Pain management difficult for stoic residents, those with dementia, study finds

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Effective pain management in long-term care is hampered by residents' attitudes and caregivers' misinterpretation of behaviors, according to newly published research in the journal Nursing Older People.

Researchers from the Community Nursing Unit and the Catherine McAuley School of Nursing and Midwifery at University College in Cork, Ireland, undertook a study of nurses working in long-term care settings. The nurses perceived that residents' stoicism and a desire to hide their pain from others made effective pain management difficult, the researchers discovered.

Residents' medical conditions, particularly hearing and vision deficits and dementia or delirium, also created pain management challenges, the researchers found. Nurses sometimes attributed residents' behaviors to their cognitive or sensory deficits, when, in fact, the residents were in pain.

The findings suggest that care staff should actively encourage residents to verbalize their pain, and should utilize tools such as the Abbey pain scale to assess those with dementia, the researchers stated. They also warned that antipsychotic medications are sometimes prescribed in cases when a pain management intervention is actually called for.

A separate study provided further reason to exercise caution when medicating those with dementia. Four common Alzheimer's drugs do not improve cognitive function in those with mild impairments and may degrade overall health, according to an analysis of previously conducted randomized trials. These drugs are: donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon) and memantine (Namenda).

The research team was led by Andrea C. Tricco, Ph.D., of St. Michael's Hospital in Toronto. Findings appear in the Canadian Medical Association Journal.