Pain Assessment and Management Among Nursing Home Residents Living With Dementia.

Abstract

Purpose: The purpose of this study was to describe adherence to survey guidance for the assessment, diagnosis and management of pain across four nursing home communities.

Design: This was a descriptive study using baseline data from the study, Testing the Implementation of the Pain Clinical Practice Guideline Using the Evidence Integration Triangle (Pain-CPG-EIT).

Methods: Community level data were obtained from Care Compare. Resident data were obtained from the electronic medical record and direct assessments of cognitive status based on the Brief Interview for Mental Status (BIMS) and the Pain Assessment in Advanced Dementia scales.

Results: The study included 88 residents with a mean age of 81(SD = 9) and mean BIMS score of 5(SD = 5). The majority was female (72%), white (70%), and non-Hispanic (90%). For 74% of participants, the appropriate assessment tool was not used based on the individual's cognitive status. The majority (93%) of residents had pain addressed in their care plans although these were generic and not person-centered. Overall, 35% of the residents were exposed to nonpharmacologic interventions for pain, 59% were exposed to pharmacologic interventions, and only 2.9(SD = 3.6) out of 10 items were completed for appropriate use of opioids.

Conclusions: Pain assessment for residents living with dementia did not meet survey guidance and continues to be a challenge for nursing home staff.

Clinical implications: Ongoing work is needed to monitor that interventions are appropriate, effective and safe and that care plans are individualized. Increased adherence to survey guidance for the assessment and management of pain in residents living with dementia will decrease risk to the communities and improve pain assessment and management for residents.