Pain management in community-dwelling older adults with moderate-to-severe dementia

Abstract

Background: This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. Methods: A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. Findings: The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. Conclusion: Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.

Effect of Auricular Acupressure on Acute Pain in Nursing Home Residents with Mild Dementia: A Single-Blind, Randomized, Sham-Controlled Study

“…Even fewer studies have focused on acute pain management in nursing home residents with dementia. Abundant studies have reflected that optimal acute pain management in elderly patients with dementia remains an elusive goal [ 4 , 8 , 10 , 13 ]. For dementia patients in the nursing home, it is recommended that a first-line treatment modality for pain is pharmacological intervention [ 11 ].…”

“…Currently, it is used in nursing homes worldwide. Acute or long-term overdose of paracetamol can contribute to hepatotoxicity, especially for the elderly who are more susceptible to drug-related adverse effects [ 8 ]. Patients with dementia are facing more challenges than those without cognitive impairment regarding controlling pain.…”

“…The amount of analgesics prescribed by the doctor is only one-third of the normal cognitive elderly, which does not have access to the best clinical standard [ 13 ]. The use of strong opioids for dementia patients with moderate to severe pain is appropriate in some national guidelines [ 8 , 11 ], but they receive fewer opioids because medical workers, patients, and family members are concerned about the potential negative side effects [ 13 , 14 ]. Studies have shown that pain management may be insufficient or inappropriate in nursing home settings [ 8 , 10 ].…”

“…The use of strong opioids for dementia patients with moderate to severe pain is appropriate in some national guidelines [ 8 , 11 ], but they receive fewer opioids because medical workers, patients, and family members are concerned about the potential negative side effects [ 13 , 14 ]. Studies have shown that pain management may be insufficient or inappropriate in nursing home settings [ 8 , 10 ]. Efforts to explore non-pharmacological therapies to control pain have never stopped.…”

“…Pain is not only an unpleasant subjective experience but also the main culprit of many detrimental consequences. ey include neuropsychiatric symptoms, social interaction impairment, poor quality of life, lack of appetite, and other geriatric syndromes and events, including suicide attempts [7][8][9]. Potentially, the risk of disability increases with pain intensity [9].…”