Pain management in community-dwelling older adults with moderate-to-severe dementia

Factors related to nurses' beliefs regarding pain assessment in people living with dementia

AIM

To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia.

DESIGN

A descriptive cross-sectional survey was conducted between July 2022 and April 2023.

METHODS

An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia.

RESULTS

RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge).

CONCLUSION

The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes.

IMPACT

Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia.

REPORTING METHOD

This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

PATIENT OR PUBLIC CONTRIBUTION

RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.

Cultural Influence on Nurses' Pain Observations Related to Dementia: An Integrative Review

BACKGROUND

Nurses play a pivotal role in pain observation in people living with dementia. However, currently, there is little understanding of the influence culture may have on the way nurses observe pain experienced by people living with dementia.

AIM

This review explores the influence of culture on nurses... pain observations experienced by people living with dementia.

SETTINGS

Studies were included regardless of the setting (e.g., acute medical care, long-term care, community).

DESIGN

An integrative review.

PARTICIPANTS/SUBJECTS

PubMed, Medline, Psychological Information Database, Cochrane Library, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and ProQuest were included in the search.

METHODS

Electronic databases were searched using synonyms for "dementia," "nurse," "culture," and "pain observation." The review included ten primary research papers following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

RESULTS

Nurses reported that pain observation in people living with dementia is challenging. Four themes were identified by data synthesis: (1) using behaviors for pain observation; (2) information from carers for pain observation; (3) pain assessment tools for pain observation; and (4) role of knowledge, experience, and intuition in pain observation.

CONCLUSIONS

There is a limited understanding of the role of culture on nurses' pain observations. However, nurses take a multifaceted approach to observing pain using behaviors, information from carers, pain assessment tools, and their knowledge, experience, and intuition.

Pain assessment and management for people with dementia in the community

People with dementia commonly experience pain, but it is often unrecognised, unrelieved and remains an underlying issue as the condition progresses. As a result, pain management for people with dementia is inadequate. Community nurses have a fundamental role in the assessment and management of pain and in supporting family carers. This article details the causes and effects of pain in people with dementia, explains the components of a holistic approach to individualised pain assessment, and describes various pharmacological and non-pharmacological interventions that can be used to manage pain in this population.

Pain management for people with dementia: a cross-setting systematic review and meta-ethnography

Background

Pain management for people with dementia is challenging. There is limited understanding on the experiences of pain management from people with dementia, but also from those who support them. This study synthesised the qualitative evidence to explore the perspectives of people with dementia, their family, friends, carers and healthcare professionals to pain management.

Methods

A systematic literature review was undertaken of published and unpublished literature databases (to 01 November 2021). All qualitative research studies reporting the perspectives of people with dementia, their family, friends, carers and healthcare professionals to managing pain were included. Eligible studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative appraisal tool. A meta-ethnography analysis approach was adopted, with findings assessed against the GRADE-CERQual framework.

Results

Of the 3994 citations screened, 33 studies were eligible. Seven themes were identified from the data. There was moderate evidence from six studies indicating inequity of pain management for people with dementia. There was moderate evidence from 22 studies regarding anxieties on cascading pain information. There was moderate evidence from nine studies that familiarisation of the person with pain, their preferences, routines and behaviours were key factors to better pain management. Consistently, carers and healthcare professionals had a low opinion of the management of pain for people with dementia, with tensions over the 'best' treatment options to offer. This was associated with poor training and understanding on how pain 'should' be managed.

Conclusion

The findings highlight the challenges faced by people with dementia and pain, and those who support them. Improvements in education for people who support these individuals would be valuable across health and social care pathways. Supporting family members and relatives on pain experiences and treatment options could improve awareness to improve quality of life for people with dementia and pain and those who support them.

A Systematic Review of Barriers and Facilitators of Pain Management in Persons with Dementia

Approximately 50% of persons living with dementia experience pain, yet it is frequently undetected and inadequately managed resulting in adverse consequences. This review aims to synthesize evidence on the barriers and facilitators of pain management in persons living with dementia. PubMed, CINAHL, PsycINFO, and Web of Science datasets were used for article searching. Inclusion criteria were peer-reviewed original articles written in English that examined the barriers and facilitators of pain management for persons living with dementia. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. A total of 26 studies were selected, including 18 qualitative and 3 quantitative (all high quality), as well as 5 mixed methods studies (low-to-high quality). Results were categorized into intrapersonal, interpersonal, environmental, and policy categories. Factors that impact pain management in dementia include cognitive and functional impairment, healthcare workers' knowledge, collaboration and communication, healthcare workers' understanding of patients' baseline behaviors, observation of behaviors, pain assessment tool use, pain management consistency, staffing level, pain guideline/policy, and training. Overall, pain management is challenging in persons living with dementia. The results indicate that there is a need for multi-component interventions that involves multidisciplinary teams to improve pain management in persons living with dementia at the intrapersonal, interpersonal, environmental, and policy levels. PERSPECTIVES: This review systematically synthesized barriers and facilitators of providing pain management in persons living with dementia. Results were presented in intrapersonal, interpersonal, environmental, and policy categories and suggests that multicomponent interventions involving multidisciplinary teams are needed to systematically improve pain management in persons living with dementia.

Analgesic effect of auricular point acupressure for acute pain in patients with dementia: study protocol for a randomized controlled trial

Background

Common and frequent as acute pain is, it is often underestimated and undertreated in older people with dementia in nursing homes and inadequate pain management remains an issue.

Methods

The study is designed to be a randomized, sham-controlled trial and is underway in nursing homes located in China. A total of 206 dementia patients are being recruited from nursing homes in Yinchuan, China. They are randomly allocated to an intervention or a controlled group in a 1:1 ratio. The intervention group will be treated with true APP therapy, while the other group will receive APP at sham point stimulation therapy. The patients will be assessed at baseline (T0), at 5 min during performing the intervention (T1), and at 5 min after completion of the intervention (T2). The primary outcome is the level of pain relief at T1 and T2. Physiological parameters, side effects and additional use of analgesics during the procedure, satisfaction from caregivers, and acceptance of patients are evaluated as secondary outcomes.

Discussion

The results of this study are expected to verify the analgesic effect of APP for acute pain in patients with mild dementia in nursing homes. It has the potential to prompt APP therapy to be implemented widely in dementia patients with acute pain in nursing homes.

Trial registration

Chinese Clinical Trial Registry ChiCTR2100047932. Registered on 27 June 2021. Currently, patient recruitment is ongoing. Recruitment is expected to take place from December 2020 to December 2021.

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

Introduction

Acute pain is a prevalent problem for dementia residents in nursing homes. A variety of intervention strategies have been applied to address this problem. However, there remains an issue of inadequate pain control. This study aims to explore the analgesic efficacy of auricular acupressure (AA) for dementia residents with acute pain in nursing homes.

Methods

A multicenter, single-blind, randomized, and sham-controlled clinical trial was performed in three nursing homes in Yinchuan, China. All of the 206 eligible patients with acute pain were randomly divided into two groups for real AA therapy or sham AA (at sham point stimulation) therapy. The primary outcome was measured with a face pain scale revised (FPS-R) score before the procedure, 5 min after the start of the intervention, and 5 min after finishing the procedure. Secondary outcomes covered three physiological parameters, adverse reactions observed, satisfaction level of caregivers, acceptance of patients, and additional use of analgesics.

Results

There was a significant difference in pain scores based on FPS-R between the two groups (p < 0.01). Pain score in the true AA group was 1.84 ± 0.23, compared with 2.22 ± 0.81 in the sham AA group. No adverse events were found during the whole procedure for all patients. The satisfaction level of caregivers and acceptance of patients in the real AA group were significantly higher than those in the sham AA group.

Conclusion

This study shows that real AA was an alternative analgesic modality in reducing acute pain in patients with mild dementia.