Pain in Older Adults With Dementia: A Survey in Spain

Abstract

The risk of suffering pain increases significantly throughout life, reaching the highest levels in its latest years. Prevalence of pain in nursing homes is estimated to range from 40 to 80% of residents, most of them old adults affected with dementia. It is already known that pain is under-diagnosed and under-treated in patients with severe cognitive impairment and poor/absent verbal communication, resulting in a serious impact on their quality of life, psychosocial, and physical functioning. Under-treated pain is commonly the cause of behavioral symptoms, which can lead to misuse of antipsychotic treatments. Here, we present two Regional and National Surveys in Spain (2015–2017) on the current practices, use of observational tools for pain assessment, guidelines, and policies. Results, discussed as compared to the survey across central/north Europe, confirm the professional concerns on pain in severe dementia, due to poor standardization and lack of guidelines/recommendations. In Spain, observational tools are scarcely used because of their difficulty and low reliability in severe dementia, since the poor/absent verbal communication and comprehension are considered limiting factors. Behavioral observation tools should be used while attending the patients, in a situation including rest and movement, should be short (3–5 min) and scored using a numeric scale. Among the pain items to score, “Facial expression” and “Verbalization” were considered essential and very useful, respectively. This was in contrast to “Body movements” and “Vocalizations,” respectively, according to the survey in central/north Europe. Scarce time availability for pain assessment and monitoring, together with low feasible and time-consuming tools, can make pain assessment a challenge. The presence of confounding factors, the low awareness and poor knowledge/education of specific tools for this population are worrisome. These complaints draw future directions to improve pain assessment. More time available, awareness, and involvement of the teams would also benefit pain assessment and management in cognitive impairment. The experiences and opinions recorded in these surveys in Spain and other E.U. countries were considered sources of knowledge for designing the “PAIC-15 scale,” a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition and the “Observational pain assessment” in older persons with dementia.

Family Involvement in Pain Management for People Living With Dementia: An Integrative Review

“…The reduced ability of residents to report pain brings challenges to an appropriate pain assessment and management. In addition, health professionals’ lack of awareness of pain and knowledge of using appropriate pain assessment tools constitute some of the significant difficulties in pain management and further prevent family involvement (Giménez-Llort et al, 2020; Zwakhalen et al, 2018). Further challenges arise from the organizational-level high turnover rates among care workers leading to a lack of familiarity and stability in the care worker–resident relationship, particularly in long-term care.…”

“…The reduced ability for people with dementia to report and communicate their pain experience is a challenge for formal and informal carers. In addition, it is widely accepted that people with dementia are under-recognized and under-treated for pain (Achterberg et al, 2021;Giménez-Llort et al, 2020), leading to behavioral and psychological symptoms in people living with dementia (Boltz et al, 2021;Wei et al, 2021) and the use of psychotropic medications (Nowak et al, 2018). This can also increase health care providers' and family carers' care burden (Guliani et al, 2021;Regier et al, 2021).Pain management is one of the most identified care burdens family carers face, particularly in end-of-life caregiving for people with advanced dementia (Malhotra et al, 2021).…”

Assessment and Treatment of Pain in Dementia Patients

“…It is accompanied by higher rates of hospitalization, chronic diseases, and surgery which increase their risk for pain and its prevalence vary from 40% to 80 %.in nursing homes [1]. Approximately 50 % of older adults admitted to a hospital report pain, with 20 % endorsing moderate-to severe levels of pain that represents discomfort and a burden physical, psychological and social [2,3]. Cognitively impaired older adults are a particularly vulnerable population for untreated pain.…”

Development and Translation of NanoBEO, a Nanotechnology-Based Delivery System of Bergamot Essential Oil Deprived of Furocumarins, in the Control of Agitation in Severe Dementia

“…Alzheimer’s disease (AD) is the most widespread form of dementia estimated to affect some 75 million people by 2030 and to double by 2050 [ 2 , 3 ]. Chronic pain is often experienced by the elderly, ranging from 50% of community-dwelling older adults to 80% of care facilities residents, of whom 25% do not receive pain-relief [ 4 , 5 , 6 ]. The problem of pain can be even more burdensome when it coincides with severe dementia.…”