The importance of pain management in older people with dementia

Corbett, Anne; Husebø, Bettina S.; Achterberg, Wilco P.; Aarsland, Dag; Erdal, Ane; Flo, Elisabeth

doi:10.1093/bmb/ldu023

Cited by 85 publications

(68 citation statements)

References 52 publications

(60 reference statements)

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“…Prevalence reports estimate that 41% to 52% of older adults with dementia experience pain in the nursing home (Zwakhalen, Koopmans, Geels, Berger, & Hamers, 2009). With the chronic progressive decline of cognition and loss of function that occurs in dementia (Corbett et al, 2014), the expression of pain becomes more challenging (Corbett et al, 2014; Flo, Gulla, & Husebo, 2014; Shega et al, 2008). Consequently, as dementia progresses, these older adults tend to report fewer painful conditions (Burfield, Wan, Sole, & Cooper, 2012), even though they may suffer from the same painful diagnoses as cognitively intact older adults (Closs, Cash, Barr, & Briggs, 2005; Husebo et al, 2008; Reynolds, Hanson, DeVellis, Henderson, & Steinhauser, 2008).…”

Section: Background and Significancementioning

confidence: 99%

Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia

Ford

Snow

Herr

et al. 2015

Pain Management Nursing

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Section: Background and Significancementioning

confidence: 99%

Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia

Ford

Snow

Herr

et al. 2015

Pain Management Nursing

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“…These symptoms affect over 75 % of people with dementia admitted to acute hospitals and can increase the risk of mortality and cognitive decline [21]. Neuropsychiatric symptoms are particularly challenging for clinical staff to manage, and are often associated with sub-optimal care or inappropriate prescriptions of antipsychotic medications [22]. Consequently, people with dementia are at higher risk of adverse events during their hospital stay [23] and are more likely to spend an extended time in hospital compared to their cognitively healthy counterparts [17, 24, 25].…”

Section: Introductionmentioning

confidence: 99%

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

Lichtner

Dowding

Allcock

et al. 2016

BMC Health Serv Res

150

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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.

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“…34 Neuropsychiatric symptoms are particularly challenging for clinical staff to manage, and are often associated with suboptimal care or inappropriate prescriptions of antipsychotic medications. 35 Consequently, people with dementia are at higher risk of adverse events during their hospital stay 36 and are more likely than their counterparts without cognitive impairment to spend an extended time in hospital. [37][38][39] There are no behaviours which are exclusively associated with pain, increasing the difficulty of identifying its presence.…”

Section: Pain In Hospital Patients With Dementiamentioning

confidence: 99%

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

Closs

Dowding

Allcock³

et al. 2016

Health Serv Deliv Res

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 11/2000/05. The contractual start date was in October 2012. The final report began editorial review in October 2015 and was accepted for publication in March 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Heal...

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The importance of pain management in older people with dementia

Abstract: Introduction: Pain is common in people with dementia, representing a critical aspect of treatment and care. However, there remain considerable gaps in evidence to support pain assessment and treatment.

Cited by 85 publications

References 52 publications

Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia

Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia

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

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

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