What makes recognizing and treating pain difficult in care homes, especially for residents with dementia?

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Internationally, 2–5% of people live in residential or nursing homes, many with multiple coexisting conditions, including severe cognitive impairment. Pain is frequently considered an expected part of old age and illness, and may often be under-reported by residents or go unrecognized by care staff.

The researchers conducted a systematic scoping review to explore the complexity of recognizing, assessing and treating pain among care home residents, and to understand the contexts that might influence pain management. They used the methodological framework of Levac and colleagues. Articles were eligible if they examined pain assessment and/or management for care or nursing home residents. The researchers searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library and Google Scholar. They also screened reference lists and searched the websites of key organisations. Conversations with 16 local care home managers were included to understand their perspectives.

A total of 109 studies met the inclusion criteria. Three overarching themes were identified. The first was staff factors and beliefs: factors related to pain assessment and management, such as experience and qualifications, as well as beliefs and perceptions about pain. The second was pain assessment, including the use of pain assessment tools and assessment and management for residents with cognitive impairment. The third was interventions, including the efficacy or effects of pharmaceutical and non-pharmaceutical interventions, as well as pain training interventions and their outcomes.

Overall, the review indicated a lack of staff training and confidence in pain assessment and management. This was particularly the case for residents with dementia. The researchers concluded that care home staff need further training and detailed guidelines for appropriate pain assessment and treatment. Professionals working outside care homes also need to understand the issues facing staff and residents so that they can target their input in the most appropriate way.