percent of pain relief after pain management. 0% represented "no relief" and 100% referred to "full relief". This study classified effectiveness of pain management to two groups: 1) effective pain relief group, referring to the percentage of pain alleviation ≥ 70%, and 2) ineffective group, referring to < 70%. Multiple linear regression was employed to examine the relationship between cognitive performance and self-efficacy for pain management, and logistic regression analysis was conducted to test the association between cognitive performance, self-efficacy for pain management, and pain management. At baseline, the CPSE mean (standard deviation [SD]) was 34.58 (10.18). 53.62% (229 of 427) of participants had self-reported effective pain management, and 25.44% (130 of 511) of participants employed recommended pain management. After adjusting for sociodemographic characteristics, CBT and TMT-A were associated with self-efficacy for pain management. Cognitive performance was not associated with recommended or self-reported effectiveness of pain management. Self-efficacy for pain management was independently associated with self-reported effective pain management. It was also negatively associated with the likelihood of recommended pain management. The relationship between cognitive performance and pain management did not differ by self-efficacy. Longitudinal analysis showed baseline self-efficacy predicted self-reported effective pain management at 18 months. Healthcare providers should use tailored intervention to improve memory and self-efficacy for pain management to encourage older adults to effectively control pain. Further studies are needed to investigate the effect of other cognitive performance domains on pain management and the strategies to improve self-efficacy in diverse older population.

Comments

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