Q: Why have you focused on studying pain among nursing home patients with dementia?
A: We don’t do a good job of assessing, diagnosing the underlying cause of the pain and then managing it. We don’t, in general, with anyone, but particularly not in older adults, and particularly not in people who are living with dementia. They can’t express it, and it’s hard to interpret pain symptoms. We try to have staff use multiple different ways to look for pain and then, also, really get people to think about what could be the cause of this pain. Sometimes, it’s as simple as a fingernail digging into your hand. There can be a sore somewhere that nobody realized was there.
Q: What does your latest NIH-funded study focus on?
A: What we’re testing is how to implement the use of AMDA’s revised clinical practice guideline for pain management in nursing home residents so that the staff will use it, the staff will help make sure that the residents will engage in the behaviors that they need to — for example, range of motion exercises. Mostly what we are looking at are staff behaviors with regard to residents, and they’re all things that we’re required to do. Assess and evaluate pain: That’s a requirement, but that doesn’t mean that it always gets done in the best way possible.
Q: Are there any secondary goals?
A: First of all, demonstrating use of the Pain Management Clinical Practice Guideline will show how to use it to improve pain management among older adults in nursing homes; and secondly, demonstrating the effectiveness of this approach will provide support that this model can be used to effectively disseminate the use of a similar approach to implement this and other clinical practice guidelines in nursing homes.
