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Dresden SM. Optimizing the Care of Persons Living with Dementia in the Emergency Department. Clin Geriatr Med 2023; 39:599-617. [PMID: 37798067 DOI: 10.1016/j.cger.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Emergency department (ED) care for persons living with dementia (PLWD) involves the identification of dementia or cognitive impairment, ED care which is sensitive to the specific needs of PLWD, effective communication with PLWD, their care partners, and outpatient clinicians who the patient and care-partner know and trust, and care-transitions from the emergency department to other health care settings. The recommendations in this article made based on wide-ranging heterogeneous studies of various interventions which have been studied primarily in single-site studies. Future research should work to incorporate promising findings from interventions such as hospital at home, or ED to home Care Transitions Intervention.
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Affiliation(s)
- Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Center for Healthcare Studies and Outcomes Research, 211 East Ontario Street, Suite 200, Chicago, IL 60611, USA.
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Minaya-Freire A, Subirana-Casacuberta M, Pou-Pujol G, Ramon-Aribau A. Nursing Practice Variations in Pain Management in Older Adults With Dementia Admitted to an Acute Geriatrics Unit During the COVID-19 Pandemic. Res Gerontol Nurs 2023; 16:173-182. [PMID: 37040309 DOI: 10.3928/19404921-20230405-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The current retrospective descriptive study evaluated nursing practice variations on pain management in older adults with dementia admitted to an acute geriatrics unit (AGU) before (2018) and during (2021) the coronavirus disease 2019 (COVID-19) pandemic. Data were gathered from electronic health records. Pain intensity was evaluated a median of 1.9 times per day of stay in the pre-COVID-19 sample, whereas in the COVID-19 sample, the median was 0.7 times per day of stay. Median number of analgesic administrations per day of stay and mean percentage of clinical care records that mentioned pain were higher in patients admitted during the pandemic. Variations in nursing care organization in the AGU due to the COVID-19 pandemic had an impact on the patterns of pain management nursing practice in older adults with dementia. [Research in Gerontological Nursing, 16(4), 173-182.].
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Pu L, Chen H, Jones C, Moyle W. Family Involvement in Pain Management for People Living With Dementia: An Integrative Review. JOURNAL OF FAMILY NURSING 2023; 29:43-58. [PMID: 35898190 DOI: 10.1177/10748407221114502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This review aimed to synthesize current evidence on family involvement in pain management for people living with dementia from the perceptions of family carers and health care professionals. An integrative review was conducted using CINAHL, Embase, PubMed, PsycINFO and Cochrane Library electronic databases. The Mixed Methods Appraisal Tool was used to appraise the articles, followed by thematic analysis. Twelve studies were included and four themes were identified: (1) The roles and responsibilities of family carers; (2) Enablers and barriers for pain identification; (3) Strategies and concerns for pain management; and (4) Lack of staff education and communication with health care providers. Family carers play an important role in pain assessment and management for people living with dementia, but they cannot be actively involved in this process due to a lack of communication with health care providers. An integrated approach that includes education and communication with family carers and health care providers is needed.
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Affiliation(s)
- Lihui Pu
- Griffith University, Nathan Queensland, Australia
| | | | - Cindy Jones
- Bond University, Robina Queensland, Australia
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Dunford E, West E, Sampson EL. Psychometric evaluation of the Pain Assessment in Advanced Dementia scale in an acute general hospital setting. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5830. [PMID: 36317464 PMCID: PMC9828226 DOI: 10.1002/gps.5830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/16/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with dementia are at risk of unplanned hospital admissions and commonly have painful conditions. Identifying pain is challenging and may lead to undertreatment. The psychometric properties of the Pain Assessment in Advanced Dementia (PAINAD) scale, in medical inpatients with dementia have not been evaluated. METHODS A secondary data analysis from a longitudinal study of 230 people with dementia admitted to two acute general hospitals in London, UK. Internal consistency, inter-rater reliability, test-retest reliability, concurrent validity, construct validity and discriminant validity of PAINAD were tested at rest and in movement. RESULTS This predominantly female (65.7%) sample had a mean age of 87.2 (Standard Deviation; SD = 5.92) years. Inter-rater reliability showed an intra-class correlation (ICC) of 0.92 at rest and 0.98 in movement, test-retest reliability ICC was 0.54 at rest and 0.66 in movement. Internal consistency was 0.76 at rest and 0.80 in movement (Cronbach's α). Concurrent validity was weak between PAINAD and a self-rating level of pain (Kendall's Tau; τ = 0.29; p > 0.001). There was no correlation between PAINAD and a measure of behavioural and psychological symptoms of dementia, suggesting no evidence of convergent validity. PAINAD scores were higher during movement than rest, providing evidence of discriminant validity (z = -8.01, p < 0.001). CONCLUSIONS We found good inter-rater reliability and internal consistency. The test-retest reliability was modest. This study raises concerns about the validity of the PAINAD in general acute hospitals. This provides an insight into pain assessment in general acute hospitals which may inform further refinements of the PAINAD.
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Affiliation(s)
- Emma Dunford
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Emily West
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK,Department of Psychological MedicineEast London NHS Foundation TrustRoyal London HospitalLondonUK
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Dresden SM, Taylor Z, Serina P, Kennedy M, Wescott AB, Hogan T, Shah MN, Hwang U. Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review. J Am Med Dir Assoc 2022; 23:1314.e1-1314.e29. [PMID: 35940683 DOI: 10.1016/j.jamda.2022.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities. DESIGN Systematic scoping review. SETTINGS AND PARTICIPANTS PLWDs in the ED. METHODS The following Patient-Intervention-Comparison-Outcome (PICO) questions were developed: PICO 1, What components of emergency department care improve patient-centered outcomes for persons with dementia? PICO 2, How do emergency care needs for persons with dementia differ from other patients in the emergency department? A scoping review was conducted following PRISMA-ScR guidelines and presented to the Geriatric Emergency care Applied Research 2.0 Advancing Dementia Care network to inform research priorities. RESULTS From the 6348 publications identified, 23 were abstracted for PICO 1 and 26 were abstracted for PICO 2. Emergency care considerations for PLWDs included functional dependence, behavioral and psychological symptoms of dementia, and identification of and management of pain. Concerns regarding ED care processes, the ED environment, and meeting a PWLD's basic needs were described. A comprehensive geriatric assessment and dedicated ED unit, a home hospital program, and a low-stimulation bed shade and contact-free monitor all showed improvement in patient-centered or health care use outcomes. However, all were single-site studies evaluating different outcomes. These results informed the following research priorities: (1) training and dementia care competencies; (2) patient-centric and care partner-centric evaluation interventions; (3) the impact of community- and identity-based factors on ED care for PLWDs; (4) economic or other implementation science measures to address viability; and (5) environmental, operational, personnel, system, or policy changes to improve ED care for PLWDs. CONCLUSIONS AND IMPLICATIONS A wide range of components of both ED care practices and ED care needs for PLWDs have been studied. Although many interventions show positive results, the lack of depth and reproducible results prevent specific recommendations on best practices in ED care for PLWDs.
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Affiliation(s)
- Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Zachary Taylor
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Peter Serina
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Annie B Wescott
- Galter Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Teresita Hogan
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
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Poggiali E, De Iaco F. The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pain is a frequent reason for referral to the Emergency Department (ED). Adequate management of pain is a moral and ethical imperative. If not correctly treated, acute pain can cause physical and psychological complications, and become chronic with severe consequences such as anxiety, depression, and social isolation. As consequence, emergency clinicians should treat pain as soon as possible, avoiding delays even in case of acute abdominal pain. Pain management is particularly complex in the elderly and emergency clinicians should always consider AGS Beers criteria ® to avoid inappropriate medications, severe side-effects, and drug-drug interactions. Pain is also a common cause of delirium in older patients. The SARS CoV-2 infection not only can cause acute pain, but also exacerbate chronic pain, particularly in the elderly, who are at high risk to be infected. Looking at all this evidence, emergency clinicians should treat pain with different strategies according to their experience and cultural background, making the right choice for each patient. This work is a critical review of the pain management in the ED, with a particular attention on the effects of COVID-19 in the EDs. We conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline from 2000 to 2020, using the keywords of “pain”, “emergency”, “COVID19”, “elderly”, “palliative care”, “ketamine”, “dexmedetomidine”, and “post-traumatic stress disorder”. The aim of this review is to help emergency clinicians to correctly manage pain in the ED with a new point of view regarding the pain management in COVID-19 patients.
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Rejula V, Anitha J, Belfin RV, Peter JD. Chronic Pain Treatment and Digital Health Era-An Opinion. Front Public Health 2021; 9:779328. [PMID: 34957031 PMCID: PMC8702955 DOI: 10.3389/fpubh.2021.779328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/22/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | - R. V. Belfin
- Department of Computer Science and Engineering, Karunya Institute of Technology and Sciences, Coimbatore, India
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Minaya-Freire A, Subirana-Casacuberta M, Puigoriol-Juvanteny E, Ramon-Aribau A. Pain management nursing practice assessment in older adults with dementia. Nurs Open 2021; 8:3349-3357. [PMID: 33826237 PMCID: PMC8510716 DOI: 10.1002/nop2.880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/29/2021] [Accepted: 03/21/2021] [Indexed: 01/13/2023] Open
Abstract
Aim To assess pain management nursing practice in older adults with dementia through electronic health records (EHR). Design Retrospective study. Methods Data were collected from EHR related to pain management in older adults with dementia treated at the Acute Geriatrics Unit (AGU) of a university hospital in early 2018. Results EHR related to the pain of 111 patients were reviewed. Pain intensity was assessed at admission in 88% of patients and a median of 1.9 times per day of stay. A disproportionate number of the assessments (39%) occurred during the late shift. A median of 1 drug per day was administered. Pain was recorded in 28% of patients’ care plans, and non‐pharmacological interventions were recorded in 12%. In conclusion, exist variability in pain management nursing practice in older adults with dementia. Admission diagnosis correlated with the analgesic administration schedule, the number of drugs administered and the number of pain nursing annotations.
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Affiliation(s)
- Alícia Minaya-Freire
- University Hospital Of Vic-Vic Hospital Consortium (HUV-CHV). C. Francesc Plà "El Vigatà", Vic, Barcelona, Spain.,Research Group on Methodology, Methods, Models and Health and social Outcomes (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC). C. Sagrada Família, Vic, Barcelona, Spain
| | - Mireia Subirana-Casacuberta
- Research Group on Methodology, Methods, Models and Health and social Outcomes (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC). C. Sagrada Família, Vic, Barcelona, Spain.,Nursing Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Emma Puigoriol-Juvanteny
- University Hospital Of Vic-Vic Hospital Consortium (HUV-CHV). C. Francesc Plà "El Vigatà", Vic, Barcelona, Spain.,Tissue Repair and Regeneration Laboratory (TR2Lab), Faculty of Sciences and Technology, University of Vic - Central University of Catalonia, Faculty of Medicine, University of Vic - Central University of Catalonia. C. Sagrada Família, Vic, Barcelona, Spain
| | - Anna Ramon-Aribau
- Research Group on Methodology, Methods, Models and Health and social Outcomes (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC). C. Sagrada Família, Vic, Barcelona, Spain
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Nia Manning S. Managing behaviour that challenges in people with dementia in the emergency department. Emerg Nurse 2020; 29:34-40. [PMID: 33377357 DOI: 10.7748/en.2020.e2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/09/2022]
Abstract
Dementia symptoms can manifest in a variety of ways, such as anxiety, agitation and an inability to communicate unmet needs. In emergency departments (EDs), these symptoms, as well as various environmental factors, can lead to behaviour that challenges in people with dementia. Therefore, ED staff must be skilled in screening, assessing and managing this patient group effectively. This article details a literature review that was conducted to explore the evidence on managing behaviour that challenges in people with dementia in the ED and what de-escalation strategies may be useful. A literature search of eight databases was undertaken, resulting in 11 articles that were included in this literature review. Four main themes were identified: violence and aggression towards staff; manual and chemical restraint in the ED; identifying delirium and dementia; and environment and person-centred care. Strategies identified to de-escalate and reduce the risk of behaviour that challenges include: making environmental modifications to the ED; providing person-centred care; excluding or evaluating pain and unmet needs; using various tools and strategies to improve communication; and using distraction techniques.
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Goebel JR, Ferolito M, Gorman N. Pain Screening in the Older Adult With Delirium. Pain Manag Nurs 2019; 20:519-525. [PMID: 31473169 DOI: 10.1016/j.pmn.2019.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/01/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In patients with cognitive impairments who are unable to self-report pain, nurses must rely on behavioral observation tools to assess and manage pain. Although frequently employed in medical-surgical units, evidence supporting the psychometric efficacy of the Pain in Advanced Dementia (PAINAD) for pain screening in older adults with delirium is lacking. AIM To examine the psychometrics of the PAINAD for older adults with delirium in medical-surgical settings. DESIGN A descriptive repeated measures design. SETTING Medical-surgical units in an urban tertiary care hospital. PARTICIPANTS Sixty-eight older adults with delirium. METHODS Patients with delirium unable to self-report pain were screened by two data collectors with the PAINAD and the Critical Care Pain Observation Tool (CPOT). Patients with a PAINAD score ≥3 or a CPOT score ≥2 received a pain intervention. Pain assessments were repeated 30 minutes post baseline or pain intervention. RESULTS Patients were predominately female (58.8%) with dementia (71%). Thirty-nine patients screened positive for pain and received a pain intervention. PAINAD reliability was strong (Cronbach's α = 0.81-0.87; interrater intraclass coefficients [ICC] = 0.91-0.94; test-retest ICC = 0.76-0.77). Construct validity was supported by a statistically significant interaction effect between time (baseline versus follow-up) and condition (pain intervention versus no pain group; Rater 1: F(1,66) = 8.31, p = 0.005, ηp2 = 0.11; Rater 2: F(1,66) = 8.22, p = 0.006, ηp2 = 0.11. CONCLUSIONS The PAINAD is a reliable and valid tool for pain screening for older adults with delirium in medical-surgical settings. CLINICAL IMPLICATIONS Pain and delirium frequently co-occur in the older adult population. Best practices require a holistic assessment for contributing pain and non-pain factors in patients exhibiting distress.
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Affiliation(s)
- Joy R Goebel
- School of Nursing, California State University Long Beach, Long Beach, California.
| | - Michelle Ferolito
- Department of Geriatrics, University of California Los Angeles, Los Angeles, California
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