Pain Assessment and Management for Older Patients With Dementia in Hospitals

An Integrative Literature Review

I-Pei Tsai, RN, PhD Candidate; Sarah Yeun-Sim Jeong, RN, PhD; Sharyn Hunter, RN, PhD

Disclosures

Pain Manag Nurs. 2018;19(1):54-71. 

In This Article

Abstract and Introduction

Abstract

Previous studies have suggested that pain in older people with dementia is often underestimated and undertreated in acute hospitals. Undermanaged pain negatively affects a person's recovery and prolongs hospital stays. However, the issues related to pain assessment and management by nurses for this group have not been fully understood. (1) To synthesize evidence about pain assessment and management for older people with dementia in hospital settings, and (2) to discuss implications for nurses and their practice. Integrative literature review. A systematic search of evidence-based research from six electronic databases (CINAHL, MEDLINE, ProQuest, Cochrane, JBI, and Scopus) was conducted for the period of 2006–2016. Following Cooper's integrative review framework and a systematic screening process, the articles included were analyzed and synthesized to identify the common issues and relationships. Fourteen empirical research articles were examined and synthesized. Two main categories were identified and include: the nursing practice of pain assessment in older patients with dementia is less than optimal, and the nursing practice of pain management for this group varies. The lack of initiation of pain assessment and use of pain assessment tools may contribute to the inadequate pain management by nurses. Whereas this review uncovered the extent and challenges related to pain assessment and management, previous studies were explorative and descriptive. The findings from the review provide nurses with an opportunity to establish empirical evidence that may improve nursing practice of pain assessment and management for older people with dementia in hospital settings.

Introduction

For older patients with dementia in acute settings, pain and dementia have been the cause of concern for many years. Dementia is a group of cognitive disorders that gradually reduce a person's ability to function in everyday life (Alzheimers' Australia, 2016) and is common among the older population admitted to hospital. A study reported that 42.4% of the older patients who were admitted to a hospital had dementia (Sampson, Blanchard, Jones, Tookman, & King, 2009). Pain, although common among older people with dementia, is often underestimated and undertreated (Achterberg et al., 2013, Alzheimers' Australia, 2011, McAuliffe et al., 2012). Because cognitive impairment limits the ability of older people with dementia to express their pain, nurses rely on what they observe. However, the behavioral and psychological symptoms of dementia, such as agitation, confusion, aggression, and hallucinations, often obscure the indicators of pain such as repeated calling out, moaning, crying, facial grimacing, restless, distressed pacing, pulling, kicking, or pushing away, which hinders pain assessment (Husebo et al., 2012, Scott et al., 2011).

Inadequate pain management attributed to inappropriate pain assessment results in a poor quality of care for older patients with dementia in acute settings (Atkinson and Almahdi, 2014, Scott et al., 2011). In particular, unmanaged pain among older patients with dementia has many detrimental consequences, such as depression, delirium, aggression, decreasing mobility and daily functioning, and prolonging hospital stays (Herr, 2011). An increased the use of analgesics for management of pain for patients with dementia has been noted in recent years (Husebo, Achterberg, & Flo, 2016). However, inadequate pain management among the older people with dementia remains an issue, and there is little known about nursing practice for this group of people in acute care settings.

Objectives

The aims of this review were: (1) to synthesize evidence about pain assessment and management for older people with dementia in acute hospital settings, and (2) to discuss implications for nurses and nursing practice.

Comments

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