There are millions of nursing home residents living with Alzheimer’s disease and related dementias (ADRD). Recent research has found that residents experiencing contextual isolation are likely to also experience higher levels of pain.

This study was supported by the Office of Behavioral and Social Sciences Research (OBSSR), the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the National Center for Advancing Translational Sciences (NCATS).

What Is Contextual Isolation?

Contextual isolation means having a noticeable trait (e.g., ethnicity, habit/preference, age, interest, health condition) that few others in the same environment share. This lack of connection with others in a nursing home can lead to fewer opportunities to share experiences and bond with other residents, especially for people with ADRD.

In this study, researchers from the University of Massachusetts Chan Medical School assessed contextual isolation based on 17 characteristics. These characteristics included:

• Demographic characteristics (e.g., age, race, marital status, need for translation services),
• Preferences and habits (e.g., tobacco use, religious practices, access to animals/pets)
• Clinical characteristics (e.g., living with an intellectual disability, difficulty hearing or speaking, living with a visibly stigmatizing condition like amputation, being diagnosed with cancer or stroke)

Residents were considered contextually isolated if fewer than 20% of other residents shared these characteristics.

How did the researchers measure contextual isolation and pain?

For this study, researchers examined the yearly assessments of more than 300,000 nursing home residents conducted in 2016. These assessments are mandatory for all residents in nursing homes supported by Medicare and Medicaid and are conducted on admission to the nursing home, then regularly on a quarterly basis, and whenever there is a significant change in a person’s clinical status.

Participants’ pain was evaluated through self-reporting or staff observations. Medical histories indicating potentially painful conditions, such as cancer or arthritis, were also taken into consideration.

The researchers assessed the level of contextual isolation experienced by residents and correlated it with their ability to report pain. They also examined whether certain nursing home characteristics (e.g., size, staff-to-resident ratios) were associated with staff responsiveness to resident complaints of pain.

What did the study results show?

The study revealed that over 40% of nursing home residents living with ADRD experienced contextual isolation based on at least one of the 17 characteristics examined. Men, younger individuals, racial minorities, and those requiring translation services were more susceptible to this isolation as compared to women, older residents, and non-Hispanic White individuals.

In addition, residents who experienced contextual isolation were more likely to self-report pain than those who did not. This association was found to be modestly higher among those residents experiencing a greater degree of contextual isolation. Interestingly, the association between contextual isolation and pain was consistent regardless of whether or not residents had medical conditions known to cause chronic pain. These findings were consistent across all types of nursing homes.

The authors suggest that screening residents who are at risk of contextual isolation within specific nursing home environments could lead to timely interventions.

Jesdale BM, Bova CA, Mbrah AK, Lapane KL. Self- and staff-reported pain in relation to contextual isolation in long-term nursing home residents with Alzheimer's disease and related dementias. Geriatr Nurs. 2024 Jan-Feb;55:161-167. doi: 10.1016/j.gerinurse.2023.11.006. Epub 2023 Nov 24. PMID: 38000331; PMCID: PMC10872894.