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Tasseron-Dries PEM, Smaling HJA, Nakanishi M, Achterberg WP, van der Steen JT. What are best practices for involving family caregivers in interventions aimed at responsive behaviour stemming from unmet needs of people with dementia in nursing homes: a scoping review. BMJ Open 2023; 13:e071804. [PMID: 38149428 PMCID: PMC10711828 DOI: 10.1136/bmjopen-2023-071804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/03/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES This study aimed to determine best practices for involving family caregivers in interventions aimed at preventing and reducing responsive behaviour stemming from unmet needs, including pain. DESIGN Scoping review, reported according to the Preferred Reporting Items for Systematic Reviews, Meta-Analyses extension for Scoping Reviews reporting guideline. DATA SOURCES PubMed, Embase, Emcare, Web of Science, COCHRANE Library, PsycINFO, Academic Search Premier and Cinahl searched up to 23 July 2023. ELIGIBILITY CRITERIA Studies reporting on family involvement in interventions for nursing home residents with dementia were included. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted the data, followed by a content analysis. RESULTS Of the 1486 records screened, 20 studies were included. Family caregivers were involved in interventions aimed at planning care, life review (eg, documentation of life experiences of their relative), and selecting activities for their relative. Family caregivers preferred an active role in developing optimal care for their relative. Drivers of success and barriers to family involvement centred around three themes: (1) communication between all involved; (2) prerequisites (organisational and other conditions) and (3) personal circumstances (family's coping and skills). CONCLUSION Best practices for involving family caregivers in interventions aimed at addressing responsive behaviour in residents with dementia concerned those interventions in which family caregivers were given an important role in managing responsive behaviour. This means that, in order to achieve an active role of family caregivers in the whole care process, their needs must be taken into account. TRIAL REGISTRATION NUMBER The protocol of the review was regisered at OSF; https://osf.io/twcfq.
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Affiliation(s)
- Petra E M Tasseron-Dries
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Warande (Nursing Home Organization), Zeist, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Primary and Community Care, and Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
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Helvik AS, Bergh S, Tevik K. A systematic review of prevalence of pain in nursing home residents with dementia. BMC Geriatr 2023; 23:641. [PMID: 37817061 PMCID: PMC10566134 DOI: 10.1186/s12877-023-04340-z] [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] [Received: 06/30/2022] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The prevalence of dementia in nursing home (NH) residents is high, and pain is a troublesome symptom for them. Several studies since 2010 have focused on pain in NH residents with dementia, but there is a lack of systematic reviews on the prevalence of pain in NH residents with dementia. AIM To systematically review observational studies published from 2010 to 2023 on how pain is assessed and prevalence of pain found in NH residents with dementia. METHODS A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, Embase, CINAHL, AgeLine, and Cochrane databases for studies published from January 2010 to August 2023. Studies were included if they were observational studies with a quantitative design where self-report, staff assessment, and/or chart review were used to define the prevalence of pain in samples or subsamples of NH residents with dementia. RESULTS Of 184 studies considered, 25 were included. The studies assessed pain as daily, present, clinically relevant, chronic, intermittent, persistent pain and/or if pain affected quality of life. The prevalence of pain was high in most studies of NH residents with dementia independent of whether pain was reported as presence of pain or clinically relevant pain, but the prevalence varied from 8.6% to 79.6%. This prevalence was quite stable across the NH stay, but higher towards the end of life (up to 80.4%). Study designs and methodologies differed considerably. About half relied on an observational assessment inventory. CONCLUSION The number of studies focusing on pain in NH residents with dementia was restricted and methodologies differed considerably. Relatively few studies used an observational assessment inventory. In view of the fact that residents with dementia may have difficulties communicating pain, clinicians should pay attention to pain in these residents, systematically and reliably uncover pain by use of observational inventories, and subsequently treat pain to secure high quality care.
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Affiliation(s)
- Anne-S Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Nowak T, Neumann-Podczaska A, Deskur-Śmielecka E, Styszyński A, Wieczorowska-Tobis K. Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia. Clin Interv Aging 2018; 13:1045-1051. [PMID: 29872283 PMCID: PMC5973322 DOI: 10.2147/cia.s157246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction In patients with dementia, observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare, and as a consequence pain is frequently underdiagnosed and undertreated in these types of subjects. Thus, the aim of the study was to assess analgesic treatment in nursing home residents with cognitive impairment and to delineate the relationship between pain and behavioral and psychological symptoms of dementia. Patients and methods The research was conducted in 2 nursing home facilities in Wielkopolska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen-Mansfield Agitation Inventory (CMAI). Thereafter, medical files related to drug prescriptions were analyzed. Results Analgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment and 7 individuals (7%) - as when needed pain treatment. A relationship was found between the APS and CMAI (r=0.45, p<0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p<0.001), and despite having a higher APS (p=0.001), this did not correlate with higher analgesia. Conclusion Our study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. In order to reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management are essential.
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Affiliation(s)
- Tomasz Nowak
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Ewa Deskur-Śmielecka
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Arkadiusz Styszyński
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Katarzyna Wieczorowska-Tobis
- Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
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van Dijk M, Buijck BI. What is desirable care in the opinion of formal and informal caregivers in nursing-home care for patients with dementia? Nurs Open 2018; 5:139-148. [PMID: 29599989 PMCID: PMC5867291 DOI: 10.1002/nop2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/30/2017] [Indexed: 11/08/2022] Open
Abstract
Aim To examine care characteristics related to desirable care as reported by formal and informal caregivers in Dutch Psycho‐geriatric nursing homes for patients with dementia. Design Qualitative exploratory study. Methods The sample consisted of four nursing homes. In each home, semi‐structured interviews were conducted with a manager, a quality advisor or head nurse, a daily care supervisor and an informal caregiver. The findings were analysed by labelling and coding the text fragments. Results The 16 semi‐structured interviews contained 60 discussion items. The 16 items that were shared by the four interviewee categories were clustered into the following six major themes: good quality of care; poor quality of care; elements of a vision; extra hands; bureaucracy; and formal caregivers.
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Affiliation(s)
| | - Bianca I Buijck
- Erasmus MC University Medical Center Rotterdam the Netherlands.,Rotterdam Stroke Service Rotterdam the Netherlands
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Jensen-Dahm C, Madsen CS, Waldemar G, Ballegaard M, Hejl AM, Johnsen B, Jensen TS. Contact Heat Evoked Potentials (CHEPs) in Patients with Mild-Moderate Alzheimer's Disease and Matched Control--A Pilot Study. PAIN MEDICINE 2015; 17:675-84. [PMID: 26814248 DOI: 10.1093/pm/pnv012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Clinical studies have found that patients with Alzheimer's disease report pain of less intensity and with a lower affective response, which has been thought to be due to altered pain processing. The authors wished to examine the cerebral processing of non-painful and painful stimuli using somatosensory evoked potentials and contact heat evoked potentials in patients with Alzheimer's disease and in healthy elderly controls. DESIGN Case-control study SETTING AND SUBJECTS Twenty outpatients with mild-moderate Alzheimer's disease and in 17 age- and gender-matched healthy controls were included METHOD Contact heat evoked potentials and somatosensory evoked potentials were recorded in all subjects. Furthermore, warmth detection threshold and heat pain threshold were assessed. Patients and controls also rated quality and intensity of the stimuli. RESULTS The authors found no difference on contact heat evoked potential amplitude (P = 0.59) or latency of N2 or P2 wave (P = 0.62 and P = 0.75, respectively) between patients and controls. In addition, there was no difference in regard to pain intensity scores or pain quality. The patients and controls had similar warmth detection threshold and heat pain threshold. Somatosensory evoked potentials, amplitude, and latency were within normal range and similar for the two groups. CONCLUSIONS The findings suggest that the processing of non-painful and painful stimuli is preserved in patients with mild to moderate Alzheimer's disease.
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Affiliation(s)
- Christina Jensen-Dahm
- *Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark;
| | - Caspar Skau Madsen
- Danish Pain Research Centre, Department of Neurology, Aarhus University Hospital, Denmark
| | - Gunhild Waldemar
- *Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Martin Ballegaard
- Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Anne-Mette Hejl
- *Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Birger Johnsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
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van Kooten J, Delwel S, Binnekade TT, Smalbrugge M, van der Wouden JC, Perez RSGM, Rhebergen D, Zuurmond WWA, Stek ML, Lobbezoo F, Hertogh CMPM, Scherder EJA. Pain in dementia: prevalence and associated factors: protocol of a multidisciplinary study. BMC Geriatr 2015; 15:29. [PMID: 25879681 PMCID: PMC4436741 DOI: 10.1186/s12877-015-0025-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/02/2015] [Indexed: 01/28/2023] Open
Abstract
Background Pain is a common problem in people with dementia, however the exact prevalence of pain in dementia subtypes, e.g. Alzheimer’s Disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia (FTD) and dementia with Lewy Bodies (DLB), is unknown, as is the relation between pain and the different subtypes of dementia. In this study, the prevalence of pain in people with dementia will be investigated per dementia subtype and the relationship between the various subtypes of dementia and the presence of specific types of pain (i.e. musculoskeletal pain, neuropathic pain and orofacial pain) will be examined. Secondly, associations between various types of pain, cognitive functioning, neuropsychiatric symptoms and quality of life in people with dementia will be examined. A third purpose is to study the value of the assessment of autonomic responses in assessing pain in people with dementia. Finally, the effect of feedback to the attending physician on the presence of pain, based on examination by investigators with backgrounds in neuropsychology, geriatric dentistry and elderly care medicine, will be evaluated. Methods/Design A cross-sectional, partially longitudinal observational study in 400 participants with dementia, aged 60 years and older. Participants will be recruited from an outpatient memory clinic and dementia special care units. All participants will be examined by an elderly care medicine trainee, a dentist with experience in geriatric dentistry, and a neuropsychologist. The primary outcome is presence of pain. Secondary outcomes will include oral health, autonomic responses to pain stimulus, vital sensibility and gnostic sensibility, musculoskeletal examination, cognitive functioning, neuropsychiatric symptoms, and quality of life. Discussion This study will help to enhance our knowledge regarding the prevalence of different types of pain in different dementia subtypes i.e. AD, VaD, FTD and DLB. This study also aims to contribute to a better understanding of oral health status in people with dementia, the use of autonomic responses in the assessment of pain in people with dementia and the relationships between pain and cognitive symptoms, neuropsychiatric symptoms and quality of life in people with various dementia subtypes and in different stages of the disease.
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Affiliation(s)
- Janine van Kooten
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suzanne Delwel
- Department of Clinical Neuropsychology VU University, Amsterdam, The Netherlands. .,Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
| | - Tarik T Binnekade
- Department of Clinical Neuropsychology VU University, Amsterdam, The Netherlands.
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Roberto S G M Perez
- Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Didi Rhebergen
- GGZ InGeest /Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Wouter W A Zuurmond
- Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Max L Stek
- GGZ InGeest /Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
| | - Cees M P M Hertogh
- Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Erik J A Scherder
- Department of Clinical Neuropsychology VU University, Amsterdam, The Netherlands.
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8
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Sandvik RK, Selbaek G, Seifert R, Aarsland D, Ballard C, Corbett A, Husebo BS. Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: a cluster randomized trial. Eur J Pain 2014; 18:1490-500. [PMID: 24819710 PMCID: PMC4232010 DOI: 10.1002/ejp.523] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 11/30/2022]
Abstract
Background Pain is frequent and distressing in people with dementia, but no randomized controlled trials have evaluated the effect of analgesic treatment on pain intensity as a key outcome. Methods Three hundred fifty-two people with dementia and significant agitation from 60 nursing home units were included in this study. These units, representing 18 nursing homes in western Norway, were randomized to a stepwise protocol of treating pain (SPTP) or usual care. The SPTP group received acetaminophen, morphine, buprenorphine transdermal patch and pregabalin for 8 weeks, with a 4-week washout period. Medications were governed by the SPTP and each participant's existing prescriptions. We obtained pain intensity scores from 327 patients (intervention n = 164, control n = 163) at five time points assessed by the primary outcome measure, Mobilization-Observation-Behaviour-Intensity-Dementia-2 (MOBID-2) Pain Scale. The secondary outcome was activities of daily living (ADL). We used a linear intercept mixed model in a two-way repeated measures configuration to assess change over time and between groups. Results The SPTP conferred significant benefit in MOBID-2 scores compared with the control group [average treatment effect (ATE) −1.388; p < 0.001] at week 8, and MOBID-2 scores worsened during the washout period (ATE = −0.701; p = 0.022). Examining different analgesic treatments, benefit was conferred to patients receiving acetaminophen compared with the controls at week 2 (ATE = −0.663; p = 0.010), continuing to increase until week 8 (ATE = −1.297; p < 0.001). Although there were no overall improvements in ADL, an increase was seen in the group receiving acetaminophen (ATE = +1.0; p = 0.022). Conclusion Pain medication significantly improved pain in the intervention group, with indications that acetaminophen also improved ADL function. What's already known about this topic? What does this study add?
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Affiliation(s)
- R K Sandvik
- Department of Global Public Health and Primary Care, Centre for Elderly- and Nursing Home Medicine, University of Bergen, Norway; Institute for Nursing Subjects, Bergen University College, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
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Achterberg WP, Pieper MJC, van Dalen-Kok AH, de Waal MWM, Husebo BS, Lautenbacher S, Kunz M, Scherder EJA, Corbett A. Pain management in patients with dementia. Clin Interv Aging 2013; 8:1471-82. [PMID: 24204133 PMCID: PMC3817007 DOI: 10.2147/cia.s36739] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer's disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic effects, supported by better training and support for care staff across all settings.
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Affiliation(s)
- Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjoleine JC Pieper
- Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Annelore H van Dalen-Kok
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Margot WM de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stefan Lautenbacher
- Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
| | - Miriam Kunz
- Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
| | - Erik JA Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
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Takai Y, Yamamoto-Mitani N, Ko A. Prevalence of and factors related to pain among elderly Japanese residents in long-term healthcare facilities. Geriatr Gerontol Int 2013; 14:481-9. [DOI: 10.1111/ggi.12094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Yakari Takai
- Graduate School of Health Sciences; Gunma University; Maebashi Gunma
| | - Noriko Yamamoto-Mitani
- Department of Adult Nursing/Palliative Care Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine; the University of Tokyo
| | - Ayako Ko
- Department of Gerontological Nursing, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
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Lukas A, Mayer B, Fialová D, Topinkova E, Gindin J, Onder G, Bernabei R, Nikolaus T, Denkinger MD. Pain characteristics and pain control in European nursing homes: cross-sectional and longitudinal results from the Services and Health for Elderly in Long TERm care (SHELTER) study. J Am Med Dir Assoc 2013; 14:421-8. [PMID: 23375521 DOI: 10.1016/j.jamda.2012.12.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 12/19/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE AND DESIGN Few studies have compared cross-national characteristics of residents with pain in European long term care facilities. The SHELTER project, a cross-national European study on nursing home residents, provides the opportunity to examine this issue. The present study aimed to evaluate key figures about pain and compare them with seven European countries and Israel. SETTING, PARTICIPANTS, AND MEASUREMENTS A total of 3926 nursing home residents were assessed by the interRAI instrument for Long Term Care Facilities (interRAI LTCF). Prevalence of pain, frequency, intensity, consistency, and control were estimated and compared cross-nationally. Correlates between patient-related characteristics and inadequate pain management were tested using bivariate and multivariate logistic regression models. RESULTS Overall, 1900 (48.4%) residents suffered from pain. Pain prevalence varied significantly among countries, ranging from 19.8% in Israel to 73.0% in Finland. Pain was positively associated with female gender, fractures, falls, pressure ulcers, sleeping disorders, unstable health conditions, cancer, depression, and number of drugs. It was negatively associated with dementia. In a multivariate logistic regression model, all associations remained except for sleeping disorders. Clinical correlations varied considerably among countries. Although in 88.1% of cases, pain was self-rated by the residents as sufficiently controlled, in only 56.8% of cases was pain intensity self-rated as absent or mild. Pain control and intensity improved within 1 year. CONCLUSION Pain prevalence is high and varies considerably across Europe. Although most residents considered pain as adequately controlled, a closer look confirmed that many still suffer from high pain intensities. Analyzing the reasons behind these differences may help to improve pain management.
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Affiliation(s)
- Albert Lukas
- AGAPLESION Bethesda Clinic, Competence Center of Geriatrics and Aging Research, University of Ulm, Germany.
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Landmark BT, Gran SV, Kim HS. Pain and persistent pain in nursing home residents in Norway. Res Gerontol Nurs 2012; 6:47-56. [PMID: 23244567 DOI: 10.3928/19404921-20121204-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 02/23/2012] [Indexed: 11/20/2022]
Abstract
The objective of this study was to examine the nature of pain and persistence of pain in nursing home residents. The study was carried out with 201 participants drawn from six nursing homes in Norway. The participants rated their pain on 5 different days within a 14-day period on the modified McGill Pain Questionnaire regarding the intensity and location of pain. Four patterns in the persistence of pain were extracted, with the results showing approximately 50% of the participants experiencing persistent pain of a moderate to intense level. Pain ratings and persistent pain were significantly associated with number of body areas with pain, sleeping problems, number of medical diagnoses, and number of medications. The findings of this study suggest that both persistence and fluctuation of pain within short time periods may be related to inadequacy in pain management in nursing home residents, and fill the gap in the literature regarding patterns of persistent pain in nursing home residents.
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Affiliation(s)
- Bjørg T Landmark
- Faculty of Health, Buskerud University College, Drammen, Norway.
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Wulff I, Könner F, Kölzsch M, Budnick A, Dräger D, Kreutz R. Interdisziplinäre Handlungsempfehlung zum Management von Schmerzen bei älteren Menschen in Pflegeheimen. Z Gerontol Geriatr 2012; 45:505-44. [DOI: 10.1007/s00391-012-0332-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Albers G, Harding R, Pasman HRW, Onwuteaka-Philipsen BD, Hall S, Toscani F, Ribbe MW, Deliens L. What is the methodological rigour of palliative care research in long-term care facilities in Europe? A systematic review. Palliat Med 2012; 26:722-33. [PMID: 21697265 DOI: 10.1177/0269216311412232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The European population is rapidly ageing, resulting in increasing numbers of older people dying in long-term care facilities. There is an urgent need for palliative care in long-term care facilities. AIM The aim of this study was to systematically review the literature on palliative care research in long-term care facilities in Europe with respect to how the palliative care populations were described, and to determine the study designs and patient outcome measures utilized. METHODS We used a systematic literature review. The search strategy included searches of PubMed, Embase and PsychINFO databases from 2000 up to May 2010, using search terms related to 'palliative care' and 'end-of-life care' combined with search terms related to 'long-term care'. We selected articles that reported studies on patient outcome data of palliative care populations residing in a long-term care facility in Europe. RESULTS This review demonstrated that there are few, and mainly descriptive, European studies on palliative care research in long-term care facilities. Fourteen studies were retained in the review, of which eight were conducted in the Netherlands. None of these studies described their study population specifically as a palliative care or end-of-life care population. Retrospective and prospective designs were applied using many different measurement instruments. Most instruments were proxy ratings. Symptom (management) was the most frequently measured outcome. CONCLUSION To improve future research on palliative care in long-term care facilities, agreement on what can be considered as palliative care in long-term care facilities and, the availability of well-developed and tested measurement instruments is needed to provide more evidence, and to make future research more comparable.
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Affiliation(s)
- Gwenda Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands.
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15
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Plooij B, van der Spek K, Scherder EJ. Pain Medication and Global Cognitive Functioning in Dementia Patients with Painful Conditions. Drugs Aging 2012; 29:377-84. [DOI: 10.2165/11630850-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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16
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Corbett A, Husebo B, Malcangio M, Staniland A, Cohen-Mansfield J, Aarsland D, Ballard C. Assessment and treatment of pain in people with dementia. Nat Rev Neurol 2012; 8:264-74. [PMID: 22487749 DOI: 10.1038/nrneurol.2012.53] [Citation(s) in RCA: 221] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many elderly people experience pain and regularly take analgesic medication. Pain is also frequent in people with dementia, particularly those with severe disease. As no robust clinical guidelines are available for the treatment of pain in the context of dementia, the risk of inadequate treatment in individuals with this condition is high. Furthermore, our understanding of the aetiology of pain and the potential role of dementia-associated neuropathology in pain is limited. These issues are important in the clinical management of individuals with dementia, as untreated pain is a major contributor to reduced quality of life and disability, and can lead to increased behavioural and psychological symptoms. Assessment scales to identify pain in people with dementia have been highlighted in recent studies, but there is little evidence for consistency between these tools. Numerous studies have evaluated various approaches for the treatment of pain, including stepped-care protocols and/or administration of paracetamol and opioid medications. In this Review, we summarize the best-available evidence regarding the aetiology, assessment and treatment of pain in people with dementia. Further validation of assessment tools and large-scale trials of treatment approaches in people with dementia are needed to improve clinical guidance for the treatment of pain in these individuals.
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Affiliation(s)
- Anne Corbett
- Alzheimer's Society, 58 St Katharine's Way, London E1W 1LB, UK
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17
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Abstract
Increasing age and dementia are accompanied by an increased risk for undertreatment of pain owing to difficulty in assessing pain. Registration of autonomic responses to pain may contribute to a more reliable pain assessment. The aim of this review was to gain more insight into autonomic responses to pain in older persons with and without dementia. Literature searches were performed in the online databases MEDLINE and Web of Science. Seven studies on autonomic responses to pain in older people with or without dementia were included in the review. Autonomic responses to pain are present in older people with and without dementia, although they may be attenuated. Because no distinction could be made between different dementia subtypes based on these studies, predictions of changes in autonomic responses to pain have been made based on neuropathological changes. It can be concluded that autonomic responses to pain are attenuated in older people with and without dementia. Studies to specify the changes in the different autonomic responses for the different dementia subtypes are needed.
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Affiliation(s)
- Bart Plooij
- Department of Clinical Neuropsychology, VU University, 1081 BT Amsterdam, The Netherlands.
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Husebo BS, Kunz M, Achterberg WP, Lobbezoo F, Kappesser J, Tudose C, Strand LI, Lautenbacher S. Pain Assessment and Treatment Challenges in Patients with Dementia 1This article is a modified version of the article „Pain in patients with dementia: An overview of pain assessment and treatment challenges” that will be printed in the Journal of Norsk Epidemiologi. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2012. [DOI: 10.1024/1016-264x/a000078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pain is likely to be equally prevalent in people with dementia, however, only a small minority are prescribed regular analgesics. This is a key issue since untreated pain leads to reduced quality of life and increases the likelihood of emergence of behavioural and psychological symptoms such as agitation. Better assessment and treatment of pain in this fragile patient group are therefore mandatory. In this context, we reviewed the literature on pain and dementia and summarised the best available evidence regarding the frequency of pain and pain diagnosis. Unfortunately, hardly any randomized, controlled studies of pain treatment efficacy in patients with dementia are available, with the consequence that most pain treatment recommendations are not based on the highest level of evidence.
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Affiliation(s)
- Bettina S. Husebo
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, and Center for Age-Related Medicine, University Hospital, Stavanger, Norway
| | - Miriam Kunz
- Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
| | - Wilco P. Achterberg
- EMGO Institute, VU Medical Centre, Department of Nursing Home Medicine, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Judith Kappesser
- Department of Clinical Psychology, Justus-Liebig-University, Giessen, Germany
| | - Catalina Tudose
- Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania
| | - Liv Inger Strand
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, and Center for Age-Related Medicine, University Hospital, Stavanger, Norway
| | - Stefan Lautenbacher
- Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
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Hjaltadóttir I, Hallberg IR, Ekwall AK, Nyberg P. Health status and functional profile at admission of nursing home residents in Iceland over 11-year period. Int J Older People Nurs 2011; 7:177-87. [DOI: 10.1111/j.1748-3743.2011.00287.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Docking RE, Fleming J, Brayne C, Zhao J, Macfarlane GJ, Jones GT. Epidemiology of back pain in older adults: prevalence and risk factors for back pain onset. Rheumatology (Oxford) 2011; 50:1645-53. [DOI: 10.1093/rheumatology/ker175] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pieper MJC, Achterberg WP, Francke AL, van der Steen JT, Scherder EJA, Kovach CR. The implementation of the serial trial intervention for pain and challenging behaviour in advanced dementia patients (STA OP!): a clustered randomized controlled trial. BMC Geriatr 2011; 11:12. [PMID: 21435251 PMCID: PMC3072328 DOI: 10.1186/1471-2318-11-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 03/24/2011] [Indexed: 11/23/2022] Open
Abstract
Background Pain (physical discomfort) and challenging behaviour are highly prevalent in nursing home residents with dementia: at any given time 45-80% of nursing home residents are in pain and up to 80% have challenging behaviour. In the USA Christine Kovach developed the serial trial intervention (STI) and established that this protocol leads to less discomfort and fewer behavioural symptoms in moderate to severe dementia patients. The present study will provide insight into the effects of implementation of the Dutch version of the STI-protocol (STA OP!) in comparison with a control intervention, not only on behavioural symptoms, but also on pain, depression, and quality of life. This article outlines the study protocol. Methods/Design The study is a cluster randomized controlled trial in 168 older people (aged >65 years) with mild or moderate dementia living in nursing homes. The clusters, Dutch nursing homes, are randomly assigned to either the intervention condition (training and implementation of the STA OP!-protocol) or the control condition (general training focusing on challenging behaviour and pain, but without the step-wise approach). Measurements take place at baseline, after 3 months (end of the STA OP! training period) and after 6 months. Primary outcome measures are symptoms of challenging behaviour (measured with the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory-Nursing Home version (NPI-NH)), and pain (measure with the Dutch version of the Pain Assessment Checklist for Seniors (PACSLAC-D) and the Minimum Data Set of the Resident Assessment Instrument (MDS-RAI) pain scale). Secondary outcome measures include symptoms of depression (Cornell and MDS-RAI depression scale), Quality of Live (Qualidem), changes in prescriptions of analgesics and psychotropic drugs, and the use of non-pharmacological comfort interventions (e.g. snoezelen, reminiscence therapy). Discussion The transfer from the American design to the Dutch design involved several changes due to the different organisation of healthcare systems. Specific strengths and limitations of the study are discussed. Trial registration Netherlands Trial Register (NTR): NTR1967
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Affiliation(s)
- Marjoleine J C Pieper
- EMGO+ Institute for Health and Care Research, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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22
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Literature Review of Pain Prevalence Among Older Residents of Nursing Homes. Pain Manag Nurs 2010; 11:209-23. [DOI: 10.1016/j.pmn.2010.08.006] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/27/2010] [Accepted: 08/27/2010] [Indexed: 11/19/2022]
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Boerlage AA, Masman AD, Hagoort J, Tibboel D, Baar FPM, van Dijk M. Is pain assessment feasible as a performance indicator for Dutch nursing homes? A cross-sectional approach. Pain Manag Nurs 2010; 14:36-40. [PMID: 23452525 DOI: 10.1016/j.pmn.2010.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 04/28/2010] [Accepted: 05/04/2010] [Indexed: 10/19/2022]
Abstract
Quality of care gains transparency with the help of performance indicators. For Dutch nursing homes, the current set of performance indicators does not include pain. To determine the feasibility of pain assessment as performance indicator, information about pain prevalence and analgesic prescription in one nursing home was collected. Within the time span of 3 days, pain intensity was measured in 91% of the residents (201 out of 221), either with a numeric rating scale, a verbal rating scale, or the Rotterdam Elderly Pain Observation Scale (REPOS). Numerical rating was used for 72%, verbal rating for 3%, and REPOS observation for 25% of the residents. Pain was substantial in 65 residents (32%), who received the following analgesic prescription: World Health Organization (WHO) step 1, 45%; WHO step 3, 12%; and neuroactive agents, 5%. Thirty-eight percent of these residents were in pain and received no analgesics. Residents with substantial pain significantly more often received analgesics (p = .007). Results suggest that pain assessment is feasible in a nursing home and would stimulate staff attention to pain. Further investigation is necessary to find out if a pain algorithm is feasible and will lead to improved pain treatment.
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Affiliation(s)
- Anneke A Boerlage
- Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Gran SV, Festvåg LS, Landmark BT. ‘Alone with my pain - it can’t be explained, it has to be experienced’. A Norwegian in-depth interview study of pain in nursing home residents. Int J Older People Nurs 2010; 5:25-33. [DOI: 10.1111/j.1748-3743.2009.00195.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Achterberg WP, Gambassi G, Finne-Soveri H, Liperoti R, Noro A, Frijters DHM, Cherubini A, Dell'Aquila G, Ribbe MW. Pain in European long-term care facilities: cross-national study in Finland, Italy and The Netherlands. Pain 2009; 148:70-74. [PMID: 19910119 DOI: 10.1016/j.pain.2009.10.008] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 09/18/2009] [Accepted: 10/13/2009] [Indexed: 11/19/2022]
Abstract
There have been very few and limited cross-national comparisons concerning pain among residents of long-term care facilities in Europe. The aim of the present cross-sectional study has been to document the prevalence of pain, its frequency and severity as well as its correlates in three European countries: Finland (north), Italy (south) and the Netherlands (western central). Patients (aged 65years or above) were assessed with the Minimum Data Set 2.0 (MDS).The final sample comprised 5761 patients from 64 facilities in Finland, 2295 patients from 8 facilities in the Netherlands and 1959 patients from 31 facilities in Italy. The prevalence of pain - defined as any type of pain - varied between 32% in Italy, 43% in the Netherlands and 57% in Finland. In nearly 50% of cases, pain was present daily; there were no significant differences in pain prevalence between patients with cancer diagnosis and those with non-cancer diagnosis. Regardless of the different prevalence estimates, pain was moderate-to-severe in over 50% of cases in all the countries. In multivariate logistic regression models, clinical correlates of pain were substantially similar across countries: pain was positively correlated with more severe physical disability (ADL impairment), clinical depression and a diagnosis of osteoporosis. Pain was negatively correlated with a diagnosis of dementia and more severe degrees of cognitive deterioration. We conclude that pain is frequently encountered in long-term care facilities in Europe and that, despite cultural and case-mix differences, pain speaks one language.
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Affiliation(s)
- Wilco P Achterberg
- Department of Nursing Home Medicine, EMGO - VU University Medical Center, Amsterdam, The Netherlands Centro Medicina Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy THL National Institute for Health and Welfare, Helsinki, Finland Institute of Gerontology and Geriatrics, University of Perugia Medical School, Perugia, Italy
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Scherder E, Herr K, Pickering G, Gibson S, Benedetti F, Lautenbacher S. Pain in dementia. Pain 2009; 145:276-278. [DOI: 10.1016/j.pain.2009.04.007] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/24/2009] [Accepted: 04/13/2009] [Indexed: 11/26/2022]
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Pain Management in Dutch Nursing Homes Leaves Much to Be Desired. Pain Manag Nurs 2009; 10:32-9. [DOI: 10.1016/j.pmn.2008.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 06/11/2008] [Accepted: 06/11/2008] [Indexed: 11/19/2022]
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Gender and analgesic use in nursing home residents with dementia. THE JOURNAL OF PAIN 2008; 9:970-1. [PMID: 18674971 DOI: 10.1016/j.jpain.2008.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 05/29/2008] [Indexed: 11/20/2022]
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