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Ewy DF. Ethical Obligation of Adequate Pain Management in Long Term Care Residents with Dementia. Kans J Med 2024; 17:87-89. [PMID: 39091369 PMCID: PMC11291185 DOI: 10.17161/kjm.vol17.22135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/06/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Donna F Ewy
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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Ku NW, Cheng MT, Liew CQ, Chen YC, Sung CW, Ko CH, Lu TC, Huang CH, Tsai CL. Prospective study of pain and patient outcomes in the emergency department: a tale of two pain assessment methods. Scand J Trauma Resusc Emerg Med 2023; 31:56. [PMID: 37872561 PMCID: PMC10594810 DOI: 10.1186/s13049-023-01130-9] [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: 08/13/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Accurate pain assessment is essential in the emergency department (ED) triage process. Overestimation of pain intensity, however, can lead to unnecessary overtriage. The study aimed to investigate the influence of pain on patient outcomes and how pain intensity modulates the triage's predictive capabilities on these outcomes. METHODS A prospective observational cohort study was conducted at a tertiary care hospital, enrolling adult patients in the triage station. The entire triage process was captured on video. Two pain assessment methods were employed: (1) Self-reported pain score in the Taiwan Triage and Acuity Scale, referred to as the system-based method; (2) Five physicians independently assigned triage levels and assessed pain scores from video footage, termed the physician-based method. The primary outcome was hospitalization, and secondary outcomes included ED length of stay (EDLOS) and ED charges. RESULTS Of the 656 patients evaluated, the median self-reported pain score was 4 (interquartile range, 0-7), while the median physician-rated pain score was 1.5 (interquartile range, 0-3). Increased self-reported pain severity was not associated with prolonged EDLOS and increased ED charges, but a positive association was identified with physician-rated pain scores. Using the system-based method, the predictive efficacy of triage scales was lower in the pain groups than in the pain-free group (area under the receiver operating curve, [AUROC]: 0.615 vs. 0.637). However, with the physician-based method, triage scales were more effective in predicting hospitalization among patients with pain than those without (AUROC: 0.650 vs. 0.636). CONCLUSIONS Self-reported pain seemed to diminish the predictive accuracy of triage for hospitalization. In contrast, physician-rated pain scores were positively associated with longer EDLOS, increased ED charges, and enhanced triage predictive capability for hospitalization. Pain, therefore, appears to modulate the relationship between triage and patient outcomes, highlighting the need for careful pain evaluation in the ED.
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Affiliation(s)
- Nai-Wen Ku
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ming-Tai Cheng
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd., Taipei, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Hsinchu, Taiwan
| | - Chiat Qiao Liew
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd., Taipei, 100, Taiwan
| | - Yun Chang Chen
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Hsinchu, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chia-Hsin Ko
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd., Taipei, 100, Taiwan
| | - Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd., Taipei, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd., Taipei, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd., Taipei, 100, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Zhou Y, Choi NG, Sadak T, Ghosh N, Phelan EA. Association Between Pain and Fall Worry Among Community-Dwelling Older People With Cognitive Impairment in the United States. Innov Aging 2023; 7:igad100. [PMID: 38094927 PMCID: PMC10714914 DOI: 10.1093/geroni/igad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Previous studies have found that pain is associated with fall worry among community-dwelling older people. However, both pain and fall worry are poorly understood and underaddressed among community-dwelling older people with cognitive impairment (CI). It is essential to examine the association between pain and fall worry, and how sociodemographic and health characteristics may shape fall worry among this subgroup. Research Design and Methods We used data from the 2015 National Health and Aging Trends Study (analytic sample: n = 1150 community-dwelling older people with CI; were self-interviewed; mean age: 81; age range: 65-107). The number of pain sites in the prior month was assessed by presenting a card listing common pain sites (eg, back, knees). Two questions assessed past-month fall worry, "did you worry about falling down" and "did this worry ever limit your activities." Following descriptive statistics, we fit multinomial logistic regression models to examine the associations between different pain characteristics (number of sites, severity, location) and non-activity-limiting and activity-limiting fall worry. Results Non-activity-limiting fall worry was endorsed by 21.1% and activity-limiting fall worry by 13.6% of community-dwelling older people with CI. After adjusting for sociodemographic characteristics and fall-worry-related covariates, multinomial logistic regression analysis found that a greater number of pain sites (relative risk ratio [RRR] = 1.22, 95% Confidence Interval [95% CI] = 1.12-1.33, p <.001) and severe pain (RRR = 2.05, 95% CI = 1.12-3.75, p = .020) was associated with activity-limiting fall worry. Both lower body (knee, foot, and leg) and upper body (hand, wrist, shoulder, neck, and stomach) pain were found to be associated with a high risk of activity-limiting fall worry. Discussion and Implications These findings suggest pain and fall worry are common among community-dwelling older people with CI and can be elicited directly from those who are communicative. Fall prevention for this population should prioritize pain management to mitigate activity-limiting fall worry because activity limitation increases the risk of falls.
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Affiliation(s)
- Yuanjin Zhou
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Tatiana Sadak
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Nayanika Ghosh
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Elizabeth A Phelan
- Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
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Rutkowski K, Wyszatycki M, Ejdys K, Hawryluk NM, Stompór M. Pain and Its Management in Patients Referred to a Geriatric Outpatient Clinic. J Pers Med 2023; 13:1366. [PMID: 37763134 PMCID: PMC10532457 DOI: 10.3390/jpm13091366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: A major problem affecting geriatric patients is pain. In addition to pain, a significant problem of old age is dementia and depression, which can hinder the diagnosis and treatment of pain. The aim of this study was to analyse the prevalence of pain in patients treated in a geriatric outpatient clinic and the treatment used. (2) Methods: The analysis was based on the records of 937 patients who visited the Geriatric Outpatient Clinic in Dobre Miasto between 2015 and 2020. Based on records containing data dating back to their first visit to the hospital, patients' experiences of pain, the presence of depressive symptoms and dementia, and the pharmacological treatment used for pain (analgesics and coanalgesics) were analysed. (3) Results: Pain complaints were reported by 311 patients (33.2% of the study group), 76% of the complaints were from females. The mean age of the patients was 78 years (SD = 8.45). At least one analgesic drug was taken by 107 patients (34.4%). The most commonly used analgesics were opioids (63 patients, 58.87%), especially tramadol. Of the potential coanalgesics, the largest number of patients used an antidepressant. (4) Conclusions: Despite the widespread prevalence of pain among the elderly, only about one-third of them were taking pain medication, mainly in the form of weak opioids. Patients with symptoms of dementia were found to report pain less frequently.
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Affiliation(s)
- Krzysztof Rutkowski
- The Nicolaus Copernicus Municipal Polyclinical Hospital in Olsztyn, 10-045 Olsztyn, Poland
| | - Mateusz Wyszatycki
- Marie Sklodowska-Curie Specialist Hospital in Zgierz, 95-100 Zgierz, Poland
| | - Krystian Ejdys
- Students’ Scientific Group, Department of Cardiology, Medical University of Bialystok, 15-089 Białystok, Poland
| | - Natalia Maria Hawryluk
- The Nicolaus Copernicus Municipal Polyclinical Hospital in Olsztyn, 10-045 Olsztyn, Poland
- Department of Family Medicine and Infectious Diseases, Medical Faculty, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Małgorzata Stompór
- Department of Family Medicine and Infectious Diseases, Medical Faculty, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
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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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Puente-Fernández D, Olivencia Peña P, Soto-Felipe C, Montoya-Juárez R, Roldán C, García-Caro MP. Quality of dying among elderly people diagnosed with dementia in nursing homes: A mixed methods study. J Psychiatr Ment Health Nurs 2022; 30:435-450. [PMID: 36066569 DOI: 10.1111/jpm.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Nurses working at nursing homes can play a pivotal role in mental health as a high proportion of residents diagnosed with dementia are in these facilities. Many institutionalized residents diagnosed with dementia develop clinical complications and symptoms that reduce the quality of dying. A mixed-methods approach can help nurses with the difficult task of assessing the quality of dying among these residents and identify inconsistencies that cannot be found using scales alone, but no studies were found in this topic. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Through the Quality of dying in Long-Term Care Scale (QoD-LTC), nurses described symptom management, quality of care, and end-of-life appearance as adequate and end-of-life communication as lacking. Generally speaking, the scores on the scale were consistent with the data from semi-structured interviews conducted with nurses. In the semi-structured interviews, some of the concepts on the scale, including 'dignity', 'holistic' care, 'good relationships with healthcare professionals', and 'a peaceful death', are complex and not fully incorporated into nurses' practice in nursing homes when assessing residents diagnosed with dementia. This could be improved by using the SENSES Model or person-centred care frameworks. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is evidence of shortcomings among professionals in the correct use of concepts linked to psychological wellbeing, communication, therapeutic relationship, safety and participation, preservation of dignity, decision-making, and resident autonomy, which can be addressed using specific theoretical approaches developed in the field of mental health nursing. ABSTRACT Introduction The complex nature of end-of-life assessment of individuals diagnosed with dementia would benefit from a mixed-methods approach that simultaneously assess the perception and response of nurses to standardized tools. Aim/Question To examine nursing professionals' perceptions of the quality of dying among residents diagnosed with dementia using the Quality of Dying in Long-Term Care settings (QoD-LTC) questionnaire and to identify consistencies and inconsistencies in their narratives. Method Mixed-methods study using concurrent triangulation with data integration for results and interpretation. Nurses from eight nursing homes assessed 117 residents diagnosed with dementia who died in the previous 3 months using the QoD-LTC scale. After informed consent was obtained (nurses/caregivers), 17 semi-structured scale-based interviews were conducted. Results Symptom management, quality of care, and end-of-life appearance were found to be adequate, while end-of-life communication was deemed insufficient. The qualitative and quantitative data were consistent for most of the items on the QoD-LTC. Discussion Concepts such as dignity, holistic care, good relationships, and peaceful death are complex and not fully incorporated into professional practice. Implications for Practice The results highlight the need for greater involvement of mental health nurses as well as improved communication, training, and specific tools tailored to residents diagnosed with dementia.
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Affiliation(s)
- Daniel Puente-Fernández
- Programa de doctorado en Medicina clínica y salud Pública, University of Granada, Granada, Spain.,Department of Nursing, University of Jaén, Jaén, Spain
| | | | | | - Rafael Montoya-Juárez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada - IBS Granada, Granada, Spain.,Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
| | - Concepción Roldán
- Department of Statistics and Operational Research, University of Granada, Granada, Spain
| | - María Paz García-Caro
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada - IBS Granada, Granada, Spain.,Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
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Felton N, Lewis JS, Cockburn SJ, Hodgson M, Dawson S. Pain Assessment for Individuals with Advanced Dementia in Care Homes: A Systematic Review. Geriatrics (Basel) 2021; 6:geriatrics6040101. [PMID: 34698157 PMCID: PMC8544573 DOI: 10.3390/geriatrics6040101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Pain is prevalent in older people, especially in those with advanced dementia who have communication impairments. Although pain is recognised to be present in this population, it is often under-assessed and ineffectively managed. The assessment of pain in advanced dementia is extremely challenging and complex, particularly in institutional settings such as care homes. This study systematically reviews the literature to examine and characterise the evidence for the use of pain assessment tools in care homes with individuals living with advanced dementia. Relevant publications were sourced from electronic bibliometric medical databases including AMED, CINAHL Plus, Medline, PsycINFO, EMBASE, TRIP Pro, Google Scholar, and HINARI. The database search was supplemented by screening citations and reference lists, in addition to a grey literature searches. The search identified 2221 studies, among which 26 were included in the review. The majority of the studies were observational, which created a rich source of data to create four major themes. The findings were informed and shaped by working with key stakeholders to develop a conceptual model that can contribute to developing evidence-based practice. This highlights the importance of a comprehensive, multi-disciplinary approach to pain assessment in this population, which is beyond the use of tools.
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Affiliation(s)
- Nansi Felton
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
- Correspondence:
| | - Jennifer S. Lewis
- School for Health and Social Wellbeing, University of the West of England, Bristol BS16 1DD, UK;
- National Complex Regional Pain Syndrome Service, Pain Specialty, Royal United Hospitals NHS Trust, Bath BA1 3NG, UK
| | - Sarah-Jane Cockburn
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
- Doctoral College, Department of Psychology, University of Southampton, Building 44, Highfield Campus, Southampton SO17 1BJ, UK
| | - Margot Hodgson
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; (S.-J.C.); (M.H.)
| | - Shoba Dawson
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK;
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Forrester S, Mbrah A, Lapane KL. A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain. J Pain Res 2021; 14:2283-2293. [PMID: 34345184 PMCID: PMC8324982 DOI: 10.2147/jpr.s302305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pain assessment in people with cognitive impairment is challenging. OBJECTIVE The study sought to 1) identify pain subgroups based on staff-assessed pain, agitated and reactive behavior, functional status, and symptoms of depression; and 2) understand if cognitive impairment was associated with transitions between pain subgroups at nursing home admission, 3 months, and 6 months. METHODS Using national Minimum Data Set 3.0 data (2011-2016), we included 26,816 newly admitted residents with staff-assessed pain at admission, 3 months, and 6 months. Pain subgroups were identified by latent class analysis at each time point. Transitions between pain subgroups were described using latent transition analysis. RESULTS Five latent statuses of pain were identified at admission: "Behavioral and Severe Depression" (prevalence stable, severe or worsening cognitive impairment: 11%, mild/moderate or improved cognitive impairment: 10%), "Functional" (21%; 25%), "Physical" (22%; 23%), "Behavioral" (23%, 19%), and "Low" (23%; 24%). Regardless of change in cognitive status, most residents remained in the same pain latent class. Among residents with stable, severe or worsening cognitive impairment, 11% in the "Behavioral" class transitioned to the "Behavioral and Severe Depression" class by 3 months. Fewer residents transitioned between latent classes in the 3- to 6-month period (>80% remained in their 3-month class). CONCLUSION For nursing home residents unable to self-report pain, consideration of additional indicators including functioning, depressive symptoms, and agitation may be useful in identifying pain subgroups. Longitudinal changes in the pain subgroups over 6 months post-admission highlight that residents with severe cognitive impairment may be at risk for worsening pain.
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Affiliation(s)
- Sarah Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Attah Mbrah
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Piirainen P, Pesonen HM, Kyngäs H, Elo S. Challenging situations and competence of nursing staff in nursing homes for older people with dementia. Int J Older People Nurs 2021; 16:e12384. [PMID: 34075711 DOI: 10.1111/opn.12384] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dementia causes behavioural changes in people that often lead to earlier placement in a nursing home. Staff can find these behavioural changes challenging and require specific competencies to support and care of people living with dementia. However, there is little information regarding the competencies nurses require in dementia care. Thus, the aims of this study were to determine the prevalence of challenging situations in nursing homes of older people with dementia, characterise the nursing staff's responses to such situations and contribute to a model outlining competences that dementia care nurses require. METHODS Data were collected using mixed methods in a cross-sectional survey of views of nursing staff (n = 106) in two nursing homes in Finland during May to June 2018 using a structured questionnaire including open-ended questions. Quantitative data acquired were analysed statistically, and responses to the open-ended question were analysed using content analysis methodology. RESULTS Most nurses (98%) reported that challenging situations occurred daily or weekly. The most common reported forms of challenging behaviour were as follows: wandering, restlessness, constant leaving, repeated inquiries and requests and opposition to treatment (mentioned by 95%, 90%, 85%, 83% and 83% of respondents, respectively). Five key competencies were identified from their responses: practical knowledge, theoretical knowledge, therapeutic use of self, social competence and self-management. They also indicated significant correlations between leadership and both the impact of challenging behaviour on coping at work and use of physical restraints on older people with dementia. CONCLUSION Challenging situations in nursing homes of older people with dementia are very common. There is a need to identify specific competencies for caring for people with dementia in addition to updating official guidelines to handle such situations. The support of supervisors and competencies related to therapeutic use of self in nursing are highly important for nurses providing care for people with dementia.
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Affiliation(s)
- Paula Piirainen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | | | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Satu Elo
- Lapland University of Applied Sciences, Kemi, Finland
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Altered nociception in Alzheimer disease is associated with striatal-enriched protein tyrosine phosphatase signaling. Pain 2021; 162:1669-1680. [PMID: 33433143 DOI: 10.1097/j.pain.0000000000002180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/18/2020] [Indexed: 01/16/2023]
Abstract
ABSTRACT Alzheimer disease (AD) is the most common form of dementia, accounting for approximately 60% of cases. In addition to memory loss, changes in pain sensitivity are found in a substantial proportion of patients with AD. However, the mechanism of nociception deficits in AD is still unclear. Here, we hypothesize that the nociception abnormality in AD is due to the aberrant activation of striatal-enriched protein tyrosine phosphatase (STEP) signaling, which modulates proteins related to nociception transduction. Our results indicated that the transgenic mice carrying human amyloid precursor protein (APP) gene had lower sensitivity to mechanical and thermal stimulation than the wild-type group at the ages of 6, 9, and 12 months. These APP mice exhibited elevated STEP activity and decreased phosphorylation of proteins involved in nociception transduction in hippocampi. The pharmacological inhibition of STEP activity using TC-2153 further reversed nociception and cognitive deficits in the APP mice. Moreover, the phosphorylation of nociception-related proteins in the APP mice was also rescued after STEP inhibitor treatment, indicating the key role of STEP in nociception alteration. In summary, this study identifies a mechanism for the reduced nociceptive sensitivity in an AD mouse model that could serve as a therapeutic target to improve the quality of life for patients with AD.
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Tobis S, Neumann-Podczaska A, Yermukhanova L, Sultanova G, Kurmanalina G, Kimatova K, Dworacka M, Wieczorowska-Tobis K. Pain in People with Advanced Dementia: The Opinions of Kazakh Medical Students. J Pain Res 2020; 13:3307-3314. [PMID: 33324091 PMCID: PMC7732167 DOI: 10.2147/jpr.s276479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The medical students’ attitude toward pain in people with advanced dementia, while constituting an important factor in care, has rarely been assessed to date. The aim of our study was thus to perform such assessment in medical students in Kazakhstan, to enable an improvement of the existing curriculum (like we previously did in Poland). Materials and Methods We analyzed the knowledge about pain using a short anonymous questionnaire, which was completed by 112 students of the Medical University of Aktobe, Kazakhstan. Results On average, students listed symptoms of 1.4 ± 1.2 (out of 6 analyzed) pain areas (median 2.0). The symptoms related to changes in mental status were suggested the most often (57 students: 50.9%). The students who indicated these symptoms also listed a higher number of symptoms from the remaining domains (1,1 ± 1.0 [median 1.0] vs 0.6 ± 0.8 [median 0.0]; p<0.01). Observational methods in the assessment of the severity of pain in people with dementia were indicated by 44 students (39.3%), but only one participant (0.9%) was able to name an observational scale for pain assessment. Correct answers regarding pain treatment rules were presented by 18 students (16.0%), and the answers of the next 47 participants (42.0%) were very general but suggested the same treatment no matter what the cognitive status. Conclusion The study revealed gaps in the knowledge of Kazakh medical students regarding pain in advanced stages of dementia. Demographic changes, combined with the coexistence of pain with dementia, indicate that medical students worldwide must have sufficient knowledge and skills to adequately care for the continually growing number of people with these conditions. It is imperative in countries like Kazakhstan, where the dementia burden was unrecognized until now, but it will blow up in the near future.
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Affiliation(s)
- Slawomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Neumann-Podczaska
- Geriatric Unit, Department and Chair of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Lyudmila Yermukhanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Gulnara Sultanova
- West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Gulnara Kurmanalina
- Department of Internal Medicine, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Kerbez Kimatova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Marzena Dworacka
- Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Wieczorowska-Tobis
- Geriatric Unit, Department and Chair of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Pu L, Moyle W, Jones C, Todorovic M. The Effect of Using PARO for People Living With Dementia and Chronic Pain: A Pilot Randomized Controlled Trial. J Am Med Dir Assoc 2020; 21:1079-1085. [PMID: 32122797 DOI: 10.1016/j.jamda.2020.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the effect of interaction with a robotic seal (PARO) on pain and behavioral and psychological symptoms of people with dementia and chronic pain. DESIGN A parallel pilot randomized controlled trial conducted between January 2018 and January 2019. SETTING Three long-term care facilities in Australia. PARTICIPANTS Forty-three participants aged ≥65 years living with dementia and chronic pain. INTERVENTION Participants were randomized to the PARO group (individual, nonfacilitated, 30-minute sessions, 5 days per week for 6 weeks) or a usual care group using a computer-generated random number. MEASUREMENTS The primary outcome was researcher-rated observational pain behaviors before and after each session. Secondary outcomes were staff-rated pain level, agitation, depression, and anxiety measured at baseline and the end of week 6. Medications regularly prescribed and as needed were recorded weekly. Analyses followed intention-to-treat, using the generalized estimating equation model. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202). RESULTS Participants in the PARO group had a significantly lowered level of observed pain [-0.514, 95% confidence interval (CI) -0.774 to -0.254, P < .001] and used fewer pro re nata medications (-1.175, 95% CI -2.205 to -0.145, P = .025) than those in usual care after controlling for age, sex, cognitive function and medications. There were no significant differences in staff-rated pain, agitation, anxiety, and depression, nor regularly scheduled medications between intervention and control group. CONCLUSIONS AND IMPLICATIONS PARO shows promise in reducing pain and medications for individuals with dementia and chronic pain in long-term care facilities. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Larger randomized controlled trials with longer time frames are needed to identify further and test the use of PARO in long-term care settings.
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Affiliation(s)
- Lihui Pu
- School of Nursing and Midwifery, Nathan Campus, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
| | - Wendy Moyle
- School of Nursing and Midwifery, Nathan Campus, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Michael Todorovic
- School of Nursing and Midwifery, Nathan Campus, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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Puente-Fernández D, Campos-Calderón CP, Esteban-Burgos AA, Hueso-Montoro C, Roldán-López CB, Montoya-Juárez R. Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1465. [PMID: 32106468 PMCID: PMC7084766 DOI: 10.3390/ijerph17051465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 01/17/2023]
Abstract
The aim of this study was to compare the symptomatology, palliative care outcomes, therapeutic procedures, diagnostic tests, and pharmacological treatments for people with dementia (PWD) and without dementia (PW/OD) admitted to Spanish nursing homes. DESIGN This was a cross-sectional study which is part of a long-term prospective follow-up of elderly people performed in nursing homes to measure end-of-life care processes. PARTICIPANTS 107 nursing home patients with advanced or terminal chronic diseases were selected according to the criteria of the Palliative Care Spanish Society. SETTING Two trained nurses from each nursing home were responsible for participant selection and data collection. They must have treated the residents and had a minimum seniority of 6 months in the nursing home. MEASUREMENTS Sociodemographic data; Edmonton Symptom Assessment Scale; Palliative Care Outcome Scale; and prevalence of diagnostic tests, pharmacological treatments, and therapeutic procedures were evaluated. RESULTS Pain, fatigue, and nausea were found to be significantly higher in the nondementia group and insomnia, poor appetite, and drowsiness were significantly higher in the dementia group. Patient anxiety, support, feeling that life was worth living, self-worth, and practical matters management were higher in the nondementia group. Regarding drugs, use of corticoids was higher in the nondementia group, while use of anxiolytics was higher in the dementia group. Diagnostic procedures such as urine analysis and X-ray were higher in the dementia group. CONCLUSIONS Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.
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Affiliation(s)
- Daniel Puente-Fernández
- Doctoral Programme in Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain;
| | | | - Ana Alejandra Esteban-Burgos
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.)
| | - César Hueso-Montoro
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
| | | | - Rafael Montoya-Juárez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (A.A.E.-B.); (C.H.-M.); (R.M.-J.)
- Mind, Brain and Behaviour Research Institute, University of Granada, 18071 Granada, Spain
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Nowak T, Neumann-Podczaska A, Tobis S, Wieczorowska-Tobis K. Characteristics of pharmacological pain treatment in older nursing home residents. J Pain Res 2019; 12:1083-1089. [PMID: 31114294 PMCID: PMC6489860 DOI: 10.2147/jpr.s192587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Pain in older subjects with cognitive impairement is frequently undertreated. Purpose: The aim of the study was to characterize pain treatment among 199 elderly nursing home residents (NHR), aged 65 years and above. Patients and methods: In all studied subjects, cognitive functions were assessed. Based on the results, participants were divided into two groups: group 1 - cognitively intact subjects in whom the pain was evaluated based on Numerical Rating Scale (NRS), and group 2 - subjects with cognitive impairment, in whom Abbey Pain Scale (APS) was used to assess pain. Thereafter, subjects with inappropriately treated pain (ie, ineffectively treated or untreated) were analyzed in detail as group 1a (NRS >0) and group 2a (Abbey >2). Results: The prevalence of pain in group 1 and 2 did not differ (65% and 70% respectively). However, inappropriately treated pain occurred more frequently in group 2 (2a=85% vs 1a=64%; p<0.01). This was related to the more frequent occurrence of untreated pain (52% vs 22%; p<0.001), because the presence of ineffectively treated pain was comparable in both groups (34% vs 42%). Qualitative analysis of pharmacotherapy in subjects with inappropriately treated pain demonstrated that acetaminophen in low dosages was the most frequently consumed drug from the first step of the analgesic ladder (16 individuals), from the second step - a combination of tramadol and acetaminophen (8 individuals), and from the third step - buprenorphine was the only drug applied (6 individuals). Conclusion: Our study showed a high frequency of untreated or ineffectively treated pain in NHR, regardless of the cognitive status of studied subjects. However, these phenomena were particularly frequent in subjects with cognitive impairment. Thus, proper education of the staff is needed to increase their knowledge about both the pain assessment and its treatment.
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Affiliation(s)
- Tomasz Nowak
- Laboratory of Geriatric Medicine, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Slawomir Tobis
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Wieczorowska-Tobis
- Laboratory of Geriatric Medicine, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
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