Insights to Identifying and Managing Pain in Persons With Dementia in Long-Term Care: A Mixed Methods Study Comparing the Abbey Pain Scale and Pain Assessment in Advanced Dementia Scale

Abstract

Pain is usually identified by specific behaviors driven by the need for relief; however, persons with dementia present a unique challenge for nurses in assessing and managing pain. The aim of this mixed methods study was to explore the relationship between two observational pain scales, expressed need-driven behaviors, and likelihood of medication administration for persons with dementia. The qualitative strand examined nurses' perceptions regarding facilitators and barriers to pain scale use. Quantitative data analysis indicated the Abbey Pain Scale was significantly correlated with behaviors ( r [26] = 0.41, p < 0.05) and approached significance with medication administration ( r [26] = 0.35, p = 0.067). Qualitative analysis identified three core themes: (a) Challenges in Assessing Persons With Dementia for Pain ; (b) Facilitators and Barriers to Pain Management ; and (c) Difficulty Caring for Persons With Dementia . Clinical implications suggest the need for a systematic, consistent method of observing pain-related behaviors in persons with dementia. [ Journal of Gerontological Nursing, 47 (2), 21–30.]

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

“…The 33 studies originated across Europe, North America, Australasia and Asia. As Table 1 illustrates, most studies originated from the UK [23][24][25][26][27][28][29][30][31][32][33] (n = 10), Australia [34][35][36][37][38][39] (n = 6), Sweden [40][41][42][43][44] (n = 5), USA [45][46][47][48][49] (n = 5) and Canada [50][51][52] (n = 3).…”

“…Data were gathered from care home staff in 19 studies of 510 individuals. 3,23,27,29,30,32,[36][37][38]41,42,[45][46][47][48][49][50]52,56 Data were collected using focus groups in three studies 3,48,50 and by interviews in nine studies. 23,30,36,41,45,46,47,49,52 Surveys with qualitative findings were presented in three studies 27,32,42 whilst four used a combination of focus groups and interviews.…”

“…3,23,27,29,30,32,[36][37][38]41,42,[45][46][47][48][49][50]52,56 Data were collected using focus groups in three studies 3,48,50 and by interviews in nine studies. 23,30,36,41,45,46,47,49,52 Surveys with qualitative findings were presented in three studies 27,32,42 whilst four used a combination of focus groups and interviews. 29,37,38,56 The professional roles of these care home workers ranged from care assistants, registered nurses, physicians and care home managers.…”

“…and they said no, I'd put, "Appears to be in pain, but denies it when asked…" (Lichtner et al 26 ; Page 7; Physiotherapist, H1) Barriers to the use of validated pain scores centred around access, but also time. 24,25,29,32,38,47,54 This was in community care, hospitals and care home settings. This was compounded by variation in patient presentation and the need to assess individuals over a period to detect a change in 'normal' behaviour compared to a 'snap-shot' assessment.…”

“…There were also associated benefits acknowledged by three studies of improved pain providing caregivers with reduced burden either in hospital 34 or care home settings. 47,52 Furthermore, successful pain management offered both caregivers and staff the opportunity to engage in more social activities which offer both health and wellbeing benefits for the person with dementia and the people around them. 34,50 Line of argument.…”