Successful Pain Assessment in Older Adults with Dementia Barriers and Strategies
Executive Summary
Objectives
The objectives of this paper were (a) to identify barriers to successful pain assessment in older adults with dementia, and (b) to identify possible strategies for overcoming these barriers.
Method
A database search was conducted for literature relating specifically to barriers to pain assessment in older adults with a diagnosis of dementia and methods for overcoming these barriers. In addition, further studies, that were initially retrieved following a database search for literature for a systematic review on Assessment of Pain in Older Adults with Dementia in Acute, Sub Acute, and Residential Care, were earmarked for this paper when it became apparent that there was a need for a separate paper focusing on barriers to, and strategies for, successful pain assessment in older adults with dementia. All studies were critically appraised b two independent reviewers and data was extracted using instruments specifically developed for the systematic review. Where disagreement existed between reviewers regarding inclusion or level of evidence, an Expert Reference Group or third reviewer was consulted.
Results
A number of barriers to successful pain assessment in older adults with dementia were identified in the literature. These barriers can be divided into two realms: staff considerations and patient considerations. Staff considerations included lack of recognition of pain in patients with dementia; lack of sufficient education and/or training regarding pain in patients with dementia; misdiagnosis or late diagnosis; inadequate assessment tools; restrictions imposed by nursing role; and the need for objective and sufficient evidence. Patient considerations included the subjective nature of pain; the possible existence of a ‘no pain’ subset of people with de-mentia; the type of pain experienced; and stoic attitudes. Several strategies were proposed to overcome these barriers and included knowing the person; knowing by diversity/intuitive perception; improved training and education; the development and implementation of adequate tools; the use of existing data; and increasing diligence when working with this population.
Conclusions
This review has found that pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with dementia. At particular risk are those patients who are non-communicative and are therefore unable to articulate or convey their pain, who are often dismissed as being incapable of perceiving or recalling pain. More extensive training and education regarding the experience, assessment, and management of pain in the dementia patient is urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed for detecting and measuring pain in older adults in all stages of dementia.