Pain Management in Older Adults with Dementia: a Nursing Perspective

Abstract

Aim of the study: To evaluate pain management in older adults with dementia from a nursing perspective. Dementia is very common nowadays because of huge populations of older adults around the world. Pain management in dementia patients is a very crucial topic since most of the dementia patients are undertreated and end up living in pain. There hasn’t been enough research in Lithuania in regards to pain management in dementia patients as well as the assessment of nurse’s observational skills in dealing with pain in dementia patients. There is need to understand the amount of pain a patient is going through. A variety of pain testing tools are used to assess the extent of pain. In addition, pain is best treated by using both pharmacological and non-pharmacological interventions. Objectives of the study 1. To evaluate nurses’ assessment skills of pain in dementia patients. 2. To identify the tools which are used to measure pain. 3. To know the level of knowledge the nurses have in dealing with pain in older adults living with dementia. 4. To reveal the barriers which are encountered by nurses when managing pain in older adults with dementia. Research methods: A case study was used to evaluate the pain management skills for nurses on an older adult with dementia. Conclusions 1.Pain management in adults with dementia is very complex. It requires a thorough assessment through the use of pain testing tools. In the case study an abbey pain scale was used to assess the amount of pain experienced by the patient. However, it is important to note that only a few nurses are capable to accurately use pain testing tools. This is according to the literature. 2.There is a variety of pain testing tools which are used worldwide. These tools have their own strengths and weaknesses. An Abbey pain scale stands out as it covers the main domains which are; facial expressions, vocalizations, behavioral change, physiological change and physical change. The literature review has sown that an abbey pain scale is one of the most suitable pain testing tools for patients with dementia. In addition, the abbey pain scale was used in the case study to measure the amount of pain experienced by the patient. However, it is crucial to note that pain testing tools are not 100% accurate and they cannot be universally used because they are not translated into all the languages and there are various cultural and religious beliefs around the world with different views when it comes to experiencing pain. 3. The case study shows the importance of nurses’ knowledge on managing pain using both pharmacological and non-pharmacological methods. The nurses first used an abbey pain scale to measure pain. This was followed by 4 grams of paracetamol per 24 hours and regularly assessing the amount of pain using an abbey pain scale and an EPAT. Non-pharmacological treatment methods were later introduced in the form of lite exercises and creating a safe environment for the patient. 4.There are various barriers which hinder the proper management of pain in older adults with dementia. Some patients’ cultural and religious perspectives about pain can disrupt the treatment process. On the part of the nurse there are several barriers like inadequate attention to pain in older adults, lack of competence, little to no use of pain testing tools and fear of an overdose.