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McLennan AIG, Castillo LIR, Hadjistavropoulos T. Pain in Dementia: An Empirical Test of a Common Assumption. THE JOURNAL OF PAIN 2024:104605. [PMID: 38880391 DOI: 10.1016/j.jpain.2024.104605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/18/2024]
Abstract
Numerous, and often largely overlapping, observational pain assessment tools have been developed specifically to assess pain in older adults with dementia under the assumption that a specialized approach is necessary to evaluate pain in this population. However, this assumption has never been tested empirically. As an empirical test of this implicit assumption, our goal was to compare existing tools for people living with dementia (with respect to psychometric properties), not only against each other, but also against a tool developed for a different population with cognitive impairments. Videos of older adults with severe dementia recorded in long-term care settings were coded for pain behaviors in the laboratory. Trained coders coded pain behaviors in video segments of older adults with dementia during a quiet baseline condition as well as during a physical examination (designed to identify painful areas), using various observational pain assessment tools. An observational measure of agitation was employed to facilitate the assessment of discriminant validity. Consistent with our expectations, all pain tools (including the tool developed for younger people with cognitive impairments) successfully differentiated between painful and nonpainful states, with large effect sizes. This was the first study to compare tools specifically developed to assess pain in people living with dementia to a tool developed for a different population. Given that all tools under study showed satisfactory psychometric properties when tested on persons with dementia, this study suggests that the assumption that different tools are necessary for different populations with cognitive impairments cannot be taken for granted. PERSPECTIVE: This article challenges an implicitly held assumption that specialized tools are needed to assess pain in different populations with cognitive impairments. Given commonalities in pain expression across populations, further research is needed to determine whether population-specific tools are needed.
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Affiliation(s)
- Andrew I G McLennan
- Department of Psychology and Centre of Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Louise I R Castillo
- Department of Psychology and Centre of Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre of Aging and Health, University of Regina, Regina, Saskatchewan, Canada.
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Resnick B, Boltz M, Galik E, Kuzmik A, Ellis J, Wells C, Zhu S. Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description. Res Nurs Health 2022; 45:300-313. [PMID: 35274750 PMCID: PMC9064936 DOI: 10.1002/nur.22223] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Abstract
This manuscript provides the protocol for a National Institute of Aging-funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as function-focused care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking upstairs. The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function-focused care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities. The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this study is provided.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Ashley Kuzmik
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Chris Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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Resnick B, Van Haitsma K, Kolanowski A, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Renn CL, Dorsey SG. Invariance of the PAINAD Scale Between the Black and White Residents Living With Dementia. FRONTIERS IN PAIN RESEARCH 2022; 2:757654. [PMID: 35295523 PMCID: PMC8915686 DOI: 10.3389/fpain.2021.757654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to test the reliability and validity of the Pain Assessment in Advanced Dementia (PAINAD) and particularly consider whether or not this measure was invariant when used among the Black and White residents. Baseline data from an implementation study testing that included a sample of 553 residents, 30% of who were Black, from 55 nursing were included in this study. The Winsteps statistical program was used to perform the Rasch analysis and evaluate the reliability and validity of the measure based on internal consistency, infit and outfit statistics, mapping, and a differential item functioning (DIF) analysis. The AMOS statistical program was used for confirmatory factor analysis. The findings supported the reliability and validity of the PAINAD when used with these individuals and demonstrated that there was no evidence of invariance between the Black and White residents. All the items fit the model, but there was not a good spread of the items across the pain level of the participants. The majority of the participants (75%) were so low in pain signs or symptoms that they could not be differentiated. Based on the clinical practice and observations, it is recommended that additional items can be added to the measure such as observing the individual for evidence of resisting care, retropulsion when trying to stand, hitting or kicking when turning in bed, hitting or kicking when transferring from bed to chair, hitting or kicking when ambulating, or hitting or kicking when raising arms, less engagement with others, and decreased participation in the activities previously enjoyed.
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Affiliation(s)
- Barbara Resnick
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | | | - Ann Kolanowski
- Pennsylvania State University, University Park, PA, United States
| | - Elizabeth Galik
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Marie Boltz
- Pennsylvania State University, University Park, PA, United States
| | - Jeanette Ellis
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Liza Behrens
- Pennsylvania State University, University Park, PA, United States
| | - Karen Eshraghi
- Pennsylvania State University, University Park, PA, United States
| | - Cynthia L Renn
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Susan G Dorsey
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
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Whitehead PB, Gamaluddin S, DeWitt S, Stewart C, Kim KY. Caring for Patients With Dementia at End of Life. Am J Hosp Palliat Care 2021; 39:716-724. [PMID: 34519251 DOI: 10.1177/10499091211046247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Early integration of palliative medicine is an important intervention that can lead to better manage symptoms and lessen the strain on loved ones. Additionally, early enrollment into hospice should be encouraged with loved ones to promote quality of life as defined by the patient.
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Affiliation(s)
- Phyllis B Whitehead
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | | | - Sarah DeWitt
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Christi Stewart
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Carilion Center for Healthy Aging, Roanoke, VA, USA
| | - Kye Y Kim
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Carilion Center for Healthy Aging, Roanoke, VA, USA
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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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McAnee G, Norwood K, Rosato M, Leavey G. Assessment of pain in people living with dementia at the end of life: a systematic review. Int J Palliat Nurs 2021; 27:72-85. [PMID: 33886358 DOI: 10.12968/ijpn.2021.27.2.72] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with dementia may not receive the same quality of palliative care as those with other life-limiting conditions, particularly at end of life (EoL). AIMS To understand the best way to examine pain in people with dementia. METHODS A systematic review of tools to assess pain in patients with dementia near the end of life; PubMed, Medline, Embase, EBSCO Host, CINAHL Plus, Web of Science, Psycinfo, PsycArticles and Scopus were searched. FINDINGS A total of 15 articles were identified, which were qualitatively synthesised. CONCLUSION There are a range of pain assessment tools that are appropriate for use in people with dementia, but all 15 studies used a formal tool. A more robust approach is needed to improve the quality of research for measurement and management of pain in this population.
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Affiliation(s)
- Grainne McAnee
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, United Kingdom
| | - Kelly Norwood
- School of Psychology, Ulster University, Northern Ireland, United Kingdom
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, United Kingdom
| | - Gerry Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, United Kingdom
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Mulkey MA, Munro CL. Calming the Agitated Patient: Providing Strategies to Support Clinicians. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2021; 30:9-13. [PMID: 34092999 PMCID: PMC8171292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Agitation is a symptom of many medical and psychiatric disorders that can manifest along a spectrum of severity. Agitation often delays treatment onset, potentially impacting morbidity and mortality, and may require emergency interventions. Management of acute agitation centers around three main goals: early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel. Nurses should increase use of validated techniques, including frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life.
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Affiliation(s)
- Malissa A Mulkey
- UNC-REX Hospital, Raleigh, NC; and Post-Doctoral Research Fellow, Indiana University-Purdue University, Indianapolis, IN
| | - Cindy L Munro
- School of Nursing, Miami University, Coral Gables, FL
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Xu N, Huang ST, Sun KP, Chen LW, Chen Q, Cao H. Effect of remifentanil-based fast-track anesthesia on postoperative analgesia and sedation in adult patients undergoing transthoracic device closure of ventricular septal defect. J Cardiothorac Surg 2020; 15:281. [PMID: 32993714 PMCID: PMC7523253 DOI: 10.1186/s13019-020-01339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effect of remifentanil-based fast-track anesthesia on analgesia and sedation after transthoracic device closure of ventricular septal defects (VSDs) in adult patients. Methods A retrospective analysis was performed on 59 patients aged 21–53 years who underwent transthoracic device closure of VSDs from January 2019 to September 2019. According to the different anesthesia strategies, the patients were divided into the R group (using remifentanil-based anesthesia, n = 33) and the S group (using sufentanil-based anesthesia, n = 26). Patient-related clinical data, postoperative analgesia, and sedation scores were collected and analyzed. Results There was no significant difference in age, gender, body weight, and operation time between the group R and the group S (P > 0.05). There was also no significant difference in intraoperative hemodynamic changes, BIS scores, postoperative analgesia, and sedation scores between the two groups (P > 0.05). The duration of mechanical ventilation, the length of ICU stay, and hospital stay in the group R were significantly lower than those in the group S (P < 0.05). Conclusion Remifentanil-based fast-track anesthesia is effective for adult patients undergoing transthoracic device closure of VSDs, which may shorten the mechanical ventilation duration, the ICU and hospital stay of patients.
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Affiliation(s)
- Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China. .,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Sampson EL, West E, Fischer T. Pain and delirium: mechanisms, assessment, and management. Eur Geriatr Med 2020; 11:45-52. [PMID: 32297242 DOI: 10.1007/s41999-019-00281-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Pain and delirium are common problems for older people. Both conditions are prevalent in acute hospital settings. In people living in the community, delirium often precipitates presentation to the emergency department. Pain and delirium are known to interact in a complex and multidirectional way. This can make it challenging for staff to recognize and treat pain in people with delirium. METHODS This paper aims to explore the complex relationship between pain and delirium and on pain assessment in delirium, drawing together evidence from a range of settings including acute medical, cardiac and orthopaedic post-operative cohorts, as well as from aged care. RESULTS A limited number of studies suggest there is an association between pain and delirium; however, this is a complex, particularly where analgesics which may-themselves cause delirium are prescribed. Factors acting on the pathway between pain and delirium may include depression, sleep deprivation and disturbance of the cholinergic system. Delirium affects the ability to self-report pain. The fluctuating nature of delirium as well as reduced awareness and attention may challenge practitioners in recognizing, assessing and treating pain. Evidence concerning the reliability and validity of current observational and self-assessment tools in people with delirium is unclear but some show promise in this population. CONCLUSION The current evidence base regarding assessing pain in people with delirium is lacking. Tentative recommendations, drawing on current guidelines require robust testing. Guidelines for people with pain and dementia require adaptations regarding the unique characteristics of delirium. The complex interplay between dementia, pain and delirium warrants further investigation across a range of settings.
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Affiliation(s)
- Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
- Barnet Enfield, Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK.
| | - Emily West
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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