Algorithm-based pain management for people with dementia in nursing homes

Labonté, Valérie; Sirsch, Erika; Thiesemann, Rüdiger; Mohler, R. Albert

doi:10.1002/14651858.cd013339

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…To exemplify, in care home settings, studies have examined structured, stepwise interventions with regular pain evaluation to manage pain for people with dementia. 57 However, in the community the responsibility to perform 'regular pain evaluation' would often fall to the relatives of the person with dementia, which may be burdensome without adequate support.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

The challenge of pain identification, assessment, and management in people with dementia: a qualitative study

et al. 2020

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BackgroundPainful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pain management for community-dwelling people with dementia.AimTo explore pain identification, assessment, and management for community-dwelling people with dementia.Design & settingA qualitative study was undertaken, set in England.MethodSemi-structured interviews took place with people with dementia, family caregivers, GPs, and old-age psychiatrists. Data were analysed thematically.ResultsInterviews were conducted with eight people with dementia, nine family caregivers, nine GPs, and five old-age psychiatrists. Three themes were identified that related to pain identification and assessment: gathering information to identify pain; the importance of knowing the person; and the use of pain assessment tools. A further three themes were identified that related to pain management: non-drug strategies; concerns related to analgesic medications; and responsibility of the caregiver to manage pain.ConclusionIdentifying and assessing the pain experienced by people with dementia was challenging. Most people with dementia, family caregivers, and healthcare professionals supported non-drug strategies to manage pain. The minimal concerns associated with non-drug strategies contrasted the multifactorial concerns associated with analgesic treatment for people with dementia. Given the complexity of pain identification, assessment, and management, primary care should work together with family caregivers and community services, with case finding for pain being considered in all assessment and management plans.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

The challenge of pain identification, assessment, and management in people with dementia: a qualitative study

et al. 2020

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“…Authors of the Promoting Action Research in Health Services framework (PARiHS) (Kitson et al, 1998 ) suggest the three key elements of evidence, context and facilitation provide a structure to explore issues in practice to try and ensure sustainable practices. While there is an abundance of pain management research examining the complexities of caring for older people with dementia in long‐term settings (Koppitz et al, 2017 ; Labonté et al, 2019 ; Achterberg et al, 2019 ; Pringle et al, 2021 ), less is known about the pain management challenges experienced by people with dementia as they move from the emergency department (ED) to in‐patient wards, in acute care. Therefore, this study aimed to understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of helping healthcare staff to improve practice.…”

Section: Introductionmentioning

confidence: 99%

Exploring ways to enhance pain management for older people with dementia in acute care settings using a Participatory Action Research approach

Harkin

Coates

Brown

2022

Int J Older People Nursing

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Background: Dementia is a progressive condition that leads to reduced cognition, deteriorating communication and is a risk factor for other acute and chronic health problems. The rise in the prevalence of dementia means untreated pain is becoming increasingly common with healthcare staff being challenged to provide optimal pain management. This negatively impacts the person living with dementia and their carers. There is minimal evidence that explores the pain management experience of patients as they move through acute care settings.Objective: To understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of assisting staff to improve practice. Method: A Participatory Action Research approach, guided by the Promoting ActionResearch in Health Services framework, was used. Three Action Cycles were completed comprising of an exploratory audit and two case studies (Action Cycle One), three focus groups with a total of 14 participants (Action Cycle Two) and the development and implementation of immediate and long-term actions (Action Cycle Three).Results: Thematic analysis identified four themes that affected pain management practices. These were not knowing the patient; balancing competing priorities; knowledge and understanding of pain and dementia and not assimilating available information. Conclusion:Pain management practices for patient living with dementia, across acute care settings, was influenced by shared ways of thinking and working. Not knowing the patient, fragmentation of information and having insufficient knowledge of the subtleties of dementia led participants to deliver task-focused, target and policydriven care that was not person-centred in its approach. Facilitated reflection enabled acute care teams to actively participate in identifying problems and finding solutions to enhance practice.

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