Pain in older adults with dementia : A survey across Europe on current practices, use of assessment tools, guidelines and policies.

BACKGROUND: We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings. METHODS: A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom. RESULTS: Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70-80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management. CONCLUSION: Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.

[Diagnostics of pain in old age. Perspectives on a multidimensional phenomenon]. / Diagnostik von Schmerzen im Alter. Perspektiven auf ein multidimensionales Phänomen.

Old people's experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.

[Pain assessment in elderly nursing home residents: methods paper for the S3-guideline development]. / Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe : Methodenpapier zur S3-Leitlinie.

In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group "Pain and Age" of the German Pain Society ("Deutschen Schmerzgesellschaft") in conjunction with the German Centre for Neurodegenerative Diseases ("Deutschen Zentrum für Neurodegenerative Erkrankungen"), Witten, has embarked on the development of interdisciplinary S3-Guideline for "Pain Assessment in Elderly People in Nursing Homes", based on the methodology suggested by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V."), the German Agency for Quality in Medicine ("Ärztliche Zentrum für Qualität in der Medizin"), and that described in the DELBI ("Deutschen Leitlinien-Bewertungsinstrument"). Delegates of the 38 scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.

[The pain situation for residents of nursing homes. Results of a study in Münster]. / Die Schmerzsituation von Bewohnern in der stationären Altenhilfe. Ergebnisse einer Studie in Münster.

BACKGROUND: Little is known about the phenomenon of pain in German nursing homes. In particular, it is unknown to what extent and severity pain occurs among residents and how their pain can be described. MATERIAL AND METHODS: A total of 13 nursing homes located in the city of Münster, Germany, were included as part of the health services research project "Action Alliance Pain-free City Münster." Data were collected from 436 residents over 65 years old via self-report or the observational pain tool pain assessment in advanced dementia, german version (PAINAD-G), according to the cognitive status of the residents. RESULTS: At the time of the interview, the majority of the residents questioned reported suffering from pain at rest and/or during movement. Approximately one quarter of residents complained about moderate to intolerable pain at rest and nearly 45% during movement. Residents encountered pain most often when standing up, sitting, resting in bed and walking and three quarters of residents had suffered from pain for more than 1 year. Many residents experienced pain in several body regions. Among residents assessed solely by the observational pain scale PAINAD-G, signs indicating pain existed in 21% (≥ 6) or 69% (≥ 2), respectively, depending on the cut-off value chosen on the PAINAD-G scale. CONCLUSION: Pain in nursing homes is a challenge that needs more attention as it has considerable negative consequences for the persons concerned. The extent of pain in the studied facilities indicates an urgent need for action on the part of all professionals caring for residents in nursing homes.

[Improvement of oral health care in geriatric care by training of nurses and nursing assistants for the elderly]. / Verbesserung der zahnmedizinischen Betreuung in der Altenpflege durch Schulungen von Pflegekräften.

Because oral health among residents of German nursing homes is inadequate, this intervention study evaluated the effects of dental training for nurses and nursing assistants (RN and RA) in homes for the elderly on their assessment of oral health in residents and, as a consequence, on the status of residents' oral health. 53 residents and the RNs and RAs from three homes for the elderly participated in this study. The nursing staff received training in dental health care. As primary outcome, the competence in performing the Brief Oral Health Examination (BOHSE) was measured at baseline date and four months after training. Additional outcome measures were dental and denture hygiene in residents, functional status of dentures, and treatment needs. Dental training was shown to improve the nursing staff's competences in oral health assessment in tendency. Residents' oral hygiene improved significantly, whereas no relevant effects on hygiene and functional status of dentures were registered. The need for dental treatment turned out to be considerable at both measurements. Modifications in test tools with identification of dental treatment needs seem to be indicated in order to improve cooperation between nursing staff and dentists in homes for the elderly.

[Health services research project "action alliance pain-free city Münster" : Objectives and methods]. / Versorgungsforschungsprojekt "aktionsbündnis schmerzfreie stadt Münster" : zielsetzung und methodik.

Inadequate pain care in health care facilities is still a major concern. Due to structural and organizational shortcomings the potential of modern analgesia is far from being exhausted. The project "Action Alliance Pain-free City Münster" is designed to analyze the multiprofessional pain management in health care facilities in the model City of Münster in an epidemiologic study and aims to optimize pain management in accordance with nursing standards and medical guidelines. Hospitals, nursing homes, outpatient nursing services, hospices and pain care centers will be examined. After an analysis of the current state on the basis of a pre-test, the necessary optimization measures will be developed and implemented. Subsequently, the pain management will be reevaluated in a post-test. In partly still unexplored health care areas of Germany, epidemiologic data will be generated, barriers to the implementation of standards and guidelines revealed and measures of improvements developed and tested. In addition, interface problems between the evaluated sectors will be identified. In this article the objective and the methods of the project are described.

Drug-based pain management in people with dementia after hip or pelvic fractures: a systematic review protocol.

BACKGROUND: Studies show that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent and how drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review is to identify studies addressing drug-based pain management for people with dementia who have had a hip or pelvic fracture for which they had either an operation or conservative treatment. We will analyse to what extent and how the drug-based pain treatment for people with dementia is performed across all settings and how it is assessed in the studies. METHODS: The development of this systematic review protocol was guided by the PRISMA-P requirements, which will be taken into consideration during the review procedure. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect will be searched, using keywords such as "analgesia", "dementia", "cognitive impairment", "pain treatment", "hip fracture" or "pelvic fracture". Publications published up to January 2016 will be included. The data extraction and a content analysis will be carried out systematically, followed by a critical appraisal. DISCUSSION: This review will provide a valuable overview on the current evidence on drug-based pain management for PwD in all settings who were conservatively treated after a hip or pelvic fracture. The review may expose a need to enhance pain management for PwD. It may also provide motivation for healthcare providers and policymakers to give this topic their attention and to facilitate further research by considering aspects of care transitions in all settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016037309.