Most Effective Pain Management Strategy for Older Adults with Dementia - Literature review Example

Assessment 2 – Research Paper Catrina Bathman 110062897 NURS 3046: Nursing Project 01/11/2013 Моst еffесtivе раin mаnаgеmеnt strаtеgy for оldеr adults with dеmеntiа Introduction When people get old they often experience various changes in their body, one of such changes is decrease of their cognitive ability, which is often referred to as dementia (Asswad 2013). It is not a clinical problem and is only considered severe when accompanied by any other disorder. It interferes with the intellectual capacity of a person such that their normal activities are affected. Barnes et al (2009) point out that old people with dementia usually experience much of memory loss and keep forgetting even common things. Dementia is not an element of aging, and so not all aged people experience it as (Mayeux 2010) explain. Wolitzky‐Taylor et al (2010) explain that pain in older adults with dementia can be noticed through signs and symptoms such as, constant loss of memory, mood swings, the person often getting frustrated, inability to perform basic duties, increased forgetfulness and misplacement of things, inability to effectively communicate and change of personality. Pain in older adults makes them experience anxiety, frustration and giving them attention can be difficult because they cannot communicate well, they are unable to perform their duties and their reasoning is affected. Therefore, it is important to ensure that the right strategies are put in place to take care of older people with dementia suffering from pain. According to McAuliffe et al (2009), old people with dementia experience different form of pain, which may be from normal occurrences while others may be due to issues with their health. For people with dementia pain can often be undetected or misinterpreted such that they are not adequately attended to resulting to loss of self-esteem. Pain assessment is hard in older adults with dementia because with their reasoning and communication ability being affected, it becomes difficult for the carers and health attendants to assess their pain. Older adults with dementia are at risk of multiple sources of pain, which may result from infections, injuries or from other health disorders. Pain can be either mild or chronic and failure to manage it effectively may affect the affected persons such that they stay longer in hospital, are unable to sleep or even take longer to heal. It is therefore important for the, nurses, carers and medics to understand the most effective pain management strategies for people with dementia so that they s be able to give the sufferers maximum attention. This makes them feel appreciated and cared for despite their condition. This paper will cover the most effective strategies to manage pain to older people with dementia. Using different research papers from nursing 3044, this research work will discuss, among the many strategies of managing pain, the most effective strategies that are best in managing pain to older people with dementia. Given conditions to older persons with dementia, pain management is more complicated and hence the most effective pain strategies are essential to them. Research question What is the most effective pain management strategy for older adults with dementia? Population This review will consider the older adults from the age of 60 years suffering from dementia. Dementia is more prevalent to older people above the age of 60 years hence the review. This means that any person below this age, despite having dementia, will not be involved and will not be included in this research. This review provides the reasons for using adults above the age of sixty years. They make the review save time since they are easy to find, in hospitals, care homes and nursing homes. The visits and information gathering is therefore affordable, adequate and reliable. Issue The issue being addressed in the study is the most effective strategies that can be applied in management of pain in older adults with dementia. This is because it is notably considered that effective management of their pain will boost their quality of life and will quicken their healing because poor assessment of pain in the older adult with dementia prolongs ailment and pain, makes then discontent in life and increases their anxiety and frustrations. Comparison As stated by Gill et al (2007), the most effective pain management strategies being assessed are painkillers and Antipsychotics. The effectiveness of each method and their side effects on the population are discussed in details. Outcome The expected outcomes are effectiveness in pain assessment and management in older adults with dementia through use of the most effective strategies. Pain management strategies, to older persons with dementia, reduce, relive, make sufferers to feel cared for, and appreciated through how they are taken care. Table of findings The whole process of review has assisted the researcher significantly to build up a better understanding of the research question in various ways. Through this ways, the researcher has known how to search correctly the right information in response to the research problem. As indicated from the research process, every researcher should come up with a comprehensive and clear plan of action way before starting the research itself (actual research), this would help him or her, as it helped in this research, to gather relevant and accurate information, the researcher has benefited so much from this, (Oxford University 2005). The research problem should be phrased accordingly, clearly and in consideration of the pain management, population, outcomes and comparisons. Research question formulation to reveal and reflect PICO will aid the researcher in making well-versed decisions in the process of research exertion. The exclusion and inclusion criteria has assisted the researcher in knowing and comprehending what should form part of this research and which part should not be included. In specific, the inclusion criterion has clearly identified what the researcher should include in this research in order to get higher results. On the other hand, the exclusion criterion has assisted in knowing what the researcher ought not to include in this research for getting refined information in respect to the research question. The search strategy has helped the researcher considerably, through it; the researcher learned to use electronic databases in the research process more so in designing research problem by using key words, (Boswell 2012). Medline and Cihahl databases have suitable attributes and will thus help the researcher carry out the research as recommended by (Horgas 2003). To have access of relevant information at a greater speed, the researcher searched in connection with Boolean operators; this is from key words derived from research topic. In general, the search strategy and research process has assisted with essential data and importantly, information has improved the understanding capabilities considerably in conducting this research. Table of Findings Harvard –UNISA Referencing citation Study design/Level of evidence (if applicable) Population/ participants Sample size Intervention or Exposure or Issue Results/findings Conclusion: Author’s and yours Herr (2002) Adequate Older adults above the age of 60 years Cognitive therapy for pain relief very effective Authors: pain relief Researchers: effective Zwakhalen (2006) Reliable Older adults above the age of 65 years Cognitive behavioral therapy Effective Authors: effective Researcher: effective Horgas & Elliott (2004) Effective Older adults above the age of 55 years Pain management strategies Effective Authors: very effective Researchers: effective Horgas (2003) Reliable Older adults above the age of 65 years Pain relieving medicine Effective Authors: reliable Researchers: recommendable Herr & Garand (2001) Reliable Older adults above the age of 65 years Pain assessment and measurement strategies effective Authors: reliable and effective Researchers: good McAuliffe et al. (2009) Reliable Older adults above the age of 65 years Effectiveness in pain management Effective Authors: manageable Researchers: relieves pain Discussion Pain management is also necessary in order to allow the patients to perform their daily chores and activities to their maximum (optimally), (Herr 2002). Pain among the older adults with dementia may be caused by their poor medical conditions, medical operations and or injury. Effective management of pain for older adults with dementia, as (Horgas & Elliott 2004) suggest, is important to avoid stress. Pain management strategies are such as, occupational therapy, cognitive behavioral therapy and use of pain killer medicines and drugs as (Tenopir 2003) underpins. Older persons with dementia suffering from chronic pain may be prescribed medicines such as aspirin to relieve and treat the pain, (Zwakhalen et al. 2006). Counseling is another pain management strategy that is very effective to older patients with dementia as (McPhee & Papadakis 2010) asserts. Counseling helps the patients to cope with stress that result from pain; they are trained how to cope with pain as well as to communicate whenever they have pain. This helps older patients with dementia to manage pain effectively. The care givers should determine the condition of the older adult they are attending to before they can settle on the most effective pain management strategy to apply on each specific patient, (Kaasalainen 2007). Moreover, Giron et al (2002) explain that observing and understanding conditions, signs and symptoms that indicate pain is very essential. This will enable early treatment of the patients hence are managed adequately and effectively, (Scherder et al 2009) and (Lin et al 2011). There is no such huge gap in knowledge and practice, as (Lipton & Marshall 2013) assert, however, much has to be done to ensure that medical practitioners use the most effective pain management strategy to older people with dementia, Häyrinen et al. (2008). The implications for nurses and nursing is that failure to carry out these activities and pain management strategies, as described above, is that they will be liable for any complications to the patients. Therefore, nurses have the obligation to ensure that they carry out all strategies with due care and caution. I would not change my practice because of what I have found. I would use the knowledge to help manage pain to older people with dementia as much as possible, I would also rally the governments, medical professionals and family members to create awareness and increase care for managing pain to older persons with dementia. Conclusion The contribution of this research, pain management strategies, to medical practitioners, the government, healthcare institutions, care homes and to persons with dementia is very essential. Understanding and comprehension of pain management strategies for older persons with dementia has advanced significantly in the latest years based on the physiological, preclinical and Transdisciplinary studies. In spite of this progressed studies, more studies such as translational, Transdisciplinary and transactional approaches are recommended in order to advance the understanding and perception of the most effective pain management strategies for people with dementia, this would characterize better the profile of this condition. As such, there is need for quantitative, prospective and clinical studies for improving knowledge and understanding of the complex interplay of the various pain management strategies for older people with dementia. Studies for rigorous reduction of pain and boosting of memory are other significant avenues of research. There is a need for creating a workforce that understands completely and that responds positively to older persons with pain. Pain management strategies and principles should be embedded to nurses, trainees and students practice, as (Herr & Garand (2001) recommends. These core common strategies and principles should be applied as the general framework that can be used flexibly according to the specific needs of older people with pain and suffering from dementia. In addition, providing basis of development and training for teams, individual workers and the wider corporate education plan would improve pain management and care of older persons with dementia. Having these skills and knowledge, social care practitioners and nurses would respond timely and in an appropriate manner to the needs of older persons with emerging signs and symptoms of pain. They would also respond quickly to persons with confirmed and diagnosed any form of pain. Updating the existing practices with current guidelines and policy would improve the strategies considerably. As a matter of fact, pain management to older patients with dementia, is every nurses business, they should change their mindset and be always ready to provide the required care. With education and commissioning, nurses can make a real and huge change in pain management to older persons with dementia. References Asswad, R, G, 2013, Pass with Merit. Barnes, D, E, Covinsky, K, E, Whitmer, R, A, Kuller, L, H, Lopez, O, L,, & Yaffe, K, 2009, predicting risk of dementia in older adults the late-life dementia risk index: Neurology, 73(3), 173-179. Boswell, W, 2012, Boolean search – what does Boolean search mean, retrieved on July 2, 2013. Gill, S, S, Bronskill, S, E,, Normand, S, L, T, Anderson, G, M, Sykora, K,, Lam, K., & Rochon, P, A, 2007, antipsychotic drug use and mortality in older adults with dementia: Annals of Internal Medicine, 146(11), 775-786. Giron, M, Forsell, Y, Bernstein, C, & Fastbom, J, 2002, sleep problems in a very old population: Drug use and clinical correlates Journals of Gerontology, A-Biological Science and Medical Science. Häyrinen, K, Saranto, K, & Nykänen, P 2008, “definition, structure, content, use and impacts of electronic health records: a review of the research literature”, International journal of medical informatics, 77(5), p.291. Herr, K, 2002, Pain assessment in cognitively impaired older adults: new strategies and careful observation help pinpoint unspoken pain: AJN The American Journal of Nursing, 102(12), 65-67. Herr, K, A, & Garand, L, 2001, assessment and measurement of pain in older adults, clinics in geriatric medicine, 17(3), 457. Hersh, W, R, Crabtree, M, K, Hickam, D, H, Sacherek, L, Friedman, C, P, Tidmarsh, P, & Kraemer, D, 2002, “factors associated with success in searching MEDLINE and applying evidence to answer clinical questions”, journal of the American Medical Informatics Association, 9(3), pp.283-293. Horgas, A, L, & Elliott, A, F, 2004, Pain assessment and management in persons with dementia, Nursing Clinics of North America, 39(3), 593-606. Horgas, A, L, 2003, pain management in elderly adults: journal of infusion nursing, 26(3), 161-165. Kaasalainen, S, 2007, pain assessment in older adults with dementia: journal of Gerontological Nursing, 33(6), 6-10. Lin, P, C, Lin, L, C, Shyu, Y, I, L, & Hua, M, 2011, predictors of pain in nursing home residents with dementia: a cross-sectional study journal of Clinical Nursing, 20, 1849– 1857. Lipton, A, M, & Marshall, C, D, 2013, the common sense guide to dementia for clinicians and caregivers: New York, Springer. Mayeux, R, 2010, early Alzheimer's disease: New England Journal of Medicine, 362(23), 2194-2201. McAuliffe, L, Nay, R, O’Donnell, & Fetherstonhaugh, D, 2009, pain assessment in older people with dementia: literature review: Journal of Advanced Nursing, 65(1), 2-10. McAuliffe, L, Nay, R, O’Donnell, M, & Fetherstonhaugh, D, 2009, pain assessment in older people with dementia: literature review, journal of advanced nursing, 65(1), 2-10. McPhee, S, J, & Papadakis, M, A, (Eds) 2010, current medical diagnosis & treatment 2010, McGraw-Hill Medical. Miller, C, A, 2012, fast facts for dementia care what nurses need to know in a nutshell, New York, Springer Pub. Co. Retrieved on July 2, 2013.Top of Form Moyle, W, Olorenshaw, R, Wallis, M, & Borbasi, S, 2008, best practice for the management of older people with dementia in the acute care setting: a review of the literature: International Journal of Older People Nursing, 3(2), 121-130. National Institute for Health and Clinical Exellence (NICE), 2011, dementia: supporting people with dementia and their carers in health and social care, November, 2006, Accessed on July 2, 2013. Scherder, E, Herr, K, & Lautenbacher, S, 2009, pain in dementia: pain. Tenopir, C, 2003, “use and users of electronic library resources: an overview and analysis of recent research studies.” University of Oxford, 2005, PICO: formulating an answerable question, retrieved from: retrieved on July 2, 2013. Volicer, L, 2005, end-of-life care for people with dementia in residential care settings: Alzheimer’s association, (1)1-35. Wolitzky‐Taylor, K, B, Castriotta, N, Lenze, E, J, Stanley, M, A, & Craske, M, G, 2010, anxiety disorders in older adults: a comprehensive review: Depression and Anxiety, 27(2), 190-211. Zwakhalen, S, M, Hamers, J, P,, Abu-Saad, H, H, & Berger, M, P, 2006, pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools, BMC geriatrics, 6(1), 3. Appendix Inclusion This research will include persons who are at a higher risk of developing dementia given the risk factors; hence, persons above the age of 59 years will be included. Proper pain management will enable quick processing of information and ensure nurses give all-inclusive care, (Miller 2012). Exclusion As asserted above, persons above the age of 59 years will be included in this research and therefore persons below age 60 years even if they have dementia, (NIHCE 2011). The research will only use people in hospitals and exclude those in home reason being difficulty of accessibility due to time constrain, as (Miller 2012) asserts. Persons with dementia in intensive care unit in hospital will also not be taking in to consideration. Search strategy This research will use electronic databases namely Cinahl and Medline databases. The later contains permitted publications in nursing and healthcare field and therefore the right one for conducting this research. Such publications are like drug records, instructions on research, and medical dissertations among others. Medline contains biomedicine publications which are very useful in research, it comprises the medical journals, nursing dissertations and books, (Lipton & Marshall 2013). Key words Research question: what is the most еffесtivе раin mаnаgеmеnt strаtеgy for оldеr adults with dеmеntiа? Crucial concepts of this research will be most effective, older adults, pain management and dementia. Other crucial words that would help in this research will be cognitive impairment and chronic confusion, (Lipton & Marshall 2013). 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Definite and pain relief 23. Definite and pain reprieve method 24. Ardent and pain treatment 25. Absolute and pain relief 26. Absolute and pain management strategy 27. Absolute and pain treatment 28. Absolute and pain control strategy 29. Pain management and older adults 30. Pain treatment and elderly persons 31. Pain management and dementia 32. Aging and pain management 33. Older patients and dementia 34. Pain reprieve and older adults 35. Pain relief and dementia 36. Older people and pain management 37. Dementia not insanity 38. Pain management and treatment Read More