The effectiveness of interventions to improve pain assessment and management in people living with dementia: A systematic review and meta‐analyses

Abstract

Aims To synthesize and evaluate the effectiveness of interventions for nurses to improve the assessment and management of pain in people living with dementia. Design Systematic review and meta‐analyses of randomized controlled trials. Data sources CINAHL, Joanna Briggs Institute (JBI) EBP, Cochrane Library, PubMed, and Scopus databases were searched for all journal articles published between 2009 ‐2019. Review methods Papers were included under population intervention comparator outcome (PICO) framework for: (a) people living with dementia aged 65 years and over; (b) interventions developed for nurses or other health professionals; (c) comparison group of standard care or control; and (d) outcome that measures the intervention effects on nurses and people living with dementia. Independent reviewers undertook critical appraisal, data abstraction, and synthesis. Meta‐analyses were performed to determine the effectiveness of interventions. Results Of 2099 titles and abstracts screened, six interventions with low‐to‐moderate risk of bias met inclusion criteria. Studies that implemented a routine pain assessment tool showed no effect on nurses’ analgesic management. Studies that developed a comprehensive pain model involving multidisciplinary health professionals showed overall effects on pain assessment and management in dementia care. Physician involvement had an impact on analgesic management. Conclusion Comprehensive pain models improve nurses’ pain assessment and management. A lack of balance between analgesia use and non‐pharmacological pain management in dementia care is evident. Multidisciplinary health professionals’ involvement is essential for effective intervention design for pain management in dementia. Impact Various pain assessment tools have been considered to assist identification and management of pain in people living with dementia. Nevertheless, challenges exist when caring for people living with dementia in pain. These findings support the development of a comprehensive pain model, which may be a more effective strategy than routine use of a pain tool alone for nurses to improve pain management in dementia care.

Pain Assessment for Individuals with Advanced Dementia in Care Homes: A Systematic Review

“…A large number of observational pain tools have been developed based on the behavioural cues to identify potential pain. There has been a relatively large number of evaluations and reviews of such pain assessment tools, although there is no one tool that is recommended for use in this population [ 6 , 7 ]. In addition, the care home setting has unique challenges and difficulties in how to integrate pain assessment tools into practice due to the complex care needs of the residents, the high staffing turnover, and the budget considerations [ 8 , 9 , 10 ].…”

Documented nursing practices of pain assessment and management when communicating about pain in dementia care

“…Clinical guidelines and recommendations for assessing and managing pain in people with dementia are available in most healthcare settings (Anderson et al, 2021). Various approaches have been made to improve nurses' pain assessment and management for people with dementia, including pharmacological and non‐pharmacological management (Liao et al, 2021; Tsai et al, 2020). However, inadequacies and challenges associated with nursing practice, in general, mean that pain in people with dementia remains suboptimal in the global healthcare context (Achterberg et al, 2021).…”

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

“…These guidelines recommend paracetamol as a first-line approach for dementia patients with communication problems, which aligns with systematic reviews [ 10 – 12 ]. Currently, it is used in nursing homes worldwide.…”