How is pain assessed in nursing home residents with dementia?

Details

Pain is common among people with dementia living in nursing homes, but cognitive impairment, including language and communication difficulties, can make pain assessment and self-reporting difficult. The study aimed to identify and summarize patterns, advances, and gaps in research on pain assessment in this population.

The researchers conducted a scoping review following Arksey and O'Malley's methodological framework. They systematically searched CINAHL, Embase, MEDLINE, and PsycINFO. They included studies describing pain expressions in people with dementia and/or healthcare personnel's assessment of their pain in nursing homes. Charted data included demographics, methodological descriptions, ethical and quality assessment, and relevant findings. The researchers summarized relevant findings using thematic analysis and presented an overview of patterns, advances, and gaps in the literature.

The review included 39 studies. It identified three patterns: pain awareness, suspected pain, and pain mapping. Together, these patterns form a pain assessment process that integrates the pain expressions of people with dementia. Several included studies touched on important perspectives on self-reporting, but direct descriptions of attempts to capture residents' own experiences of pain were sparse.

The review describes pain assessment in nursing home residents with dementia as a three-step process. The researchers identified several gaps in understanding this process and offered concrete recommendations for further research. They emphasized the importance of flexible pain assessment approaches that can accommodate residents' varying and potentially fluctuating ways of communicating pain. The scoping review was registered in the Open Science Framework (https://osf.io/8kaf5/).