Orofacial pain assessment and management for patients with dementia: A meta‐ethnography

Abstract

Delivering dental treatment for patients with dementia can be challenging, and the complexity of treatment provision can increase as dementia progresses. Treatment at the later stages of dementia can be associated with ethical challenges and procedural risk meaning that a comprehensive patient assessment is crucial; the presence of orofacial pain is a key indication for active intervention from dental teams. To explore the process of oro-facial pain assessment and management, a comprehensive review of qualitative literature was undertaken by searching six electronic databases. No literature specific to orofacial pain assessment was identified. The inclusion criteria were widened to explore assessment and management of pain in general for patients with dementia. Meta-ethnography with reciprocal translation was used to identify key concepts and themes and synthesise information applicable to the dental setting. Three major themes arose as follows: challenges with pain assessment, challenges with pain management and logistics and education. Healthcare teams struggle with pain identification in patients with dementia though many signs were identified which may suggest a patient is experiencing pain. The long-term knowledge of individual patients held by family members and care teams can allow identification of deviation from patients' normal states; this knowledge can assist healthcare professionals in determining whether to provide specific treatments or interventions. Pain assessment tools were found to be problematic and are unlikely to be a practical solution to use for complex patients in dental settings. Education for dental and wider care teams on orofacial pain would be highly valuable; yet, this needs to be based on suitable evidence. K E Y W O R D S dementia, facial pain, older adults, pain, pain management, pain measurement, qualitative research 17. exp Pain/ 18. pain.mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 19. (mouth adj3 pain$).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 20. Toothache/ 21. Facial Pain/ 22. (dent$ adj3 pain$).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 23. 18 or 19 or 20 or 21 or 22 24. Qualitative Research/ 25. qualitative.mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 26. ethnograph$.mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementa...

The challenge of pain identification, assessment, and management in people with dementia: a qualitative study

“…In line with this finding, many GPs questioned the 'reliability' or 'accuracy' of self-report pain tools for people with dementia. This finding is reflected in previous qualitative literature, in which nurses perceived pain assessment as a 'complex process', 50,51 with reduced or altered verbal communication as a key barrier to pain assessment, 30 and the use of self-report tools. 27,52 Identifying behavioural, psychological, and physical changes has previously been recognised as a key strategy to build a picture of the pain experience.…”

“…27,52 Identifying behavioural, psychological, and physical changes has previously been recognised as a key strategy to build a picture of the pain experience. 30,49 However, in this study, GPs often found it challenging to determine if pain was the driver of behavioural or psychological changes. This challenge may be intensified as many GPs in this study were unaware of and/or did not use behavioural observation pain tools, despite being recommended by UK guidelines.…”

“…55 This finding is important as BPSD may 'mask' the identification of pain; leading to inadequate pain identification and assessment in primary care. 56 Familiarity or 'knowing' the person with dementia has previously been recognised as important in care home and hospital settings, 22,30 with caregivers acting as 'messengers on behalf of the patient'. 28 This study builds on previous literature by highlighting the unique challenge of patient-doctor relationship continuity in primary care, and the responsibility for the family caregiver to manage pain in the community.…”

“…18,19 Qualitative research has previously highlighted the complexity of pain identification, assessment, and management for people with advanced dementia at the end of life, or in care home and hospital settings from the perspective of healthcare professionals [20][21][22][23][24][25] and family caregivers. [26][27][28] However, there is a current lack of research exploring pain for community-dwelling people with dementia, [29][30][31] particularly from the perspective of GPs. 29 This is a significant omission because the majority (>60%) of people with dementia live in community settings.…”

Gum Health Day 2020 says 'No' to bleeding gums

“…These stakeholders raised concerns about living with pain which may not be identifiable; a paper was co-written with a carer helping to explore the published research about this problem. 1 Patients also expressed concern about needing complicated treatment when they were too unwell to cope with it or when dental treatment might lead to more harm than benefit.…”