Dec 20, 2017

Assessing Pain For People With Dementia – What Can Carers And Nurses Do To Help?

Residents of aged care facilities represent some of the frailest, physically weak and therefore the most vulnerable people in society.

Many residents have conditions, and often comorbidities, that leave them in a great amount of pain.

Dementia is particularly common in aged care residents, affecting approximately 30% of residents in low care and 60% of residents in high care.

It’s been found that many residents may not report pain for a number of reasons. Some due to their beliefs about pain and its management, while others lack the ability to effectively communicate their pain.

Identification of pain is lower in residents with cognitive impairments, such as dementia and as the severity of cognitive impairment increases, the rate of pain identification decreases.

Because of this, nurses and carers have a vital role in advocating on behalf of residents with suspected pain.

Advocacy

Advocacy is about helping residents or patients to say what they want, assisting them to obtain rights, representing their views, and helping them to gain needed services while providing practical support.

Nurses and carers are in a position to advocate on behalf of residents, in particular those with failing verbal communication skills, as seen in some people with dementia approaching end of life.

However, the need for advocacy is not limited to residents with limited verbal communication skills.

Residents in pain are a vulnerable group who often need someone to advocate on their behalf for the best possible care and pain management.

The denial of pain may be due to the fear of what worsening pain might mean – such as  disease progression, fears surrounding medications, or the belief that pain is a normal part of ageing and can’t be treated.

With respect to pain management, advocacy may involve advocating for the resident’s GP to conduct a pain assessment, advocating for an analgesic trial where pain is suspected in the verbally non‐communicative residents or to address resident’s and/or their family’s concerns about their medications.

Involving the Families and Loved Ones

People with dementia and their family members have a right to be included in their care.

However, family dynamics can also make it more difficult for nurses and carers to provide optimal support.

Holding family care meetings, starting from the time of admission, can help decrease the resident’s and family’s fear surrounding the illness, assessment and treatment.

When holding family meetings it is important to:

  • Promote a friendly and comfortable environment.
  • Make information clear and easy to understand.
  • Address any knowledge gaps.
  • Provide written information or pamphlets where needed.
  • Explain that if pain is suspected, your duty of care is to attempt to ensure all residents have their pain optimally managed.
  • Address any concerns and misconceptions they may have regarding medication use.
  • Try to encourage the family to be part of the team caring for the person.
  • Encourage family members to report any changes they may observe with the resident, in particular following adjustments to the resident’s management.

For any aged care staff who are not experienced in conducting family meetings, assistance may be available from the regional palliative care service.

What to Remember When Supporting A Resident in Pain

There are some core components that support advocacy on behalf of residents that includes:

  • Be well prepared to discuss the situation with the resident’s doctor and family. To prepare, consider discussing the case with other key people on your team.
  • Be concise when discussing the resident’s case. Refer to any assessment tools that were used to assess the resident’s condition.
  • Be aware of the needs of other members of the resident’s team including the resident’s family and care workers.
  • Support your case with good documentation, as it can increase the likelihood of a positive outcome.
  • Be aware of the facility’s culture with respect to pain management and who to ask for help.
  • Irrespective of the decision, leave the way open to review the resident’s case in the future. Be persistent if you believe the resident is suffering and/or their care can be improved.

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  1. My mother is in a nursing home. I would like her assessed by a Gerontologist who would need to visit the home. How do I go about this. We live in Sydney. I am happy to pay a consultation fee for their services.

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