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Centmayer R, Leiske M, Lahmann NA. Pain Prevalence and Pain Management in Nursing Home Residents With Cognitive Impairment. Results From Five Multicenter Cross-Sectional Surveys in Germany Between 2014 and 2018. Pain Manag Nurs 2024; 25:487-493. [PMID: 38853041 DOI: 10.1016/j.pmn.2024.05.005] [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: 08/03/2023] [Revised: 04/16/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Pain management depends on continuous pain assessment and a pain concept. In particular, pain assessment and treatment are major challenges for nursing home residents (NHR) with cognitive impairment (CI). Many caregivers often lack the knowledge to recognize and appropriately treat pain in this vulnerable group. Little is known about the proportion of NHR who are fundamentally dependent on external assessment for pain due to CI. OBJECTIVE The aim of the study was to determine pain prevalence and management among NHR with and without CI. A second objective was to determine the proportion of NHR who are dependent on external assessment for pain. METHODS Information on pain was collected from 3,437 NHR in multicenter cross-sectional surveys in 51 German nursing homes between 2014 and 2018. The presence of current pain in one-to-one interviews was determined as well as dependencies on third-party information, number of daily pain recordings, and administration of medication for pain. The analysis included a contingency table and log regression analyses. RESULTS Pain prevalence was 24.9% among NHR with severe CI and 40.4% among NHR without CI. Overall, 19.8% of all NHRs relied on a third-party assessment of pain. Significantly, NHR with severe CI were less likely to be classified as having pain (OR 0.51), to be assessed for pain several times a day (OR 0.53) or to receive pain medication (OR 0.55) compared with NHR without CI. No influence on pain management was shown for the type of pain assessment. CONCLUSIONS The study provides evidence of significant deficits in pain management among NHR with moderate and severe CI in nursing homes in Germany. NHR with moderate and severe CI are significantly less likely to be observed for pain or classified as pain sufferers and receive significantly less pain medication than NHR without CI. Intensive training of staff on pain management of NHR with severe CI is recommended.
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Affiliation(s)
- Rainer Centmayer
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Manfred Leiske
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Axel Lahmann
- Department of Geriatrics, Nursing Research Group in Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Surr C, Ashley L. End of life care for people with dementia and comorbid cancer: recent studies and research gaps. Curr Opin Psychiatry 2024; 37:376-380. [PMID: 38841908 DOI: 10.1097/yco.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW This narrative review examines recent research on end of life (EOL) care for people with dementia and comorbid cancer, highlighting the complexity and challenge of providing effective EOL care for this group and areas of interest for future research. RECENT FINDINGS People with cancer and dementia and their family/supporters have more complex care and support needs at EOL that are less well met than those of older adults with cancer alone, including questionable use of aggressive EOL care interventions, poorer access to specialist palliative care teams and poor pain management. Those diagnosed with dementia at the same time as, or after their cancer diagnosis, are at greater risk of aggressive EOL care and EOL cancer treatment and care plans that are not able to meet their care needs as dementia progresses. SUMMARY There is a lack of research on EOL care for people with cancer and dementia. There is little understanding of what good care for this population looks like and if and how EOL care can best meet the needs of people with cancer and dementia or their carers/supporters. More research is needed to inform improved care for this population.
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Affiliation(s)
- Claire Surr
- Centre for Dementia Research, School of Health
| | - Laura Ashley
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
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Strong C, Burns SP, Arewasikporn A, Suri P, Hawkins EJ, Leipertz S, Haselkorn J, Turner AP. Chronic opioid prescription in veterans with spinal cord injury: Prevalence and associated factors. J Spinal Cord Med 2024:1-11. [PMID: 39051861 DOI: 10.1080/10790268.2024.2378556] [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] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Chronic opioid use presents long-term health risks for individuals with spinal cord injury (SCI). The purpose of the study was to characterize patterns and correlates of the chronic prescription of opioids among individuals with SCI in a population of Veterans receiving care though the Veteran's Health Administration. DESIGN A retrospective, longitudinal cohort study examined the US Department of Veterans Affairs electronic medical record data of veterans with SCI. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015-2017). Multivariable models examined associations with demographics and pre-existing medical comorbidities. SETTING US Department of Veterans Affairs, Veteran's Health Administration. PARTICIPANTS National sample of Veterans with SCI (N = 10,811). MAIN OUTCOME MEASURE Chronic prescription opioid use (≥90 days). RESULTS All types of prescription opioid use declined across the three study years (chronic opioid use prevalence = 33.2%, 31.7%, and 29.7%, respectively). Past history of depression, COPD, diabetes, pain condition, opioid use and tobacco use disorders were associated with a greater likelihood of current chronic prescription opioid use. Non-white race, hyperlipidemia, dementia, and tetraplegia were associated with a lower likelihood of current chronic prescription opioid use. When added to the multivariable model, prior chronic opioid prescription use was robustly associated with current chronic prescription opioid use, but most other factors were no longer significantly associated with current opioid use. CONCLUSIONS This study demonstrates opioid reduction over time from 2015 to 2017, however, chronic prescription opioid use remains common among a substantial minority of Veterans with SCI. Several demographics and comorbidities may provide clinicians with important insights into factors associated with chronic prescription opioid use, with past chronic prescription opioid use being the most important.
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Affiliation(s)
- Cameron Strong
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen P Burns
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Anne Arewasikporn
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pradeep Suri
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USA
| | - Eric J Hawkins
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Center of Excellence in Substance Addiction Treatment and Education, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Steve Leipertz
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Jodie Haselkorn
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Rambachan A, Neilands TB, Karliner L, Covinsky K, Fang M, Nguyen T. Pain management inequities by demographic and geriatric-related variables in older adult inpatients. J Am Geriatr Soc 2024. [PMID: 38997213 DOI: 10.1111/jgs.19076] [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: 11/06/2023] [Revised: 04/26/2024] [Accepted: 06/12/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric-related variables. METHODS This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric-related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end-of-life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME). RESULTS A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70-0.80), Latinx (OR 0.90, 95% CI 0.83-0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64-0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66-0.74) had lower odds of a numeric assessment, compared with English-speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end-of-life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77-96), Asian patients (55 MME, 95% CI 46-65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids. CONCLUSION Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.
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Affiliation(s)
- Aksharananda Rambachan
- Division of Hospital Medicine, Department of Medicine, UCSF, San Francisco, California, USA
- Center for Aging in Diverse Communities, Department of Medicine, UCSF, San Francisco, California, USA
| | - Torsten B Neilands
- Center for Aging in Diverse Communities, Department of Medicine, UCSF, San Francisco, California, USA
- Division of Prevention Science, Department of Medicine, UCSF, San Francisco, California, USA
| | - Leah Karliner
- Center for Aging in Diverse Communities, Department of Medicine, UCSF, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA
| | - Kenneth Covinsky
- Division of Geriatrics, Department of Medicine, UCSF, San Francisco, California, USA
- Pepper Center, Department of Medicine, UCSF, San Francisco, California, USA
| | - Margaret Fang
- Division of Hospital Medicine, Department of Medicine, UCSF, San Francisco, California, USA
| | - Tung Nguyen
- Center for Aging in Diverse Communities, Department of Medicine, UCSF, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA
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Resnick B, McPherson R, Galik E. Pilot testing implementation of the pain management clinical practice guideline in nursing homes. Geriatr Nurs 2024; 56:18-24. [PMID: 38183965 PMCID: PMC11110890 DOI: 10.1016/j.gerinurse.2023.12.012] [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: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/08/2024]
Abstract
Pain is a common symptom for older adults living with dementia in nursing homes. Unfortunately, there are many challenges to pain assessment, diagnosis and management for these individuals. The purpose of this study was to pilot test the implementation of the newly published Pain Management Clinical Practice Guideline from AMDA: The Society of Post Acute and Long-Term Care using our theoretically based Pain-CPG-EIT approach. Implementation was provided by a research nurse facilitator and included four components: Component I: Establishing and working with a stakeholder team monthly; Component II: Education of the staff; Component III: Mentoring and motivating the staff; and Component IV: Ongoing monitoring of pain assessment, diagnosis and management for residents. Findings provide some preliminary support for the feasibility and effectiveness of our implementation approach.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA.
| | - Rachel McPherson
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
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Yang Q, Yi R, Wang N, Zhang P. Perception, behavior and experience of nursing assistants towards pain of older adults with dementia: A qualitative study. Geriatr Nurs 2024; 56:100-107. [PMID: 38340431 DOI: 10.1016/j.gerinurse.2024.02.013] [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: 11/10/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Nursing assistants are strategically positioned to detect and interpret behavioral alterations indicative of pain in residents suffering from dementia. Despite this, extant literature is scarce regarding their experiences in administering pain care to this demographic. Utilizing a phenomenological approach, this study engaged 17 nursing assistants selected via purposive sampling for semi-structured interviews. Data analysed by the Colaizzi 7-step method. Four emergent themes were discerned: perception of pain; strategies for coping with pain; emotional and psychological responses to pain-related caregiving; challenges and needs in pain-related caregiving. Nursing assistants play a unique and crucial role in the identification of pain, reporting and providing feedback to healthcare professionals, and implementing non-pharmacological interventions. However, these roles have not been fully utilized. Enhancements in pain management could be facilitated by decreasing staff turnover, augmenting educational and training programs, and incorporating empathy-focused situational training. The provision of mental health services is also recommended to ameliorate caregiving-induced stress.
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Affiliation(s)
- Qing Yang
- School of Nursing, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou 510515, China
| | - Ruxue Yi
- School of Nursing, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou 510515, China
| | - Nana Wang
- Department of Nursing, Guangzhou Elderly Care Center, No. 1288 Guangcongshi Road, Baiyun District, Guangzhou 510550, China
| | - Ping Zhang
- School of Nursing, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou 510515, China.
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Pu L, Coppieters MW, Smalbrugge M, Jones C, Byrnes J, Todorovic M, Moyle W. Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study. Pain Manag Nurs 2023; 24:587-594. [PMID: 37105837 DOI: 10.1016/j.pmn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Pain is a common problem but often undiagnosed and untreated in people with dementia. AIMS This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia. DESIGN A qualitative study. SETTINGS/PARTICIPANTS Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility. METHOD Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis. RESULTS Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care. CONCLUSIONS Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.
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Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Martin Smalbrugge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Turner AP, Arewasikporn A, Hawkins EJ, Suri P, Burns SP, Leipertz SL, Haselkorn JK. Risk Factors for Chronic Prescription Opioid Use in Multiple Sclerosis. Arch Phys Med Rehabil 2023; 104:1850-1856. [PMID: 37137460 DOI: 10.1016/j.apmr.2023.04.012] [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: 06/13/2022] [Revised: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To characterize patterns of prescription opioid use among individuals with multiple sclerosis (MS) and identify risk factors associated with chronic use. DESIGN Retrospective longitudinal cohort study examining US Department of Veterans Affairs electronic medical record data of Veterans with MS. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015-2017). Multivariable logistic regression was used to identify demographics and medical, mental health, and substance use comorbidities in 2015-2016 associated with chronic prescription opioid use in 2017. SETTING US Department of Veterans Affairs, Veteran's Health Administration. PARTICIPANTS National sample of Veterans with MS (N=14,974). MAIN OUTCOME MEASURE Chronic prescription opioid use (≥90 days). RESULTS All types of prescription opioid use declined across the 3 study years (chronic opioid use prevalence=14.6%, 14.0%, and 12.2%, respectively). In multivariable logistic regression, prior chronic opioid use, history of pain condition, paraplegia or hemiplegia, post-traumatic stress disorder, and rural residence were associated with greater risk of chronic prescription opioid use. History of dementia and psychotic disorder were both associated with lower risk of chronic prescription opioid use. CONCLUSION Despite reductions over time, chronic prescription opioid use remains common among a substantial minority of Veterans with MS and is associated with multiple biopsychosocial factors that are important for understanding risk for long-term use.
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Affiliation(s)
- Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA MS Center of Excellence West, Seattle, WA; Center of Excellence in Substance Addiction Treatment and Education, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | | | - Eric J Hawkins
- VA Puget Sound Health Care System, Seattle, WA; Center of Excellence in Substance Addiction Treatment and Education, Seattle, WA; Health Services Research & Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Pradeep Suri
- VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Clinical Learning, Evidence, and Research Center (CLEAR), University of Washington, Seattle, WA
| | - Stephen P Burns
- VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Steve L Leipertz
- VA Puget Sound Health Care System, Seattle, WA; VA MS Center of Excellence West, Seattle, WA
| | - Jodie K Haselkorn
- VA Puget Sound Health Care System, Seattle, WA; VA MS Center of Excellence West, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Schmidt L, Zabelberg S, Schlatter S, Adams I, Douplat M, Perchet C, Lilot M, Rey AE, Mazza S. The impact of shift work on pain recognition, a robust ability among intensive care nurses. Eur J Pain 2023; 27:1203-1215. [PMID: 37434490 DOI: 10.1002/ejp.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Pain empathy is essential for high-quality of care. The cognitive ability to identify and understand the pain in others remains underexplored in the context of hospital shift work. This study aimed to observe the early subliminal ability to detect pain in other faces and to investigate pain intensity evaluations during day and night shifts. METHODS Twenty-one nurses (31 ± 7 years, 20 women) from cardio-paediatric intensive care participated in this study. Eighteen nurses completed all testing in the morning and evening hours, before and after the 12-hour day and night shift. In the first test, the nurses had to decide if facial stimuli presented subliminally showed pain or not. During the second test, they consciously determined the intensity of the painful faces on a numerical scale. Sleep, sleepiness and empathy were also measured. RESULTS Recognition accuracy and pain sensitivity remained stable over time, only sensitivity increased following the work shift (F(1,15) = 7.10, p = 0.018). Intensity ratings remained stable. Sleepiness at the end of the night shift was negatively correlated with accuracy (ρ = -0.51, p = 0.018) and positively correlated with prior night shifts (ρ = -0.50, p = 0.022). CONCLUSION The judgement of facial pain expressions seems robust across shift types, only individual factors such as sleepiness interfere with pain recognition. Pain sensitivity may be enhanced during working hours. SIGNIFICANCE STATEMENT Some professions need to know how to assess pain 24/7 and a lack of sleep can disrupt the cognitive processes necessary for this assessment. Night shifts provoke a bias in pain management, and sleep deprivation, a decrease in pain evaluation. By conducting a repeated measure study in the field that applied a different paradigm (subliminal recognition of facial cues) we add evidence to the understanding of pain recognition and the impact of sleep deprivation on the early processing of pain in others.
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Affiliation(s)
- Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
| | | | - Sophie Schlatter
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
| | - Inga Adams
- Universität zu Köln, Psychologie, Cologne, Germany
| | - Marion Douplat
- Hospices Civils de Lyon, Département des Urgences, Hôpital Lyon Sud, Lyon, France
| | - Caroline Perchet
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Hôpital Louis Pradel, Groupement Hospitalier Est, Lyon, France
| | - Amandine Eve Rey
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Stéphanie Mazza
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
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Warner NS, Tung EE, DeMartino ES, Kissoon NR. Ethics of neuromodulation in adults with cognitive impairment and chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S3-S5. [PMID: 37833043 PMCID: PMC10575752 DOI: 10.1093/pm/pnad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Nafisseh S Warner
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Ericka E Tung
- Department of Community Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Erin S DeMartino
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Narayan R Kissoon
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
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Helvik AS, Bergh S, Tevik K. A systematic review of prevalence of pain in nursing home residents with dementia. BMC Geriatr 2023; 23:641. [PMID: 37817061 PMCID: PMC10566134 DOI: 10.1186/s12877-023-04340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The prevalence of dementia in nursing home (NH) residents is high, and pain is a troublesome symptom for them. Several studies since 2010 have focused on pain in NH residents with dementia, but there is a lack of systematic reviews on the prevalence of pain in NH residents with dementia. AIM To systematically review observational studies published from 2010 to 2023 on how pain is assessed and prevalence of pain found in NH residents with dementia. METHODS A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, Embase, CINAHL, AgeLine, and Cochrane databases for studies published from January 2010 to August 2023. Studies were included if they were observational studies with a quantitative design where self-report, staff assessment, and/or chart review were used to define the prevalence of pain in samples or subsamples of NH residents with dementia. RESULTS Of 184 studies considered, 25 were included. The studies assessed pain as daily, present, clinically relevant, chronic, intermittent, persistent pain and/or if pain affected quality of life. The prevalence of pain was high in most studies of NH residents with dementia independent of whether pain was reported as presence of pain or clinically relevant pain, but the prevalence varied from 8.6% to 79.6%. This prevalence was quite stable across the NH stay, but higher towards the end of life (up to 80.4%). Study designs and methodologies differed considerably. About half relied on an observational assessment inventory. CONCLUSION The number of studies focusing on pain in NH residents with dementia was restricted and methodologies differed considerably. Relatively few studies used an observational assessment inventory. In view of the fact that residents with dementia may have difficulties communicating pain, clinicians should pay attention to pain in these residents, systematically and reliably uncover pain by use of observational inventories, and subsequently treat pain to secure high quality care.
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Affiliation(s)
- Anne-S Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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12
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Guo X, Hou C, Tang P, Li R. Chronic Pain, Analgesics, and Cognitive Status: A Comprehensive Mendelian Randomization Study. Anesth Analg 2023; 137:896-905. [PMID: 37171986 DOI: 10.1213/ane.0000000000006514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Observational studies have suggested an intricate relationship among chronic pain (CP), use of analgesics, and cognitive status, but it remains unclear whether these associations are of a causal nature. METHODS To investigate the causal relationship among them, summary statistics of 9 types of CP (headache, hip, neck/shoulder, stomach/abdominal, back, knee, facial, general, and multisite CP), analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, salicylic acid and derivatives, and anilides), and cognitive status (cognitive function, Alzheimer's disease [AD], vascular dementia, Lewy body dementia [LBD], and dementia) were included in this Mendelian randomization (MR) study. As both CP and analgesic use were associated with cognitive status and vice versa, we performed a bidirectional MR analysis between CP or analgesics and dementia using strong genetic instruments ( P < .001) identified from genome-wide association studies (GWAS). The inverse-variance weighted method was applied to calculate estimates. The MR estimated odds ratio (OR) was interpreted as odds of outcome per unit increase in the exposure. The Benjamini-Hochberg method was applied to adjust the P value for multiple testing, and P < .05 means statistically significant. RESULTS Multisite CP (MCP) was associated with worse cognitive function (OR [95% confidence interval], 0.69 [0.53-0.89], P = .043), but no significant reverse effect of cognitive status on CP was found. There were no significant associations observed between analgesics and cognitive status. Unexpectedly, patients with AD and LBD had significantly lower exposure to anilides (AD: OR = 0.97 [0.94-0.99], P = .034; LBD: OR = 0.97 [0.96-0.99], P = .012) and NSAIDs (AD: OR = 0.96 [0.93-0.98], P = .012; LBD: OR = 0.98 [0.96-0.99], P = .034). CONCLUSIONS Our findings indicate that an elevated number of CP sites predict future cognitive decline. Patients with dementia had lower exposure to anilides and NSAIDs, suggesting that they might not be adequately medicated for pain.
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Affiliation(s)
- Xingzhi Guo
- From the Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, Shaanxi, People's Republic of China
- Xi'an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, People's Republic of China
| | - Chen Hou
- From the Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Peng Tang
- From the Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Rui Li
- From the Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, Shaanxi, People's Republic of China
- Xi'an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, People's Republic of China
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13
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Harrison Dening K. Assessing and managing pain in older people with dementia. Nurs Stand 2023; 38:69-75. [PMID: 37574998 DOI: 10.7748/ns.2023.e12165] [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] [Accepted: 05/25/2023] [Indexed: 08/15/2023]
Abstract
There is little evidence to suggest that people with dementia experience less pain than those without dementia, however they are less likely to report their pain due to the cognitive impairments they experience as their dementia progresses. A comprehensive pain assessment that involves family members, carers and/or friends in the process is crucial to gain an understanding of a person's medical and pain history, and to ensure effective pain management in people with dementia. This article describes the identification, assessment and management of pain in older people with dementia. The author includes a fictional case study with the aim of supporting nurses to reflect on possible indicators of pain in a person with dementia and to consider the tools they may use when identifying and assessing this pain.
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14
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De Cassai A, Geraldini F, Freo U, Boscolo A, Pettenuzzo T, Zarantonello F, Sella N, Tulgar S, Busetto V, Negro S, Munari M, Navalesi P. Erector Spinae Plane Block and Chronic Pain: An Updated Review and Possible Future Directions. BIOLOGY 2023; 12:1073. [PMID: 37626959 PMCID: PMC10452136 DOI: 10.3390/biology12081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Chronic pain is a common, pervasive, and often disabling medical condition that affects millions of people worldwide. According to the Global Burden of Disease survey, painful chronic conditions are causing the largest numbers of years lived with disability worldwide. In America, more than one in five adults experiences chronic pain. Erector spinae plane block is a novel regional anesthesia technique used to provide analgesia with multiple possible uses and a relatively low learning curve and complication rate. Here, we review the erector spinae plane block rationale, mechanism of action and possible complications, and discuss its potential use for chronic pain with possible future directions for research.
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Affiliation(s)
- Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Federico Geraldini
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Ulderico Freo
- Department of Medicine, University of Padua, 35122 Padua, Italy
| | - Annalisa Boscolo
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
- Department of Medicine, University of Padua, 35122 Padua, Italy
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Tommaso Pettenuzzo
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | | | - Nicolò Sella
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Training and Research Hospital of Samsun, Faculty of Medicine, University of Samsun, 55000 Samsun, Turkey
| | - Veronica Busetto
- Cardiac Surgery Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy
| | - Sebastiano Negro
- Anesthesia and Intensive Care 2, Istituto Oncologico Veneto IRCCS, 35128 Padua, Italy
| | - Marina Munari
- Sant’Antonio Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
- Department of Medicine, University of Padua, 35122 Padua, Italy
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15
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Riffin C, Brody L, Mukhi P, Herr K, Pillemer K, Rogers M, Henderson CR, Reid MC. Establishing the Feasibility and Acceptability of a Caregiver Targeted Intervention to Improve Pain Assessment Among Persons With Dementia. Innov Aging 2023; 7:igad074. [PMID: 38094933 PMCID: PMC10714902 DOI: 10.1093/geroni/igad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Despite its prevalence and impact, pain is underdetected and undermanaged in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial evaluating the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention that provides training in observational pain assessment and coaching in pain communication techniques. Research Design and Methods Family caregivers of persons with comorbid pain and moderate-to-advanced dementia were randomly assigned to PICT (n = 19) or a control condition (n = 15). Caregivers in the PICT group participated in four weekly sessions delivered by telephone with a trained interventionist; caregivers in the control group received an information pamphlet about pain and dementia. All participants completed surveys at baseline and 12 weeks. Caregivers in the intervention group also completed semistructured interviews at 12 weeks. Quantitative data were analyzed using descriptive statistics and t tests; qualitative data were analyzed using content analysis. Results All participants (100%) in the PICT group completed the intervention and most completed the 12-week assessment (94%). PICT randomized caregivers reported that the intervention helped them to feel more confident in their ability to recognize (67%) and communicate about pain symptoms (83%). At 12 weeks, caregivers in the PICT group showed a statistically significant improvement in self-efficacy in pain-related communication. In qualitative interviews, caregivers emphasized the utility of PICT's components, including pain assessment tools, and offered considerations for future enhancements, such as technology-based adaptations and integration within care delivery systems. Discussion and Implications This pilot trial demonstrates that PICT is feasible to implement, acceptable to caregivers, and has the potential to improve confidence in recognizing and communicating about pain. Results support conducting a fully powered efficacy trial, an important step toward future integration into real-world care delivery. Clinical Trial Registration Number NCT03853291.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Madeline Rogers
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - M Cary Reid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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16
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Resnick B, Boltz M, Galik E, Ellis J, Kuzmik A, Drazich B, McPherson R, Kim E. A Descriptive Study of Treatment of Pain in Acute Care for Patients Living With Dementia. Pain Manag Nurs 2023; 24:248-253. [PMID: 36737349 PMCID: PMC10213108 DOI: 10.1016/j.pmn.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND During the hospital stay pain is very common among patients living with dementia. METHODS Descriptive data was obtained from chart review and included age, gender, race, comorbidities and admitting diagnosis. AIMS The purpose of this study was to describe pain among patients living with dementia, the use of pharmacologic and nonpharmacologic treatment, and to compare treatments among those with and without pain. DESIGN This was a descriptive study using baseline data from the first 233 participants from the study "Testing the Implementation of Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT)". PARTICIPANTS/SUBJECTS The mean age of participants was 83 (SD=5) and the majority was female (65%) and White (67%) with evidence of dementia (based on a mean Saint Louis University Mental Status Test = 7.23, SD=5.85). RESULTS Overall 98 (42%) participants had pain and 135 (58%) no pain. Only 14 (6%) participants received no nonpharmacologic or pharmacologic interventions for pain and five of these individuals had pain. The most frequently used pharmacologic intervention among all participants was acetaminophen (n = 121, 52%), then tramadol (n = 19, 8%). Comfort measures and general nonpharmacologic approaches were the most frequently used non-pharmacologic approaches, then physical activity and therapeutic communication. From admission to discharge, there was a trend towards a decrease in pain. There was more use of opioids, physical activity, and therapeutic communication in the no pain group versus the pain group. CONCLUSIONS The majority of hospitalized medical patients living with dementia were treated for pain, but an ongoing focus is needed to assure optimal pain management for all patients.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland.
| | - Marie Boltz
- Penn State University, University Park, Pennsylvania
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Ashley Kuzmik
- Penn State University, University Park, Pennsylvania
| | | | | | - Emma Kim
- University of Maryland School of Nursing, Baltimore, Maryland
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17
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Horgas AL, Bruckenthal P, Chen S, Herr KA, Young HM, Fishman S. Assessing Pain in Older Adults: Caregivers play a key role in recognizing and documenting pain at home. Home Healthc Now 2023; 41:128-134. [PMID: 37144927 DOI: 10.1097/nhh.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Horgas, A.L., et al. Assessing Pain in Older Adults. Am J Nurs 2022; 122 (12): 42-48.
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Affiliation(s)
- Ann L Horgas
- Ann L. Horgas is an associate professor and chair of the Department of Biobehavioral Nursing Science at the University of Florida College of Nursing in Gainesville. Patricia Bruckenthal is a professor, associate dean for nursing research and innovation, and chair of doctoral studies in the School of Nursing at Stony Brook University in Stony Brook, NY. Shaoshuai Chen is a doctoral student in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This article was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Ann L. Horgas, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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18
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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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19
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Collins JT, Harwood RH, Cowley A, Di Lorito C, Ferguson E, Minicucci MF, Howe L, Masud T, Ogliari G, O'Brien R, Azevedo PS, Walsh DA, Gladman JRF. Chronic pain in people living with dementia: challenges to recognising and managing pain, and personalising intervention by phenotype. Age Ageing 2023; 52:6974848. [PMID: 36626322 DOI: 10.1093/ageing/afac306] [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: 04/19/2022] [Revised: 10/27/2022] [Indexed: 01/11/2023] Open
Abstract
Pain is common in people with dementia, and pain can exacerbate the behavioural and psychological symptoms of dementia. Effective pain management is challenging, not least in people with dementia. Impairments of cognition, communication and abstract thought can make communicating pain unreliable or impossible. It is unclear which biopsychosocial interventions for pain management are effective in people with dementia, and which interventions for behavioural and psychological symptoms of dementia are effective in people with pain. The result is that drugs, physical therapies and psychological therapies might be either underused or overused. People with dementia and pain could be helped by assessment processes that characterise an individual's pain experience and dementia behaviours in a mechanistic manner, phenotyping. Chronic pain management has moved from a 'one size fits all' approach, towards personalised medicine, where interventions recommended for an individual depend upon the key mechanisms underlying their pain, and the relative values they place on benefits and adverse effects. Mechanistic phenotyping through careful personalised evaluation would define the mechanisms driving pain and dementia behaviours in an individual, enabling the formulation of a personalised intervention strategy. Central pain processing mechanisms are particularly likely to be important in people with pain and dementia, and interventions to accommodate and address these may be particularly helpful, not only to relieve pain but also the symptoms of dementia.
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Affiliation(s)
- Jemima T Collins
- University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK.,University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rowan H Harwood
- University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,NIHR Applied Research Collaboration-East Midlands, Leicester, UK
| | - Alison Cowley
- University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Eamonn Ferguson
- University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
| | | | | | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,NIHR Applied Research Collaboration-East Midlands, Leicester, UK
| | - Giulia Ogliari
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Paula S Azevedo
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | - David A Walsh
- University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK.,Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - John R F Gladman
- University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
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20
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Ashley L, Surr C, Kelley R, Price M, Griffiths AW, Fowler NR, Giza DE, Neal RD, Martin C, Hopkinson JB, O'Donovan A, Dale W, Koczwara B, Spencer K, Wyld L. Cancer care for people with dementia: Literature overview and recommendations for practice and research. CA Cancer J Clin 2022; 73:320-338. [PMID: 36512303 DOI: 10.3322/caac.21767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/02/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.
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Affiliation(s)
- Laura Ashley
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Claire Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Mollie Price
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Nicole R Fowler
- Indiana University Center for Aging Research at Regenstrief Institute, Indianapolis, Indiana, USA
| | - Dana E Giza
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - William Dale
- Center for Cancer and Aging, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre & Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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21
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Horgas AL, Bruckenthal P, Chen S, Herr KA, Young HM, Fishman S. Assessing Pain in Older Adults. Am J Nurs 2022; 122:42-48. [PMID: 36384795 DOI: 10.1097/01.naj.0000904092.01070.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Ann L Horgas
- Ann L. Horgas is an associate professor and chair of the Department of Biobehavioral Nursing Science at the University of Florida College of Nursing in Gainesville. Patricia Bruckenthal is a professor, associate dean for nursing research and innovation, and chair of doctoral studies in the School of Nursing at Stony Brook University in Stony Brook, NY. Shaoshuai Chen is a doctoral student in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This article was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Ann L. Horgas, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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22
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Anderson AR, Monroe TB, Dietrich MS, Bruehl SP, Iversen WL, Cowan RL, Failla MD. Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease. FRONTIERS IN PAIN RESEARCH 2022; 3:914473. [PMID: 36387417 PMCID: PMC9650512 DOI: 10.3389/fpain.2022.914473] [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: 04/06/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Background Pain continues to be underrecognized and undertreated in people with Alzheimer's disease (AD). The periaqueductal gray (PAG) is essential to pain processing and modulation yet is damaged by AD. While evidence exists of altered neural processing of pain in AD, there has not been a focused investigation of the PAG during pain in people with AD. Purpose To investigate the role of the PAG in sensory and affective pain processing for people living with AD. Methods Participants from a larger study completed pain psychophysics assessments and then a perceptually-matched heat pain task (warmth, mild, and moderate pain) during a functional MRI scan. In this cross-sectional study, we examined blood oxygenation level-dependent (BOLD) responses in the PAG and other pain-related regions in participants with AD (n = 18) and cognitively intact older adults (age- and sex-matched, n = 18). Associations of BOLD percent signal change and psychophysics were also examined. Results There were significant main effects of AD status on the temperature needed to reach each perception of warmth or pain, where people with AD reached higher temperatures. Furthermore, participants with AD rated mild and moderate pain as more unpleasant than controls. PAG BOLD activation was greater in AD relative to controls during warmth and mild pain percepts. No significant differences were found for moderate pain or in other regions of interest. Greater PAG activation during mild pain was associated with higher affective/unpleasantness ratings of mild pain in participants with AD but not in controls. Conclusion Results suggest a role for the PAG in altered pain responses in people with AD. The PAG is the primary source of endogenous opioid pain inhibition in the neuroaxis, thus, altered PAG function in AD suggests possible changes in descending pain inhibitory circuits. People with AD may have a greater risk of suffering from pain compared to cognitively intact older adults.
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Affiliation(s)
- Alison R. Anderson
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
| | - Todd B. Monroe
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Stephen P. Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - W. Larkin Iversen
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
| | - Ronald L. Cowan
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
- Departments of Psychiatry and Anatomy and Neurobiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michelle D. Failla
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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23
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Klůzová Kráčmarová L, Tomanová J, Černíková KA, Tavel P, Langová K, Greaves PJ, Kisvetrová H. Perception of dignity in older men and women in the early stages of dementia: a cross-sectional study. BMC Geriatr 2022; 22:684. [PMID: 35982424 PMCID: PMC9386964 DOI: 10.1186/s12877-022-03362-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is a serious problem in old age, that impacts an individual's ability to function and may threaten personal dignity. Given the variable features of the illness and the diversity of life experiences, many factors may contribute to the perception of dignity by men and women with dementia. The purpose of the study was to explore the factors that contribute to dignity and its domains in men and women with dementia. METHODS This cross-sectional study involved 316 community-dwelling patients with early-stage dementia (aged ≥ 60) (PwD). We assessed the participants' sociodemographic and social involvement characteristics, health-related variables (pain, depression, physical performance, visual and hearing impairments), attitude to aging, and self-sufficiency in the activities of daily living (ADL). These factors were investigated as independent variables for the perception of dignity and of its domains in men and women. RESULTS Multivariate regression analysis showed that PwD experienced minor dignity problems in the early stages of dementia. In both men and women higher rates of depression, negative attitudes to aging, and pain were associated with reductions in the perception of dignity. In men, but not in women visual impairment had a negative effect on overall dignity, and on the associated domains of 'Loss of Autonomy' and 'Loss of Confidence'. In women, lowered self-sufficiency in ADL contributed to reduced self-perception of dignity and in the associated domains of 'Loss of Purpose of Life', 'Loss of Autonomy', and 'Loss of Confidence'. Sociodemographic and social involvement characteristics, hearing impairment, and physical performance did not influence the participants' self-perception of dignity. CONCLUSION The results suggested that several common factors (depression, attitudes to aging, and pain) contribute to the perception of dignity in both men and women. Other factors, visual impairments in men, and self-sufficiency in ADL in women, appear to be more gender specific. These differences might relate to their specific gender roles and experiences. The self-perception of dignity in PwD can be helped by supporting the individual, to the extent that their illness allows, in maintaining activities that are important to their gender roles, and that preserve their gender identity. TRIAL REGISTRATION NCT04443621.
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Affiliation(s)
- Lucie Klůzová Kráčmarová
- Olomouc University Social Health Institute, Sts. Cyril and Methodius Faculty of Theology, Palacky University Olomouc, Olomouc, Czech Republic.
| | - Jitka Tomanová
- The Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Kristýna A Černíková
- Olomouc University Social Health Institute, Sts. Cyril and Methodius Faculty of Theology, Palacky University Olomouc, Olomouc, Czech Republic
| | - Peter Tavel
- Olomouc University Social Health Institute, Sts. Cyril and Methodius Faculty of Theology, Palacky University Olomouc, Olomouc, Czech Republic
| | - Kateřina Langová
- The Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Peta Jane Greaves
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Helena Kisvetrová
- The Centre for Research and Science, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
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24
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Iacono A, Campitelli MA, Bronskill SE, Hogan DB, Iaboni A, Maclagan LC, Gomes T, Tadrous M, Evans C, Gruneir A, Guan Q, Hadjistavropoulos T, Cotton C, Gill SS, Seitz DP, Ho J, Maxwell CJ. Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis. Drugs Aging 2022; 39:811-827. [PMID: 35976489 PMCID: PMC9381389 DOI: 10.1007/s40266-022-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.
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Affiliation(s)
- Anita Iacono
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tara Gomes
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Unity Health, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrea Gruneir
- ICES, Toronto, ON, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Qi Guan
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Sudeep S Gill
- ICES, Toronto, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Dallas P Seitz
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. .,ICES, Toronto, ON, Canada. .,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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25
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Fowler Davis S, Humphreys H, Maden-Wilkinson T, Withers S, Lowe A, Copeland RJ. Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic-A Public Involvement Project. Healthcare (Basel) 2022; 10:1130. [PMID: 35742180 PMCID: PMC9222303 DOI: 10.3390/healthcare10061130] [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: 05/05/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups, and this leads to research that fails to include a diversity of perspectives. AIM The aim of this PI project was to understand the experiences and priorities of people from three seldom-heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain. METHODS The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted, followed by informal individual and group discussions involving professionals and people with lived experience of (a) fibromyalgia pain, (b) those waiting for elective surgery and (c) experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Resulting narratives were developed to highlight the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group. RESULTS The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people's views and needs are heard and validated by health professionals. CONCLUSIONS More research is needed to explore the most effective pain management strategies, and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is also needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.
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Affiliation(s)
- Sally Fowler Davis
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Helen Humphreys
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Tom Maden-Wilkinson
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Sarah Withers
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Broomhall, Sheffield S10 2JF, UK;
| | - Anna Lowe
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Robert J. Copeland
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
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26
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Smith TO, Harvey K. Psychometric properties of pain measurements for people living with dementia: a COSMIN systematic review. Eur Geriatr Med 2022; 13:1029-1045. [PMID: 35622210 PMCID: PMC9553783 DOI: 10.1007/s41999-022-00655-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Detecting pain in older people with dementia is challenging. Consequentially, pain is often under-reported and under-treated. There remains uncertainty over what measures should be promoted for use to assess pain in this population. The purpose of this paper is to answer this question. METHODS A search of clinical trials registered on the ClinicalTrial.gov and ISRCTN registries was performed to identify outcome measures used to assess pain in people with dementia. Following this, a systematic review of published and unpublished databases was performed to 01 November 2021 to identify papers assessing the psychometric properties of these identified measures. Each paper and measure was assessed against the COSMIN checklist. A best evidence synthesis analysis was performed to assess the level of evidence for each measure. RESULTS From 188 clinical trials, nine outcome measures were identified. These included: Abbey Pain Scale, ALGOPLUS, DOLOPLUS-2, Facial Action Coding System, MOBID-2, self-reported pain through the NRS or VAS/thermometer or Philadelphia Geriatric Pain Intensity Scale, PACSLAC/PACSLAC-2, Pain Assessment in Advanced Dementia (PAINAD), and Checklist for non-verbal pain behavior (CNPI). From these, 51 papers (5924 people with dementia) were identified assessing the psychometric properties of these measures. From these, there was strong- and moderate-level evidence to support the use of the facial action coding system, PACSLAC and PACSLAC-II, CNPI, DOLOPLUS-2, ALGOPLUS, MOBID, and MOBID-2 tools for the assessment of pain with people living with dementia. CONCLUSION Whilst these reflect measurement tools used in research, further consideration on how these reflect clinical practice should be considered. PROSPERO REGISTRATION CRD42021282032.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, OX3 7LD, UK.
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Karmen Harvey
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
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27
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Tsai YIP, Browne G, Inder KJ. Documented nursing practices of pain assessment and management when communicating about pain in dementia care. J Adv Nurs 2022; 78:3174-3186. [PMID: 35436007 PMCID: PMC9545301 DOI: 10.1111/jan.15251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/16/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate nurses' documented practice when communicating about pain for people with dementia in hospital. DESIGN Retrospective medical record review. METHOD Medical records were retrieved from four inpatient units in a district and a tertiary teaching hospital of people aged 65 years and over with documented dementia. Data were extracted on nurses' documented pain assessment and management. Pain frequency and association between patient self-report, pain scores, cognition levels and analgesics used during hospitalization were analysed using descriptive and inferential statistics. Multivariate regression examined patient characteristics, pain characteristics and length of hospital stay. RESULTS One-hundred patient records met the inclusion criteria between 1 January and 31 August 2017. Sixty-six percent of patients with dementia had pain documented at least once during hospitalization with 58% reported as moderate to severe pain intensity. Patients' pain severity during admission was associated with their length of hospital stay. Ninety-three percent of nurses used a self-reporting pain tool and 7% used an observational pain tool. Pain scores were not associated with patients' cognition level, nurses' pain reports or analgesic management. CONCLUSION Pain frequently occurs in people with dementia during hospitalization. Fragmented pain reporting influences the translation of pain messages. Disproportionate pain tool application and non-association between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical use of pain tools and practice gap between pain assessment and management in dementia care. IMPACT Pain was regularly assessed by nurses and implemented as a fifth vital sign for people with dementia in hospitals. However, the high frequency of pain affects care outcomes. Areas for improvement include nursing practice of pain assessment and management in dementia care in hospitals. Further understanding of the usefulness of pain tools and the efficacy of pain scores when communicating about pain in dementia care in hospitals is required.
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Affiliation(s)
- Yvette I-Pei Tsai
- School of Nursing & Midwifery, University of Newcastle, Newcastle, Australia
| | - Graeme Browne
- School of Nursing & Midwifery, University of Newcastle, Newcastle, Australia
| | - Kerry Jill Inder
- School of Nursing & Midwifery, University of Newcastle, Newcastle, Australia
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28
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Chover-Sierra E, Pérez-Ros P, Julián-Rochina I, Long CO, Cauli O. Knowledge and Attitudes towards Palliative Care: Validation of the Spanish Version of Questionnaire on Palliative Care for Advanced Dementia. Healthcare (Basel) 2022; 10:healthcare10040656. [PMID: 35455834 PMCID: PMC9029205 DOI: 10.3390/healthcare10040656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Palliative care is essential in the care of people with advanced dementia, due to the increasing number of patients requiring care in the final stages of life. Nurses need to acquire specific knowledge and skills to provide quality palliative care. The Questionnaire on Palliative Care for Advanced Dementia (qPAD) is useful for assessing knowledge and attitudes toward palliative care, but its adaptation to the Spanish language and analysis of its effectiveness and usefulness for the Spanish culture is lacking. Objective: To report on the Spanish language adaptation and psychometric analysis of the qPAD. Methods: The Questionnaire on Palliative Care for Advanced Dementia Spanish version (qPAD-SV) was obtained from a process that included translation, back-translation, comparison with other language versions, expert review, and pilot study. Content validity, criterion validity, and reliability of the questionnaire were analyzed. The difficulty and discrimination indices of items composing the knowledge subscale were also calculated. Results: Adequate content validity index obtained after the analysis of qPAD-SV by a heterogeneous group of experts was found (overall CVI = 0.96; 0.95 for the Knowledge subscale and 0.99 for the Attitudes subscale). Significant correlations with the Palliative Care Knowledge test (rho = 0.368, p < 0.001) and Self-Efficacy in Palliative Care Scale (rho = 0.621, p < 0.001) show an adequate criterion validity. Cronbach’s alpha coefficients for the Knowledge subscale (0.60) and the Attitudes subscale (0.91) supported the reliability of the qPAD-SV. The questionnaire had an overall difficulty index of 0.71, with three items that could be considered difficult or very difficult, and eleven items that could be considered very easy. Discussion: Although it shows internal consistency, validity, and difficulty indices similar to those obtained by qPAD versions in other languages, a reformulation of the items with lower content validity or discrimination indices and those that show difficulties in their comprehension is an aspect to be taken into account to improve this tool. Conclusions: The qPAD-SV is a useful instrument in Spanish to measure the knowledge of Spanish nurses in palliative care and is suitable for international comparisons.
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Affiliation(s)
- Elena Chover-Sierra
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Nursing Care and Education Research Group (GRIECE), University of Valencia, 46010 Valencia, Spain
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Pilar Pérez-Ros
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Iván Julián-Rochina
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Carol O. Long
- “Palliative Care Essentials” Research Institute, Fredericksburg, VA 22407, USA;
| | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Correspondence:
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29
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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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30
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Observing Pain in Individuals with Cognitive Impairment: A Pilot Comparison Attempt across Countries and across Different Types of Cognitive Impairment. Brain Sci 2021; 11:brainsci11111455. [PMID: 34827454 PMCID: PMC8615509 DOI: 10.3390/brainsci11111455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 01/23/2023] Open
Abstract
Facial expression is a key aspect in observational scales developed to improve pain assessment in individuals with cognitive impairments. Although these scales are used internationally in individuals with different types of cognitive impairments, it is not known whether observing facial expressions of pain might differ between regions or between different types of cognitive impairments. In a pilot study, facial responses to standardized experimental pressure pain were assessed among individuals with different types of cognitive impairments (dementia, mild cognitive impairment, Huntington’s disease, and intellectual disability) from different countries (Denmark, Germany, Italy, Israel, and Spain) and were analyzed using facial descriptors from the PAIC scale (Pain Assessment in Impaired Cognition). We found high inter-rater reliability between observers from different countries. Moreover, facial responses to pain did not differ between individuals with dementia from different countries (Denmark, Germany, and Spain). However, the type of cognitive impairment had a significant impact; with individuals with intellectual disability (all being from Israel) showing the strongest facial responses. Our pilot data suggest that the country of origin does not strongly affect how pain is facially expressed or how facial responses are being scored. However, the type of cognitive impairment showed a clear effect in our pilot study, with elevated facial responses in individuals with intellectual disability.
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