Abstract
BackgroundInternationally, 2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the contexts that might influence its management.MethodsScoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were also screened, and website searches carried out of key organisations. Conversations with 16 local care home managers were included to gain an understanding of their perspective.ResultsInclusion criteria were met by 109 studies. Three overarching themes were identified: Staff factors and beliefs - in relation to pain assessment and management (e.g. experience, qualifications) and beliefs and perceptions relating to pain. Pain assessment – including use of pain assessment tools and assessment/management for residents with cognitive impairment. Interventions - including efficacy/effects (pharmaceutical/non pharmaceutical), and pain training interventions and their outcomes.Overall findings from the review indicated a lack of training and staff confidence in relation to pain assessment and management. This was particularly the case for residents with dementia.ConclusionsFurther training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way.
Highlights
2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment
Internationally, 2–5% of people live in residential or nursing care homes, with almost 60% of residents being over 85 years of age [1]; many live with multimorbidities, including severe cognitive impairment [2]
Pain is frequently considered an expected part of old age and morbidity, and as a consequence is often underreported by care home residents, or may go unrecognized by care staff [3]
Summary
2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. The International Association for the Study of Pain (IASP) [4] estimates that 20% of the adult population are living with chronic pain They consider pain to be individual and subjective, and assert that the inability to communicate pain verbally, for example in people with dementia, does not negate the possibility of pain being present, and the need for treatment [4]. Where the presence of pain cannot be verbalized, pain behaviors may include guarding, agitation, facial expression, or altered mobility [4] It is unclear how well such factors are understood and, when pain is identified as the probable cause of such behaviour, whether this is acted upon by care home staff [5]. In addition to such concerns, the influence of emotional state on pain is a significant factor, which is not always acknowledged [7]
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