Abstract
Pain is prevalent in older people, especially in those with advanced dementia who have communication impairments. Although pain is recognised to be present in this population, it is often under-assessed and ineffectively managed. The assessment of pain in advanced dementia is extremely challenging and complex, particularly in institutional settings such as care homes. This study systematically reviews the literature to examine and characterise the evidence for the use of pain assessment tools in care homes with individuals living with advanced dementia. Relevant publications were sourced from electronic bibliometric medical databases including AMED, CINAHL Plus, Medline, PsycINFO, EMBASE, TRIP Pro, Google Scholar, and HINARI. The database search was supplemented by screening citations and reference lists, in addition to a grey literature searches. The search identified 2221 studies, among which 26 were included in the review. The majority of the studies were observational, which created a rich source of data to create four major themes. The findings were informed and shaped by working with key stakeholders to develop a conceptual model that can contribute to developing evidence-based practice. This highlights the importance of a comprehensive, multi-disciplinary approach to pain assessment in this population, which is beyond the use of tools.
Highlights
Three additional studies were identified through citation searches, searching the reference lists, and grey literature, with a total of n = 26 studies included in the narrative synthesis (Figure 1)
The literature shows that a large number of observational pain assessment tools have been developed; this review identified 17 pain assessment scales used worldwide in care home settings for those with advanced dementia (Table 2)
Pain perception and interpretation is highly subjective and can be influenced by a number of variables. This was explored by narrative synthesis, finding key challenges, and barriers, which can affect clinical decision-making around pain in this setting and how such barriers may be addressed. These include the role of the pain assessor, when and how pain assessments are conducted, the training provided to staff to use pain tools, and if/how clinical decisions are informed around pain management
Summary
Pain in older adults is prevalent and often underestimated and under-treated, especially in institutional settings such as care homes. Individuals with advanced dementia who have limited ability or reliability to self-report pain makes the assessment even more challenging and complex [1,2,3,4,5]. There has been a relatively large number of evaluations and reviews of such pain assessment tools, there is no one tool that is recommended for use in this population [6,7]. The care home setting has unique challenges and difficulties in how to integrate pain assessment tools into practice due to the complex care needs of the residents, the high staffing turnover, and the budget considerations [8,9,10]
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