The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective

Abstract

BackgroundPain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigate how pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group.MethodsA qualitative, multi-site exploratory case study. Data were collected in four hospitals in England and Scotland. Methods included non-participant observations, audits of patient records, semi-structured interviews with staff and carers, and analysis of hospital ward documents. Thematic analysis was performed through the lens of decision making theory.ResultsStaff generally relied on patients’ self-report of pain. For patients with dementia, however, communication difficulties experienced because of their condition, the organisational context, and time frames of staff interactions, hindered patients’ ability to provide staff with information about their pain experience. This potentially undermined the trials of medications used to provide pain relief to each patient and assessments of their responses to these treatments. Furthermore, given the multidisciplinary environment, a patient’s communication about their pain involved several members of staff, each having to make sense of the patient’s pain as in an ‘overall picture’. Information about patients’ pain, elicited in different ways, at different times and by different health care staff, was fragmented in paper-based documentation. Re-assembling the pieces to form a ‘patient specific picture of the pain’ required collective staff memory, ‘mental computation’ and time.ConclusionsThere is a need for an efficient method of eliciting and centralizing all pain-related information for patients with dementia, which is distributed in time and between personnel. Such a method should give an overall picture of a patient’s pain which is rapidly accessible to all involved in their care. This would provide a much-needed basis for making decisions to support the effective management of the pain of older people with dementia in hospital.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1690-1) contains supplementary material, which is available to authorized users.

Palliative Care in Advanced Dementia Patients: Review

“…AĞRI Demans hastalarında ağrı ve nefes darlığı en sık gö-rülen semptomlar olarak belirtilmektedir. 15,16 Ancak demans hastaları, özellikle orta evreden itibaren iletişim kuramadığı için şikâyetlerini özel-likle de ağrılarını dile getirememektedir. 3,8 Birçok büyük ölçekli çalışmalar ağrının genellikle yaşlı bireylerde daha sık olduğunu ileri sürmektedir.…”

“…8 Demanslı bireylerin %50'sinin ağrı deneyimlediği belirtilmektedir. 15 Ağrısı olduğu gözden kaçan demans hastalarında ağrı değerlendirilip, kontrol altına alınamadığı için hastaların yaşam kalitesi ve günlük aktiviteleri bozulmaktadır. 3,8 Bazı çalışma-larda da ağrının ajitasyon ve agresyon gibi davranışsal semptomların artmasında da rolünün olduğu ve ağrı kesici ile davranış değişikliklerinde azalma olduğu düşünülmektedir.…”

“…8,17 Bu nedenle demans hastalarında ağrının değerlen-dirilmesi, bu amaçla standart testlerin kullanılması ve ağrı varsa nedeninin saptanıp kontrol altına alın-ması önemlilik arz etmektedir. 3,8,[15][16][17] Bütün bu nedenler ağrı değerlendirme araçla-rına ilginin artmasına yol açmıştır. Kendi bildirim skalalarının, hâlâ iletişim kurabilen hafif-orta demansı olan bireylerde yararlı olduğu kanıtlanmış-tır.…”

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

“…The chapter finishes with a proposal for a new decision support tool designed to improve the recognition, assessment and management of pain for patients with dementia in hospital wards. Parts of this chapter are reproduced from Lichtner et al 100 …”

“…Second, there is a real concern among the carers about the 'labelling' of their loved one associated with the use of the dementia awareness forms. This insight was taken into account during the analysis of the findings and included in the discussion in one of our manuscripts submitted for publication (Lichtner et al 100 ).…”