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 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.
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:
For any aged care staff who are not experienced in conducting family meetings, assistance may be available from the regional palliative care service.
There are some core components that support advocacy on behalf of residents that includes:
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