Abstract
BACKGROUND: Pain in people with dementia is under recognized, underestimated, and under-treated due to the complexity of pain assessment in this population.SUMMARY: Self-report tools are the gold standard of pain assessment. However, people with dementia are not always able to clearly and meaningfully self-report their pain. Self-report tools capture the affective experience of pain, which is impaired in people with dementia. Observational pain tools are more useful to assess pain especially in people with advanced dementia who are unable to self-report. Observational pain tools capture the physical component of pain experience, which is unchanged in people with dementia. However, nurses often misunderstand the behavioral changes associated with pain in people with dementia. Also, there is a huge inconsistency in presentation of these behavioral changes associated with pain among people with dementia as behaviors can be due to multiple different unmet needs, pain being one.
Highlights
The gold standard of pain assessment is verbal self-reporting, but meaningful verbal communication is not always possible for older adults with severe dementia (Lukas et al, 2012)
Observational pain tools capture the physical component of pain experience, which is unchanged in people with dementia
There is no single tool captures both components of pain experience in people with dementia (PWD)
Summary
The gold standard of pain assessment is verbal self-reporting, but meaningful verbal communication is not always possible for older adults with severe dementia (Lukas et al, 2012). According to Horgas and Miller (2008), the manifestations of pain in people with dementia (PWD) can be assessed by observing changes in behavior. Neither self-reporting nor observation of changes in behavior are consistently interpreted accurately by nurses in PWD. This misunderstanding and misinterpretation of the behavioral changes contribute to ineffective or poor assessment of pain leading to unrelieved pain in PWD (Kovach, 2013). Nurses often use assessment tools that underestimate pain because of poor understanding of the differences between the physical and affective aspects of the pain experience and the best method to assess pain in PWD (Kovach, Morgan, Noonan, & Brondino, 2008)
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