ASSESSMENT OF PAIN IN ELDERLY PATIENTS WITH ADVANCED DEMENTIA

Assessment of Pain in Elderly Patients with Advanced Dementia



Table of Contents

Chapter 1: Introduction3

Overview of the Problem3

Purpose4

Aim5

Objective5

Chapter 2: Literature Review6

Chapter 3: Methodology29

Research Design29

Literature Search29

Keywords29

Chapter 4: Discussion & Conclusion31

References33

Bibliography43

Chapter 1: Introduction

Overview of the Problem

The role of discomfort, both emotional and physical, is well known and accepted as an antecedent to behavioral disturbances among people with dementia (Hall & Buckwalter, 1987; Teri & Logsdon, 2000; Volicer & Hurley, 1999). The loss of ability to process, understand, and describe internal and external experiences regularly leads to behavioral expressions of distress, particularly as the disease progresses (Kovach, Weissman, Griffie, Matson, & Muchka, 1999; Volicer, 2001). Like other aging individuals, those with dementia are likely to have one or more chronic health conditions that cause pain, which, in turn, contributes to unnecessary discomfort, dysfunctional behavior, and diverse behavioral symptoms, and potential worsening of comorbid conditions. As a result, pain is an important factor to assess in older adults with dementia.

Nurses, and other allied healthcare providers that provide day-to-day care, are in key positions to facilitate accurate assessment and adequate treatment of pain, particularly among individuals in late-stage dementia who lack the ability to process their experiences and communicate needs verbally. No matter what the care setting-home, nursing home, or inpatient unit-both advanced practice and generalist nurses regularly play pivotal roles in managing complex patient care problems like pain assessment in advanced dementia. Through direct care, supervisory, educational, consultation, and interdisciplinary roles, nurses may positively influence care practice. Enhanced awareness of methods to accurately depict the pain experiences of nonverbal individuals with advanced dementia are critically important to effective care, treatment, and management across the healthcare continuum.

Dementia is an organic brain syndrome which results in global cognitive impairments. Dementia can occur as a result of a variety of neurological diseases. Some of the more well known dementing diseases include Mike Nolan's disease (AD), multi-infarct dementia (MID), and Huntington's disease (HD).

Throughout this essay the emphasis will be placed on AD (also known as dementia of the Mike Nolan's type, and primary degenerative dementia), because statistically it is the most significant dementing disease occurring in over 50% of demented patients. The clinical picture in dementia is very similar to delirium, except for the course. Delirium is an acute transitory disorder. By contrast Dementia is a long term progressive disorder (with the exception of the reversible dementias). The course of AD can range anywhere from 1.5 to 15 years with an average of about 8.1 years. AD is usually divided into three stages mild, moderate, and severe. Throughout these stages a specific sequence of cognitive deterioration is observed. (Beach, Thomas G. (1987))

Purpose

This review of literature highlights factors related to pain assessment among older adults with advanced dementia who are unable to communicate verbally. Background factors, including rates of pain among older adults as a group, common barriers to pain assessment among elderly, and problems inherent to usual pain assessment methods, are briefly reviewed to provide a framework for understanding pain assessment ...