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Chejor P, Atee M, Cain P, Whiting D, Morris T, Porock D. Pain prevalence, intensity, and association with neuropsychiatric symptoms of dementia in immigrant and non-immigrant aged care residents in Australia. Sci Rep 2024; 14:16948. [PMID: 39043912 PMCID: PMC11266499 DOI: 10.1038/s41598-024-68110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 07/19/2024] [Indexed: 07/25/2024] Open
Abstract
Pain recognition for culturally diverse people is complex as pain experience is subjective and influenced by cultural background. We compared the prevalence, intensity, and association of pain with neuropsychiatric symptoms (NPS) between immigrants and non-immigrants living with dementia in residential aged care homes (RACHs) who were referred to two Dementia Support Australia programs. Immigrant status was defined by the documented country of birth. Pain and NPS were assessed using PainChek® and the Neuropsychiatric Inventory, respectively. Subgroup analyses were also completed for English-speaking and non-English-speaking immigrants. A total of 17,637 referrals [immigrants, n = 6340; non-immigrants, n = 11,297] from 2792 RACHs were included. There were no significant differences for the prevalence of pain across all groups. Immigrants were slightly more likely to have moderate pain or severe pain than non-immigrants. Non-English-speaking immigrants had 0.5 points higher total pain scores on average (Cohen's d = 0.10 [0.05, 0.15], p < 0.001) than non-immigrants. Total pain score had a significant effect on total NPS severity scores in all groups. While pain prevalence is similar across groups, higher pain intensities are more common among immigrants living with dementia. Increased care staff awareness, education, and training about the potential effect of culture on pain expression is needed.
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Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
| | - Mustafa Atee
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
- The Dementia Centre, HammondCare, Osborne Park, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Patricia Cain
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel Whiting
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
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Otaka E, Osawa A, Kato K, Obayashi Y, Uehara S, Kamiya M, Mizuno K, Hashide S, Kondo I. Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study. JMIR Aging 2024; 7:e52443. [PMID: 38623717 PMCID: PMC11034362 DOI: 10.2196/52443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/17/2024] Open
Abstract
Background Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for "happy," "sad," "angry," "surprised," "scared," and "disgusted" were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for "happy" was compared between the different types of robots. Results A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for "happy" was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care.
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Affiliation(s)
- Eri Otaka
- Laboratory of Practical Technology in Community, Assistive Robot Center, National Center for Geriatrics and Gerontology Research Institute, Obu, Aichi, Japan
| | - Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
- Laboratory of Cognitive Rehabilitation and Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology Research Institute, Obu, Aichi, Japan
| | - Kenji Kato
- Laboratory of Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology Research Institute, Obu, Aichi, Japan
| | - Yota Obayashi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan
| | - Masaki Kamiya
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Katsuhiro Mizuno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Shusei Hashide
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Izumi Kondo
- Assistive Robot Center, National Center for Geriatrics and Gerontology Research Institute, Obu, Aichi, Japan
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Patrick KS, Gunstad J, Spitznagel MB. Pain in the Context of Virtual Neuropsychological Assessment of Older Adults. Arch Clin Neuropsychol 2024; 39:157-166. [PMID: 37644879 PMCID: PMC10879923 DOI: 10.1093/arclin/acad064] [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] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results. METHOD The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing. RESULTS Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms. CONCLUSIONS Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.
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Affiliation(s)
- Karlee S Patrick
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Mary B Spitznagel
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Sabater-Gárriz Á, Molina-Mula J, Montoya P, Riquelme I. Pain assessment tools in adults with communication disorders: systematic review and meta-analysis. BMC Neurol 2024; 24:66. [PMID: 38368314 PMCID: PMC10873938 DOI: 10.1186/s12883-024-03539-w] [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: 08/01/2023] [Accepted: 01/15/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. METHODS A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. RESULTS Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. CONCLUSIONS While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. TRIAL REGISTRATION This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .
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Affiliation(s)
- Álvaro Sabater-Gárriz
- Balearic ASPACE Foundation, Marratxí, Spain
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Jesús Molina-Mula
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Pedro Montoya
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain.
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain.
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El-Tallawy SN, Ahmed RS, Nagiub MS. Pain Management in the Most Vulnerable Intellectual Disability: A Review. Pain Ther 2023; 12:939-961. [PMID: 37284926 PMCID: PMC10290021 DOI: 10.1007/s40122-023-00526-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
This review is made up of two parts; the first part discussing intellectual disability (ID) in general, while the second part covers the pain associated with intellectual disability and the challenges and practical tips for the management of pain associated with (ID). Intellectual disability is characterized by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. ID is a disorder with no definite cause but has multiple risk factors, including genetic, medical, and acquired. Vulnerable populations such as individuals with intellectual disability may experience more pain than the general population due to additional comorbidities and secondary conditions, or at least the same frequency of pain as in the general population. Pain in patients with ID remains largely unrecognized and untreated due to barriers to verbal and non-verbal communication. It is important to identify patients at risk to promptly prevent or minimize those risk factors. As pain is multifactorial, thus, a multimodal approach using both pharmacotherapy and non-pharmacological management is often the most beneficial. Parents and caregivers should be oriented to this disorder, given adequate training and education, and be actively involved with the treatment program. Significant work to create new pain assessment tools to improve pain practices for individuals with ID has taken place, including neuroimaging and electrophysiological studies. Recent advances in technology-based interventions such as virtual reality and artificial intelligence are rapidly growing to help give patients with ID promising results to develop pain coping skills with effective reduction of pain and anxiety. Therefore, this narrative review highlights the different aspects regarding the current status of the pain associated with intellectual disability, with more emphasis on the recent pieces of evidence for the assessment and management of pain among populations with intellectual disability.
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Affiliation(s)
- Salah N. El-Tallawy
- King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Anesthesia Department, Faculty of Medicine, Minia University and NCI, Cairo University, Giza, Egypt
| | - Rania S. Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Rissel C, Tate N, Moore L, Hughes J, Campbell N, Smith C, Lew-Fatt A, Ullah S. Assessing pain using facial recognition software among Aboriginal aged care residents with cognitive impairment: A retrospective cohort study. Australas J Ageing 2023. [PMID: 36847297 DOI: 10.1111/ajag.13170] [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: 07/27/2022] [Revised: 11/13/2022] [Accepted: 12/12/2022] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To assess the observed pain behaviours of Aboriginal residents with cognitive impairment in aged care facilities and compare these results with a matched national sample of non-Aboriginal residents. METHODS Observed pain behaviours of Aboriginal residents (N = 87) with cognitive impairment in aged care facilities across the Northern Territory of Australia were assessed using PainChek® Adult and compared with data from a matched national sample of non-Aboriginal residents (N = 420). Pain scores were derived from inbuilt automated facial recognition and analysis software plus a series of digital checklists requiring manual input by care staff. RESULTS The median total pain score for the Aboriginal residents was 2 (IQR 1-4) and for the matched external residents was 3 (IQR 2-5). In a multivariable negative binomial regression model, this difference in total pain score was statistically significant (p < 0.001). The pain score derived from the automated facial recognition and analysis component of the PainChek® Adult app was not statistically different between the two groups when adjusted for multiple observations and context of observation (odds ratio = 1.06, 95% confidence interval 0.97-1.16, p = 0.169). CONCLUSIONS We found under-reporting of observed pain signs and behaviours for Aboriginal aged care residents by assessors. Further training in the assessment of pain in Aboriginal and Torres Strait Islander aged care residents may be necessary and a continuing shift in clinical practice to using technology and point-of-care assessment.
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Affiliation(s)
- Chris Rissel
- Rural and Remote Health Northern Territory, Flinders University, Darwin, Northern Territory, Australia
| | - Nicole Tate
- Australian Regional and Remote Community Services, Darwin, Northern Territory, Australia
| | - Leigh Moore
- Rural and Remote Health Northern Territory, Flinders University, Darwin, Northern Territory, Australia
| | - Jeff Hughes
- PainChek Ltd, Sydney, New South Wales, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Narelle Campbell
- Rural and Remote Health Northern Territory, Flinders University, Darwin, Northern Territory, Australia
| | | | - Anthony Lew-Fatt
- Australian Regional and Remote Community Services, Darwin, Northern Territory, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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ASAD: A Novel Audification Console for Assessment and Communication of Pain and Discomfort. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2022. [DOI: 10.1155/2022/9307316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pain and discomfort are subjective perceptions that are difficult to quantify. Various methods and scales have been developed to find an optimal manner to describe them; however, these are difficult to use with some categories of patients. Audification of pain has been utilized as feedback in rehabilitation settings to enhance motor perception and motor control, but not in assessment and communication settings. We present a novel tool, the Audification-console for Self-Assessment of Discomfort (ASAD), for assessing and communicating pain and discomfort through sound. The console is a sequence of increasing pitch and frequencies triggered at the press of buttons and displayed as a matrix that can be associated with the subjective perception of pain and discomfort. The ASAD has been evaluated in its ability to capture and communicate discomfort, following a fatigue test in the lower limbs with thirty healthy volunteers, and compared to the most common self-reported methods used in the NHS. (The National Health Service (NHS) is the publicly funded healthcare system in England and one of the four National Health Service systems in the United Kingdom.) This was a qualitative, within subjects and across groups experiment study. The console provides a more accurate assessment than other scales and clearly recognizable patterns of sounds, indicating increased discomfort, significantly localized in specific frequency ranges, thus easily recognizable across subjects and in different instances of the same subject. The results suggest a possible use of the ASAD for a more precise and automatic assessment of pain and discomfort in health settings. Future studies might assess if this is easier to use for patients with communication or interpretation difficulties with the traditional tools.
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Saunders R, Crookes K, Seaman K, Ang SGM, Bulsara C, Bulsara MK, Ewens B, Gallagher O, Graham RM, Gullick K, Haydon S, Hughes J, Atee M, Nguyen KH, O'Connell B, Scaini D, Etherton-Beer C. Effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults: protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e059388. [PMID: 35725261 PMCID: PMC9214388 DOI: 10.1136/bmjopen-2021-059388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. METHODS AND ANALYSIS This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. ETHICS AND DISSEMINATION Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER ACTRN12620001173987.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Seng Giap Marcus Ang
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Renee M Graham
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karen Gullick
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Clinical Services, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Sue Haydon
- Clinical Services, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Jeff Hughes
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- PainChek, Sydney, New South Wales, Australia
| | - Mustafa Atee
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- The Dementia Centre, HammondCare, Wembley, Western Australia, Australia
| | - Kim-Huong Nguyen
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bev O'Connell
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Debra Scaini
- Clinical Services, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Atee M, Hoti K, Chivers P, Hughes JD. Faces of Pain in Dementia: Learnings From a Real-World Study Using a Technology-Enabled Pain Assessment Tool. FRONTIERS IN PAIN RESEARCH 2022; 3:827551. [PMID: 35295796 PMCID: PMC8915628 DOI: 10.3389/fpain.2022.827551] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is common in people living with dementia (PLWD), including those with limited verbal skills. Facial expressions are key behavioral indicators of the pain experience in this group. However, there is a lack of real-world studies to report the prevalence and associations of pain-relevant facial micro-expressions in PLWD. In this observational retrospective study, pain-related facial features were studied in a sample of 3,144 PLWD [mean age 83.3 years (SD = 9.0); 59.0% female] using the Face domain of PainChek®, a point-of-care medical device application. Pain assessments were completed by 389 users from two national dementia-specific care programs and 34 Australian aged care homes. Our analysis focused on the frequency, distribution, and associations of facial action units [AU(s)] with respect to various pain intensity groups. A total of 22,194 pain assessments were completed. Of the AUs present, AU7 (eyelid tightening) was the most frequent facial expression (48.6%) detected, followed by AU43 (closing eyes; 42.9%) and AU6 (cheek raising; 42.1%) during severe pain. AU20 (horizontal mouth stretch) was the most predictive facial action of higher pain scores. Eye-related AUs (AU6, AU7, AU43) and brow-related AUs (AU4) were more common than mouth-related AUs (e.g., AU20, AU25) during higher pain intensities. No significant effect was found for age or gender. These findings offer further understanding of facial expressions during clinical pain in PLWD and confirm the usefulness of artificial intelligence (AI)-enabled real-time analysis of the face as part of the assessment of pain in aged care clinical practice.
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Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Osborne Park, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Kreshnik Hoti
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Jeffery D. Hughes
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- *Correspondence: Jeffery D. Hughes
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Chen LY, Tsai TH, Ho A, Li CH, Ke LJ, Peng LN, Lin MH, Hsiao FY, Chen LK. Predicting neuropsychiatric symptoms of persons with dementia in a day care center using a facial expression recognition system. Aging (Albany NY) 2022; 14:1280-1291. [PMID: 35113806 PMCID: PMC8876896 DOI: 10.18632/aging.203869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
Background: Behavioral and psychological symptoms of dementia (BPSD) affect 90% of persons with dementia (PwD), resulting in various adverse outcomes and aggravating care burdens among their caretakers. This study aimed to explore the potential of artificial intelligence-based facial expression recognition systems (FERS) in predicting BPSDs among PwD. Methods: A hybrid of human labeling and a preconstructed deep learning model was used to differentiate basic facial expressions of individuals to predict the results of Neuropsychiatric Inventory (NPI) assessments by stepwise linear regression (LR), random forest (RF) with importance ranking, and ensemble method (EM) of equal importance, while the accuracy was determined by mean absolute error (MAE) and root-mean-square error (RMSE) methods. Results: Twenty-three PwD from an adult day care center were enrolled with ≥ 11,500 FERS data series and 38 comparative NPI scores. The overall accuracy was 86% on facial expression recognition. Negative facial expressions and variance in emotional switches were important features of BPSDs. A strong positive correlation was identified in each model (EM: r = 0.834, LR: r = 0.821, RF: r = 0.798 by the patientwise method; EM: r = 0.891, LR: r = 0.870, RF: r = 0.886 by the MinimPy method), and EM exhibited the lowest MAE and RMSE. Conclusions: FERS successfully predicted the BPSD of PwD by negative emotions and the variance in emotional switches. This finding enables early detection and management of BPSDs, thus improving the quality of dementia care.
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Affiliation(s)
- Liang-Yu Chen
- Aging and Health Research Center, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan.,uAge Day Care Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Andy Ho
- Value Lab, Acer Incorporated, New Taipei City, Taiwan
| | - Chun-Hsien Li
- Value Lab, Acer Incorporated, New Taipei City, Taiwan
| | - Li-Ju Ke
- uAge Day Care Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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11
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Automatic Coding of Facial Expressions of Pain: Are We There Yet? Pain Res Manag 2022; 2022:6635496. [PMID: 35069957 PMCID: PMC8767386 DOI: 10.1155/2022/6635496] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 09/11/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022]
Abstract
Introduction The experience of pain is regularly accompanied by facial expressions. The gold standard for analyzing these facial expressions is the Facial Action Coding System (FACS), which provides so-called action units (AUs) as parametrical indicators of facial muscular activity. Particular combinations of AUs have appeared to be pain-indicative. The manual coding of AUs is, however, too time- and labor-intensive in clinical practice. New developments in automatic facial expression analysis have promised to enable automatic detection of AUs, which might be used for pain detection. Objective Our aim is to compare manual with automatic AU coding of facial expressions of pain. Methods FaceReader7 was used for automatic AU detection. We compared the performance of FaceReader7 using videos of 40 participants (20 younger with a mean age of 25.7 years and 20 older with a mean age of 52.1 years) undergoing experimentally induced heat pain to manually coded AUs as gold standard labeling. Percentages of correctly and falsely classified AUs were calculated, and we computed as indicators of congruency, “sensitivity/recall,” “precision,” and “overall agreement (F1).” Results The automatic coding of AUs only showed poor to moderate outcomes regarding sensitivity/recall, precision, and F1. The congruency was better for younger compared to older faces and was better for pain-indicative AUs compared to other AUs. Conclusion At the moment, automatic analyses of genuine facial expressions of pain may qualify at best as semiautomatic systems, which require further validation by human observers before they can be used to validly assess facial expressions of pain.
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12
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David L, Popa SL, Barsan M, Muresan L, Ismaiel A, Popa LC, Perju-Dumbrava L, Stanculete MF, Dumitrascu DL. Nursing procedures for advanced dementia: Traditional techniques versus autonomous robotic applications (Review). Exp Ther Med 2022; 23:124. [PMID: 34970347 PMCID: PMC8713171 DOI: 10.3892/etm.2021.11047] [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: 08/25/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to perform a comparative analysis of traditional nursing techniques and autonomous robotic applications used for managing patients with advanced stages of dementia. PubMed, Cochrane Library, EMBASE, and WILEY databases were searched for relevant articles concerning nursing techniques applied in the treatment of patients with advanced dementia. The search terms included: (advanced dementia OR severe dementia) AND [artificial intelligence (AI) OR robotic OR robots OR neural networks OR deep learning OR automated procedures OR autonomous application]. This search identified a total of 2,679 articles and 298 articles were selected. Finally, 23 articles were included in this systematic review, out of which 8 studies analyzed traditional nursing techniques and 15 studies analyzed autonomous robotic applications. Significant evidence was revealed, demonstrating that autonomous robotic applications used for patients with advanced stages of dementia are a feasible, cost-efficient solution and represent an excellent benefit for patients and the healthcare system.
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Affiliation(s)
- Liliana David
- Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400000, Romania
| | - Stefan L Popa
- Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400000, Romania
| | - Maria Barsan
- Department of Occupational Health, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400000, Romania
| | - Lucian Muresan
- Department of Cardiology, 'Emile Muller' Hospital, Mulhouse, 68200 Mulhouse, France
| | - Abdulrahman Ismaiel
- Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400000, Romania
| | - Luminita C Popa
- Department of Neurosciences, Discipline of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
| | - Lacramioara Perju-Dumbrava
- Department of Neurosciences, Discipline of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
| | - Mihaela Fadgyas Stanculete
- Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
| | - Dan L Dumitrascu
- Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400000, Romania
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13
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Tzeng HM, Knight G. Could negative behaviors by patients with dementia be positive communication? Seeking ways to understand and interpret their nonverbal communication. Nurs Forum 2021; 57:318-322. [PMID: 34812493 PMCID: PMC9299486 DOI: 10.1111/nuf.12674] [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: 08/12/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
In interactions with caregivers, patients with dementia have communication challenges that are common and worrisome to families. Family and professional caregivers find it challenging to “guess” or “interpret” what their patients with dementia are trying to tell them. In this creative controversy article, we discuss how family and professional caregivers can seek to understand and correctly interpret the nonverbal communications of patients with dementia (behaviors, actions, facial expressions, and vocal sounds). Equipping family and professional caregivers with the resources to interpret the nonverbal communications of patients with dementia requires a commitment to in‐service and family education in healthcare facilities. Nurses could play a critical role in raising the awareness among the public about the potential changes and declines in verbal communications of the patients with dementia.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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14
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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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15
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Atee M, Morris T, Macfarlane S, Cunningham C. Pain in Dementia: Prevalence and Association With Neuropsychiatric Behaviors. J Pain Symptom Manage 2021; 61:1215-1226. [PMID: 33068708 DOI: 10.1016/j.jpainsymman.2020.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT Pain is linked to behaviors and psychological symptoms of dementia (BPSD); however, it often remains underrecognized in this population. OBJECTIVES We aimed to investigate the prevalence and intensity of pain in people living in aged care homes with BPSD and by dementia subtypes and the association between pain intensity and BPSD. METHODS A 1-year retrospective cross-sectional analysis was conducted on BPSD and the presence of pain in referrals to a national BPSD support service using the Neuropsychiatric Inventory and PainChek®, respectively. Referrals were categorized into two groups: pain group and no pain group. RESULTS Of the 479 referrals (81.9 ± 8.3 years old) included in the analysis, two-thirds (65.6%) had pain identified, with almost half (48.4%) of these categorized as experiencing moderate-severe pain. Pain was highly prevalent (range: 54.6-78.6%) in all subtypes of dementia, particularly in mixed dementia and dementia with Lewy bodies. Compared with the no pain group, the pain group had 25.3% more neuropsychiatric behaviors, 33.6% higher total severity of these behaviors, and 31.4% higher total distress caused to caregivers. For all results, effect sizes were small to medium (η²p = 0.04-0.06). Despite a high prevalence of aggressive or agitated behaviors across the entire group, the pain group was 3.8 times more likely to experience these behaviors than referrals not in pain. CONCLUSION There is a strong need to consider the possibility of pain as a contributor to behavioral changes in aged care residents living with dementia.
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Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Wembley, Western Australia, Australia; Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia.
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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16
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Saunders R, Crookes K, Atee M, Bulsara C, Bulsara MK, Etherton-Beer C, Ewens B, Gallagher O, Graham RM, Gullick K, Haydon S, Nguyen KH, O'Connell B, Seaman K, Hughes J. Prevalence of frailty and pain in hospitalised adult patients in an acute hospital: a protocol for a point prevalence observational study. BMJ Open 2021; 11:e046138. [PMID: 33757956 PMCID: PMC7993156 DOI: 10.1136/bmjopen-2020-046138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. METHODS AND ANALYSIS A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. ETHICS AND DISSEMINATION Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020-02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER ACTRN12620000904976.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mustafa Atee
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- The Dementia Centre, St Leonards, New South Wales, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- WA Centre for Health & Ageing, University of Western Australia, Crawley, Western Australia, Australia
| | - Beverley Ewens
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Renee M Graham
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karen Gullick
- Clinical Services, Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Sue Haydon
- Clinical Services, Hollywood Private Hospital, Nedlands 6009, Western Australia, Australia
| | - Kim-Huong Nguyen
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Bev O'Connell
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Jeff Hughes
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- PainChek Ltd, Bentley, Western Australia, Australia
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17
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Atee M, Morris T, Macfarlane S, Hughes JD, Cunningham C. Commentary on Pain Behaviors in Dementia: Letter to the Editor with Reference to the Article by Morrison et al. (2020). Dement Geriatr Cogn Dis Extra 2021; 11:16-18. [PMID: 33790935 PMCID: PMC7989828 DOI: 10.1159/000513881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Wembley, Washington, Australia.,School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Washington, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St. Leonards, New South Wales, Australia
| | - Stephen Macfarlane
- The Dementia Centre, HammondCare, St. Leonards, New South Wales, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jeffery D Hughes
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Washington, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St. Leonards, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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18
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Harmon J, Pitt V, Summons P, Inder KJ. Use of artificial intelligence and virtual reality within clinical simulation for nursing pain education: A scoping review. NURSE EDUCATION TODAY 2021; 97:104700. [PMID: 33341064 DOI: 10.1016/j.nedt.2020.104700] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/02/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses. DESIGN A scoping review of published and unpublished research from 2009 to 2019. DATA SOURCES Nine electronic databases and hand-searching of reference lists. REVIEW METHODS Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis. RESULTS The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement. CONCLUSION Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.
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Affiliation(s)
- Joanne Harmon
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, 101 Currie street, Adelaide, SA 5001, Australia.
| | - Victoria Pitt
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Peter Summons
- School of Electrical Engineering and Computing, Faculty of Engineering and Built Environment, The University of Newcastle, NSW, Australia.
| | - Kerry J Inder
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, Australia.
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19
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Morrison RA, Jesdale BM, Dubé CE, Nunes AP, Bova CA, Liu SH, Lapane KL. Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment. Dement Geriatr Cogn Disord 2020; 49:243-251. [PMID: 32610321 PMCID: PMC7704920 DOI: 10.1159/000508096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment. METHODS The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010-2016, n = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs. RESULTS Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93-0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85-0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment. CONCLUSIONS The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners' perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.
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Affiliation(s)
- Reynolds A Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carol A Bova
- School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA,
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20
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Ferrer RA, Ellis EM. Moving beyond categorization to understand affective influences on real world health decisions. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019; 13. [PMID: 33912229 DOI: 10.1111/spc3.12502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This paper provides an overview of affect and health decision-making research, with a focus on identifying gaps, opportunities, and challenges to guide future research. We begin by defining common categorical distinctions of affective processes that influence health decisions: integral (i.e., related to the decision) and incidental (i.e., normatively unrelated to the decision) influences, and current (experienced in the moment) and anticipated ("cognitive representations" of future affect) affect. We then summarize key discoveries within the most common categories of affective influences on health decision making: current integral affect, current incidental affect, and anticipated integral affect. Finally, we highlight research gaps, challenges, and opportunities for future directions for research aimed at translating affective and decision science theory to improve our understanding of, and ability to intervene upon, health decision making.
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Affiliation(s)
- Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, National Cancer Institute
| | - Erin M Ellis
- Office of Disease Prevention, National Institutes of Health
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21
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Kuramoto E, Yoshinaga S, Nakao H, Nemoto S, Ishida Y. Characteristics of facial muscle activity during voluntary facial expressions: Imaging analysis of facial expressions based on myogenic potential data. Neuropsychopharmacol Rep 2019; 39:183-193. [PMID: 31136686 PMCID: PMC7292300 DOI: 10.1002/npr2.12059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Facial expressions are formed by the coordination of facial muscles and reflect changes in emotion. Nurses observe facial expressions as way of understanding patients. This study conducted basic research using facial myogenic potential topography to visually determine changes in the location and strength of facial muscle activity associated with voluntary facial expression to examine relationships with facial expressions. METHODS Participants comprised 18 healthy adults (6 men, 12 women; mean age, 24.3 ± 4.3 years). Facial myogenic potentials were measured from 19 electrodes arranged concentrically on the face, and topographic analysis was conducted. Using potential changes and topograms, the muscle activity associated with nonvoluntary facial expression and voluntary facial expressions of happiness and disgust were classified according to the characteristics of expressions. To classify homogeneous groups among the reaction of disgust, hierarchical cluster analysis was utilized. RESULTS One characteristic of the facial expression of happiness was activity in areas including the greater zygomatic muscle. With the facial expression of disgust, characteristic changes were seen in areas including the corrugator supercilii. Cluster analysis of the expression of disgust showed four homogeneous subgroups. CONCLUSION With facial myogenic potential topography, facial expressions can be evaluated objectively without being influenced by face shape or countenance. Color changes in topograms showed subtle changes in expressions that could not be supplemented with statistical processing alone, and these were useful in identifying individuality. Topography is thus expected to be utilized to supplement basic knowledge of facial expressions for a better understanding of patients.
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Affiliation(s)
- Eriko Kuramoto
- Faculty of NursingMiyazaki Prefectural Nursing UniversityMiyazaki CityJapan
- Department of Psychiatry, Faculty of MedicineUniversity of MiyazakiMiyazaki CityJapan
| | - Saori Yoshinaga
- School of Nursing, Faculty of MedicineUniversity of MiyazakiMiyazaki CityJapan
| | - Hiroyuki Nakao
- Faculty of NursingMiyazaki Prefectural Nursing UniversityMiyazaki CityJapan
| | | | - Yasushi Ishida
- Department of Psychiatry, Faculty of MedicineUniversity of MiyazakiMiyazaki CityJapan
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22
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Abstract
PURPOSE OF REVIEW Chronic noncancer pain is an increasing problem in elderly because of rising life expectancy together with an increase of potentially painful medical conditions. Concomitantly, adequate treatment of elderly is often limited by coexisting diseases and polypharmacy.This review summarizes the most important specifics presented by elderly patients and discusses the pharmacological and nonpharmacological options of pain management. RECENT FINDINGS A comprehensive pain assessment is a prerequisite for effective pain management. However, this can be a major challenge in patients who are unable to communicate adequately, that is, in patients with dementia. A recently developed electronic tool assessing automated facial expression and clinical behavioral indicators may help to solve this problem. The discussion about benefits and harms of opioids in elderly goes on. Although some authors underline the lack of efficacy together with the potential problems, such as, abuse, others report a beneficial effect in terms of pain relief, functional activities and disability. In addition, opioids have become an important treatment option in patients with restless legs syndrome. Various topical treatment options (i.e. capsaicin patch) and nonpharmacological interventions have been proven to be beneficial in elderly. SUMMARY Adequate pain management of elderly patients constitutes numerous pharmacological options including nonopioids, opioids, coanalgesics and topical agents. Due to age-related characteristics, all systemic analgesics have to be given very cautiously ('start low, go slow'). Whenever possible, treatment should be performed as a multimodal approach based on the biopsychosocial model of chronic pain.
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