Pain Assessment and Management in Care Homes: Understanding the Internal and External Context Through a Scoping Review

Abstract

Background: Internationally, 2-5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the internal and external contexts that might influence its management.Methods: We conducted a scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment or management for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were screened, and website searches carried out of key organisations, to ensure relevant evidence was retrieved, including grey literature. As per the methodolocal framework, stakeholder evidence from 16 local care home managers was also accessed, to undertand their current perspectives.Results: Inclusion criteria were met by 109 studies. Three overarching themes were identified: staff variables and beliefs, pain assessment, and interventions. Evidence from the review indicated a lack of training and staff confidence in relation to pain assessment and management in care homes. This was particularly the case for residents with dementia, who cannot always verbalize their pain, and may resort to behavioral manifestations to try and communicate their distress.Conclusions: This review has highlighted that training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way. Internal and external contexts need further examination in order to integrate recognition and assessment of pain, and its management, to the benefit of residents.

Exploring ways to enhance pain management for older people with dementia in acute care settings using a Participatory Action Research approach

“…Authors of the Promoting Action Research in Health Services framework (PARiHS) (Kitson et al, 1998) suggest the three key elements of evidence, context and facilitation provide a structure to explore issues in practice to try and ensure sustainable practices. While there is an abundance of pain management research examining the complexities of caring for older people with dementia in long‐term settings (Koppitz et al, 2017; Labonté et al, 2019; Achterberg et al, 2019; Pringle et al, 2021), less is known about the pain management challenges experienced by people with dementia as they move from the emergency department (ED) to in‐patient wards, in acute care. Therefore, this study aimed to understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of helping healthcare staff to improve practice.…”