Pain in older adults with dementia

Zwakhalen, Sandra; Docking, Rachael; Gnass, Irmela; Sirsch, Erika; Stewart, Carrie; Allcock, Nick; Schofield, Patricia

doi:10.1007/s00482-018-0290-x

Cited by 39 publications

(28 citation statements)

References 37 publications

(33 reference statements)

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“…Therefore, the current study confirmed many findings from the original E.U. survey ( 22 ). The majority of participants did not use national/international standards, guidelines, or local policies or were unsure if their institutions had any pain management guidelines (E.U.…”

Section: Discussion/conclusionsupporting

confidence: 89%

“…This survey was conducted across the central European participating countries, including questions about participants' knowledge and use of existing pain assessment guidelines, the usage of existing pain assessment (observational tools) and the experience health care professionals have of implementing the tools. Recently, this survey results in central-north Europe have been reported ( 22 ), and here we present the results from southern Europe (Spain). The preliminary analysis on one of the “open questions” regarding the professional concerns on problems experienced in Spain and solutions for its improvement was presented for discussion with the scientific community of the International Psychogeriatric Association in our last IPA International Congress ( 23 ).…”

Section: Introductionmentioning

confidence: 78%

“…After this preliminary survey, the self-administered “Questionnaire about the use of standards/guidelines, instruments and professional's profile” set up by the members of WG2 of the COST Action TD1005 ( 22 ) was translated into Spanish using a backward, forward procedure. Minor modifications were necessary to clarify aspects of the different levels of qualifications and healthcare settings.…”

Section: Methodsmentioning

confidence: 99%

“…The National Survey used a probability sample of healthcare professionals. As in the previous study ( 22 ), a sample size calculation was not performed since the study aimed to describe the currently used guidelines or observational tools for pain assessment amongst older adults with cognitive impairment. The response rate was very low, with no answers from the southern part of the country.…”

Section: Data Collectionmentioning

confidence: 99%

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Pain in Older Adults With Dementia: A Survey in Spain

et al. 2020

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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.

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Section: Discussion/conclusionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

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Pain in Older Adults With Dementia: A Survey in Spain

et al. 2020

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“…30,63 A recent European survey on pain assessment in older adults with dementia provides further insights into perceived challenges in pain management for persons with severe cognitive impairment. 64 Health-care professionals stated that behavioral assessment instruments are often too difficult to complete due to the lack of objectivity. The main criticism was the high subjectivity in the evaluation of pain items (ie behavioral characteristics) and the difficulty to interpret resulting scores of the measures currently available-the authors conclude the high-priority importance to improve the usefulness of proxy pain assessment instruments.…”

Section: Discussionmentioning

confidence: 99%

<p>Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial</p>

Kutschar¹,

Berger²,

Brandauer³

et al. 2020

JPR

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Purpose: Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016-2018). Participants: Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included. Intervention: In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses. Methods: Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10-30) using self-report instruments or observed (MMSE 0-9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatmentrelevant pain above cutoff (≥2) on the Pain Assessment in Advanced Dementia (PAINAD). Results: Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10-30) and logistic regression (n=222 residents, MMSE 0-9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=−0.07, p<0.001), and was lower when dementia diagnoses were present (B=−1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05). Conclusion: While no significant positive intervention effect was measured, findings suggest nurses' raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.

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