The assessment of good practice in pain management in severe dementia :a pilot study

Abstract

Introduction: Dementia constitutes a major problem for sufferers, carers and society as a whole. In common with other progressive life threatening conditions, it has been increasingly recognised that the principles of palliative care should apply to patients with dementia [1]. One important aspect of care is management of pain, which may contribute to agitated behaviour in dementia. Studies suggest that pain is under-recognised and under-treated in those with severe dementia [2]. Identifying pain is the first step in its effective management. However, research has not been carried out in the UK regarding the utility of behavioural pain and distress assessment tools in those with advanced dementia. The aim of the research was to demonstrate the importance of assessing and managing pain as part of good quality palliative care in people with severe dementia. The research objectives were to investigate the utility of a pain assessment tool (Pain Assessment in Advanced Dementia scale, PAIN AD [3]) and a distress assessment tool (Disability Distress Assessment Tool, DisDAT [4]) in a UK population with severe dementia; to demonstrate the ability of the tools to measure change in pain following a change to the management regime; to assess the nature of distress that may produce a false positive result on a pain scale and to examine the use of analgesia within the nursing homes and in those identified as experiencing pain. The PAINAD was chosen for use as it is based on a well-validated scale and changes in scores have been demonstrated on 2 analgesic administration. The DisDA T was chosen for use as it identifies distress rather than just pain and allows unique behaviours to be documented. The two assessment scales were chosen, therefore, because they offered a related but contrasting approach. Whereas PAINAD stipulates the behaviours to be observed, DisDAT allows unique behaviours to be described for individuals.