Pain in severe dementia: A comparison of a fine‐grained assessment approach to an observational checklist designed for clinical settings

Hadjistavropoulos, Thomas; Browne, Matthew; Taati, Babak; Ashraf, Ahmed Bilal; Mihailidis, Alex

doi:10.1002/ejp.1177

Cited by 27 publications

(36 citation statements)

References 45 publications

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“…When studying facial responses in a group of 129 shoulder pain patients undergoing a range of painful movement exercises, the authors found that the same set of facial movements was displayed as has been previously found for experimental pain [51]. Mainly based on these two A C C E P T E D studies, this subset is regarded as presenting the key components of the facial expression of pain [9,28,50].…”

Section: Introductionmentioning

confidence: 65%

“…Action Units (84%), with only a few studies limiting the FACS coding to a set of Action Units that has previously been found to be associated with pain (e.g. two studies [9,28] only coded those AUs reported to be pain-related by Prkachin [51]). Moreover, in most studies AU frequency (87%) and AU intensity (93%) were coded, whereas only 25% of the studies coded AU duration.…”

Section: Facs Coding: With Regard To the Facs Coding Most Studies Comentioning

confidence: 99%

See 1 more Smart Citation

Facial muscle movements encoding pain—a systematic review

Kunz

Meixner

Lautenbacher

2018

Pain

117

145

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Facial expressions of pain are not undefined grimaces but they convey specific information about the internal state of the individual in pain. With this systematic review we aim to answer the question of which facial movements are displayed most consistently during pain. We searched for studies that used the Facial Action Coding System (FACS) to analyze facial activity during pain in adults, and that report on distinct facial responses (Action Units, AUs). Twenty-seven studies using experimental pain and 10 clinical pain studies were included. We synthesized the data by taking into consideration (i) criteria used to define whether an AU is pain-related; (ii) types of pain; and (iii) the cognitive status of the individuals. When AUs were selected as being pain-related based on a "pain>baseline" increase, a consistent subset of pain-related AUs emerged across studies: lowering the brows (AU4), cheek raise/lid tightening (AUs6_7), nose wrinkling/raising the upper lip (AUs9_10) and opening of the mouth (AUs25_26_27). This subset was found independently of the cognitive status of the individuals and was stable across clinical and experimental pain with only one variation, namely that eye closure (AU43) occurred more frequently during clinical pain. This subset of pain-related facial responses seems to encode the essential information about pain available in the face. However, given that these pain-related AUs are most often not displayed all at once, but are differently combined, healthcare-professionals should use a more individualized approach, determining which pain-related facial responses an individual combines and aggregates to express pain, instead of erroneously searching for an uniform expression of pain.

show abstract

Section: Introductionmentioning

confidence: 65%

Section: Facs Coding: With Regard To the Facs Coding Most Studies Comentioning

confidence: 99%

Facial muscle movements encoding pain—a systematic review

Kunz

Meixner

Lautenbacher

2018

Pain

117

145

View full text Add to dashboard Cite

show abstract

“…This is an important issue as commonly used pain assessment instruments rely on self-report and the communicative capacity of the patient [25,26]. For patients with cognitive difficulties, pain can be assessed using observational techniques [27,28], but these observational approaches require repeat assessments over time [29] and may not be well suited to the prehospital environment. Accepted methods for assessing pain in cognitively impaired adults in prehospital care have significant limitations [30], and there is a need for further work in this area.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project

et al. 2020

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Background: Paramedics are increasingly required to make complex decisions as to whether they should convey a patient to hospital or manage their condition at the scene. Dementia can be a significant barrier to the assessment process. However, to our knowledge no research has specifically examined the process of decision-making by paramedics in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during Emergency Medical Services (EMS) calls to older people with dementia who did not require immediate clinical treatment. Methods: This qualitative study used a combination of observation, interview and document analysis to investigate the factors influencing the decision-making process during EMS calls to older people with dementia. A researcher worked alongside paramedics in the capacity of observer and recruited eligible patients to participate in case studies. Data were collected from observation notes of decision-making during the incident, patient care records and post incident interviews with participants, and analysed thematically. Findings: Four main themes emerged from the data concerning the way that paramedics make conveyance decisions when called to people with dementia: 1) Physical condition; the key factor influencing paramedics' decision-making was the physical condition of the patient. 2) Cognitive capacity; most of the participants preferred not to remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it absolutely essential. 3) Patient circumstances; this included the patient's medical history and the support available to them. 4) Professional influences; participants also drew on other perspectives, such as advice from colleagues or information from the patient's General Practitioner, to inform their decision-making. Conclusion: The preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in obtaining an accurate patient medical history and assessment, mean that decision-making can be particularly problematic for paramedics. Further research is needed to find reliable ways of assessing patients and accessing information to support conveyance decisions for EMS calls to people with dementia.

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“…Resident pain was assessed using the PACSLAC-II [44] using a standardized procedure that has been used in other evaluation studies and accommodates residents who have cognitive impairments [45]. Psychometric properties of the PACSLAC-II are very good with excellent validity [46]. Medication use was measured using the Medication Quantification Index (MQS) [47].…”

Section: Potential Effect Of the Namaste Care Interventionmentioning

confidence: 99%

Evaluating the feasibility and acceptability of the Namaste Care program in long-term care settings in Canada

Kaasalainen

Hunter

Bello-Haas

et al. 2020

Pilot Feasibility Stud

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Background: Residents living and dying in long-term care (LTC) homes represent one of society's most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality of life in their last months of life. The purpose of this study is to evaluate the feasibility, acceptability, and effects of Namaste Care: an innovative program to improve end-of-life care for people with advanced dementia. Methods: This study used a mixed-method survey design to evaluate the Namaste Care program in two LTC homes in Canada. Pain, quality of life, and medication costs were assessed for 31 residents before and 6 months after they participated in Namaste Care. The program consisted of two 2-h sessions per day for 5 days per week. Namaste Care staff provided high sensory care to residents in a calm, therapeutic environment in a small group setting. Feasibility was assessed in terms of recruitment rate, number of sessions attended, retention rate, and any adverse events. Acceptability was assessed using qualitative interviews with staff and family. Results: The feasibility of Namaste Care was acceptable with a participation rate of 89%. However, participants received only 72% of the sessions delivered and only 78% stayed in the program for at least 3 months due to mortality. After attending Namaste Care, participants' pain and quality of life improved and medication costs decreased. Family members and staff perceived the program to be beneficial, noting positive changes in residents. The majority of participants were very satisfied with the program, providing suggestions for ongoing engagement throughout the implementation process. Conclusions: These study findings support the implementation of the Namaste Care program in Canadian LTC homes to improve the quality of life for residents. However, further testing is needed on a larger scale.

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Pain in severe dementia: A comparison of a fine‐grained assessment approach to an observational checklist designed for clinical settings

Cited by 27 publications

References 45 publications

Facial muscle movements encoding pain—a systematic review

Facial muscle movements encoding pain—a systematic review

A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project

Evaluating the feasibility and acceptability of the Namaste Care program in long-term care settings in Canada

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