The Best Pain Assessment Tool in Care of Clients with Advanced Dementia - Literature review Example

Within the dementia care environment, the nurses lack knowledge on the appropriate assessment and management of pain in with advanced dementia. It is popular myth that dementia patients experience less, as they are unable to express their severity of pain. . Nurses usually often utilize their experience as guide in the assessment and management of dementia patients with pain. However, as health professionals involved in end stage of care, there is a need to review the assessment tools and management plans that are used in dementia care, in order to provide evidence based practice. AIM The aim of this review is to assess the most appropriate pain assessment tool, in care of clients with advanced dementia. REVIEW Dementia is associated with significant cognitive impairment. Most of the patients with dementia have a longer stay at hospitals which is associated with the development of complications. Pain is commonly under diagnosed and undertreated in patients with dementia (Buffum and Haberfelde 2007), as the dementia patients cannot communicate properly. A pilot study was conducted by Buffum and Haberfelde 2007 to assess families and care givers perception on pain management in patients with dementia. The study was conducted among 34 family caregivers and the study concluded various strategies for assessment of pain that include regular observation and assessment. Even though there are several methods in the management and assessment of pain, still the identification of appropriate tool remains a concern in all care settings. Most of the studies report self report as the most effective tool for pain assessment. In a study conducted by Shega et al (2005) among 115 dyads, 37 patients with dementia and 57 caregivers reported that direct self report of pain is the most appropriate tool for assessment of pain and the treatment should be done accordingly. The study suggested that the clinicians should routinely assess the pain, caregiver depression and patient agitation, as the study has reported caregiver reported pain during caregiver depression. A study by Pautex et al 2005, also supports the use of self assessment report for pain management. The prospective clinical study was conducted among 160 patients, where 97%, 90% and 40% of patients with mild, moderate and severe dementia understood the use of the self assessment scale. The study concluded that self assessment works well among patients with mild and moderate dementia. The study also suggests the use of observational pain rating scales, along with the use of self assessment reports in pains with advanced dementia. Observational scale along with self-assessment correlates moderately with each other (Pautex 2007). In another study conducted by Pautex et al 2007, assessed the use of Doloplus-2 observational scale along with visual analog as the gold standard. Prospective clinical study was conducted among 131 participants with dementia and 49 without dementia. The study concluded that Doloplus 2 scale correlated with the self assessment scale. However, study conducted by Pautex et al 2006, concludes that observational scales should not be routinely used by clinicians in advanced dementia patients, as they may not be able to reliably report their pain. The prospective clinical study was conducted among 129 severely demented patients and the researchers used three assessment tools- verbal, horizontal visual, and faces pain scale. NOPAIN (Non-communicative Patient’s Pain Assessment Instrument) was found to effective in the assessment of pain. Ferrari et al 2009 conducted a study among 60 severely demented patients on the use of the Italian version NOPAIN. The researchers concluded that their study supported the validity and the reliability of the Italian version of NOPAIN and reported that it appeared to be an easy tool in the assessment of pain in non communicative patients. To understand the relationship between behavioral psychological symptoms of dementia [BPSD] and pain, a study proposal was proposed by Scott et al 2011. The researchers believe that identification of BPSD will help to assess the pain more effectively and that, it will improve the quality of care. A sysetematic review was conducted by Zwakhalen et al. (2006) among 29 studies. Total review of 12 assessment tools were done. The researchers concluded that scales like PAINAD, PACSLAC, DOLOPLUS2 and EPUS reported the best psychometric qualities. However, the researchers reported that PACSLAC was the only scale that primarily focused on subtle changes in behavior whereas the other scales like PAINAD, DOLOPLUS2 and EPUS focused on main indicators like facial expression. From the above mentioned studies, it is evident that assessment and reassessment of pain leads to accurate scores, which is essential for providing continuing care. Authors and year Buffum & Haberfelde (2007) Davies et al (2004) Ferrari et al (2009) Pautex et al (2007) Pautex et al (2006) Pautex et al (2005) Scott et al (2011) Shega et al (2005) Zwakhalen et al (2006) Title Moving to new settings: pilot study of families perceptions of professional caregivers pain management in persons with dementia. Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient’s Pain Assessment Instrument (NOPPAIN) Psychometric properties of the Doloplus-2 observational pain assessment scale and comparison to self-assessment in hospitalized elderly Pain in severe dementia: self-assessment or observational scales? Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients. Study Protocol: The Behaviour and Pain in Dementia Study (BePAID) Factors associated with self- and caregiver report of pain among community-dwelling persons with dementia. Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools Aim To assess the appropriate pain assessment tool To verify if the Italian version of the Non-Communicative Patient’s Pain Assessment Instrument (NOPPAIN) could be used in a hospital setting To report the psychometric properties of the observational Doloplus-2 scale using the visual analog scale (VAS) pain score as a gold standard and evaluate its performance. To assess the performance of self-assessment scales in severely demented hospitalized patients and to compare it with observational data. To evaluate the feasibility and reliability of four pain self-assessment scales in this population and compare their performance to an observational pain rating scale. To examine the impact of behavioural and psychological symptoms (BPSD) and pain, during an acute hospital admission, in people with dementia. To identify patient and caregiver factors associated with self- and caregiver report of patient pain among community-dwelling persons with dementia Setting Geriatrics hospital and a geriatric psychiatry service an acute-care and intermediate-care geriatric hospital two London hospitals  Urban outpatient geriatrics clinics affiliated with a university hospital Method & Data collection Anonymous survey on 34 family caregivers 60 severely demented patients and 42 cognitive intact patients selected and NOPAIN forms administered. Prospective clinical study Prospective clinical study with there self-assessmetn tools- the verbal, horizontal visual, and faces pain scales Prospective clinical study with four undimensional self-assessment tools- visual, vertical visual and faces pain scales. Observational cohort study A cross-sectional analysis of longitudinal study using structured interviews A systematic review on publications related to dementia and psychometric properties in German, Dutcuh, English or French from 1988 to 2005 Population 34 family care givers .60 severely demented paitents and 42 cognitively intact patients 131 participants with dementia and 49 without 129 severely demented patients 160 patients with mild, moderate and severe dementia 115 dyads, 37 patients, and 57 caregivers Studies ranging from 1988 to 2005 Findings 67% not confident that staff could detect pain Positive correlation between pain scores and negative affective state scores Doloplus2 scale correlates with self assessment pain scores Observational scales correlated least moderately with self assesment Observational scales correlate only moderately with self-assessment. Caregiver depression and patient agitation significantly associated with patient-self report of pain Dopoplus2 and PACSLAC are most appropriate scales for pain assessment Limitations Heterogenic studies making results hard to compare Strength Read More