Care Strategies for Improving Pain Management in Elderly Patients with Dementia

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Table of Contents

Critical Engagement
Research Question
Methodology
Expected Outcome
References

Hospitals’ lack of dementia-friendly treatment is an issue that must be addressed. Alzheimer’s disease is a worldwide health problem, with current estimates indicating that 50 million individuals are afflicted with it in some capacity (Alzheimer’s Disease International, 2019). There are several sorts of illnesses that result in dementia, with signs varying based on the nature of the disease and the brain regions affected in each person. As the condition advances, the individual becomes more forgetful and may have communication problems. While age limit is not inherent to dementia, it is much more prevalent among older adults. Thus, it is probable that the individual will have numerous different co-morbidities and, as a consequence, may already be enduring chronic pain.

Access to effective pain treatment is seen as a basic human right. Yet, pain treatment for older individuals with dementia referred to acute care remains poor, which I have witnessed numerous times in healthcare facilities. Numerous co-morbidities and the possibility of polypharmacy complicate the treatment of pain in the elderly. Such a state of affairs justifies the relevance of the identification of pain management strategies for the elderly with dementia, which serves as a foundation of my interest in this theme.

Critical Engagement

According to research, hospital environments are not dementia-friendly, leading to longer hospital stays and lower results. Yet, those with dementia are 1.42 times more likely to be hospitalized than those without dementia. From 2013 to 2018, hospital admissions for patients with dementia increased by 35% in England (Torjesen, 2020), according to official statistics. Numerous co-morbidities and the possibility of polypharmacy complicate the treatment of pain in the elderly (Shepherd et al., 2019). According to Tsai et al. (2018), the challenges grow more complicated when dementia is present, especially because self-reporting is widely considered the best approach to comprehending an elderly individual’s suffering experience. Individuals with dementia can find it difficult to self-report their pain (Alfonso-Argilés et al., 2020). Therefore, healthcare providers must find other methods to measure it, such as including the patient’s family and using behavioral pain evaluations. Not only does untreated pain affect the individual with dementia and their relatives and caregivers, but it also adds responsibilities, including costs, to the healthcare system.

Staff must be aware of the person’s pain history since dementia sufferers often have persistent pain disorders. Patients’ incapacity to speak adequately may result in inadequate pain evaluation and treatment, especially among the elderly (Gagliese et al., 2018; Pringle et al., 2021). In such situations, family members may contribute crucial data to aid with pain management. While these treatments have limits, national recommendations have been produced to aid practitioners in optimizing the evaluation and management of pain in older patients, particularly those with dementia.

Although guidelines give some guidance, it is recognized that the setting in which treatment is provided (context) and the prevalent ward culture influence pain management approaches (Harmon et al., 2019). Evidence from a range of sources, including guidelines, investigations, practitioner-acquired expertise, and patient feedback, is seen as information that healthcare professionals may utilize to provide superior treatment. In the literature, however, the difficulties of putting knowledge into practice have indeed been thoroughly examined (Achterberg et al., 2019; Schofield et al., 2022).

Research Question

What are the evidence-based approaches toward care for improving pain management in elderly patients with dementia that may form a universal strategic framework?

Methodology

Systematic reviews were first created in medical science as a method to consolidate study results in a rigorous, transparent, and repeatable manner, and they have been considered the gold standard of reviews. A systematic review is a research technique and procedure for locating and evaluating related studies, as well as gathering and assessing data from such research (Snyder, 2019). A systematic review seeks to discover all empirical data that meets the predetermined inclusion criteria in order to answer a specific research question. By adopting specific and methodical processes for assessing papers and all relevant material, bias may be reduced, resulting in results from which conclusions and judgments can be taken with confidence.

Statistical tools, such as meta-analysis, are used often, although not always, to integrate the findings of the included research. Nonetheless, determining the quality of research results in fields that are not limited to randomized controlled trials is a significant difficulty (Snyder, 2019). It appears fair to use a qualitative method to evaluate the quality and significance of findings from various kinds of investigations and to compare outcomes. Hence, a rigorous systematic review procedure will be employed to gather papers, which will subsequently be evaluated using a qualitative manner. There are a number of benefits and possible contributions associated with performing a systematic review. For instance, one can establish if an impact is consistent across trials and whether more investigations are necessary to show the effect.

Regardless of the method chosen to do the systematic literature review, a variety of steps must be completed, and choices must be made in order to produce a review that fulfills publishing standards. In the following, the fundamental stages and significant decisions involved in performing the suggested literature review can be outlined and explored in four phases. First, it is planning the review; second, it is doing the review; third, it is analyzing the results; fourth, it is writing up the review. This method was derived from actual expertise and is a blend of and shaped by many literature review standards and recommendations.

Expected Outcome

Understanding the complexity of providing positive patient outcomes to older patients with pain and dementia in hospitals and clinics calls for a sophisticated investigation. Enabling healthcare teams to analyze their practice critically via continuous research enables them to actively engage in identifying issues and finding solutions to enhance pain management procedures. Recognizing pain using the proper pain assessment instrument is essential for effective pain treatment methods. To raise their awareness and reduce the knowledge gap, interdisciplinary groups functioning in acute care environments need ongoing training and instruction on how pain and dementia influence patients.

References

Achterberg, W., Lautenbacher, S., Husebo, B., Erdal, A., & Herr, K. (2019). Pain in dementia. Pain Reports, 5(1), 803. Web.

Alfonso-Argilés, F. J., Meyer, G., Stephan, A., Comas, M., Wijbker, A., Leino-Kilpi, H., Lethin, C., Saks, K., Soto-Martin, M., Sutcliffe, C., Verbeek, H., Zabalegui, A., & Renom-Guiteras, A. (2020). Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs. BMC Geriatrics, 20, 453.

Alzheimer’s Disease International (2019). Dementia statistics. Web.

Gagliese, L., Gauthier, L. R., Narain, N., & Freedman, T. (2018). Pain, aging and dementia: Towards a biopsychosocial model. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 87, 207–215.

Harmon, J., Summons, B., & Higgins, I. (2019). Experiences of the older hospitalised person on nursing pain care: An ethnographic insight. Journal of Clinical Nursing, 28, 23–24.

Pringle, J., Alvarado Vázquez Mellado, A. S., Haraldsdottir, E., Kelly, F., & Hockley, J. (2021). Pain assessment and management in care homes: understanding the internal andexternal context through a scoping review. BMC Geriatrics, 21(1), 431. Web.

Schofield, P., Dunham, M., Martin, D., Bellamy, G., Francis, S.-A., Sookhoo, D., Bonacaro, A., Hamid, E., Chandler, R., Abdulla, A., Cumberbatch, M., & Knaggs, R. (2022). Evidence-based clinical practice guidelines on the management of pain in older people – A summary report. British Journal of Pain, 16, 6–13.

Shepherd, H., Livingston, G., Chan, J., & Summerland, A. (2019). Hospitalisation rates and predictors in people with dementia: A systematic review and meta-analysis. BMC Medicine, 17, 130. Web.

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339.

Torjesen, I. (2020). Figures show big increase in emergency admissions for dementiapatients. BMJ, 368. Web.

Tsai, I., Jeong, S. Y., & Hunter, S. (2018). Pain assessment and management for older patients with dementia in hospitals: An integrative literature review. Pain Management Nursing, 19(1), 54–71.

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Care Strategies for Improving Pain Management in Elderly Patients with Dementia

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