To investigate the associations of self-injury ideation with pain severity, pain control, and their combination in home care elders, and to examine gender differences in the associations.
Secondary data analysis, mixed models repeated-measures design.
SETTING AND PARTICIPANTS
N=16,700 elderly participants in two publicly-funded home care programs in Michigan.
All participants received in-home assessments at baseline and every three months thereafter using a standardized instrument which included questions about self-injury ideation and pain experience. Assessment data collected over one year following baseline were used.
Participants averaged 77.5 years old. The majority was female (72.2%) and White (81.4%). At baseline 1.4% of the sample—2.1% of men and 1.2% of women—had self-injury ideation. Compared to those without pain, the risk of self-injury ideation in men increased with pain severity (some pain: adjusted OR=1.88, 95% CI=1.12-3.13; severe pain: adjusted OR=2.36, 95% CI=1.29-4.30) and pain control (controlled by medication: adjusted OR=1.81, 95% CI=1.08-3.04; uncontrolled by medication: adjusted OR=3.39, 95% CI=1.45-7.95). Men with severe and uncontrolled pain were at especially high risk (adjusted OR=4.10, 95% CI=1.37-12.28). No measures of pain were significantly associated with self-injury ideation in women. Gender differences in the association of pain severity and self-injury ideation were significant (p<.05).
Pain in home care elders should be taken seriously and treated as one means to reduce risk of suicide. Pain assessment should include severity and control of pain. In men, complaints about pain should prompt questioning for self-injury ideation.