Pain assessment for people living with dementia in care homes

Pain greatly affects the quality of life of older adults and often individuals with dementia are unable to communicate their need for pain relief. Lack of awareness of chronic pain can lead to negative effects like aggression, decreased mobility and increased confusion. Observing for signs and behaviours associated with pain are important considerations in the assessment of pain for people living with advanced dementia.
Aims and objectives. To explore the use of two pain assessment scales in a sample of care home residents living with dementia.
Design and Method. This study compared the Abbey pain scale (Abbey) and the Pain assessment in Advanced Dementia scale (PAINAD) in order to assess pain in 13 long term care residents with dementia who were also presenting with behaviours that challenge. All residents had one or more potentially painful conditions. The scales were applied consecutively (Abbey then PAINAD) during the day whilst residents were at rest. Pain histories, analgesic regimens, diagnoses and demographic information were collated.

Results. There was little correlation between the two pain scales. Pain assessments were not routine practice even where mandated. Three of the thirteen residents had no regular analgesic regimen prescribed. The review of case notes found that pain assessment tools were used in 15% of the cases.

Conclusion. Staff considered both scales easy to use and helped in identifying pain, but results suggest poor adherence to best practice guidelines for assessing pain in this client group.
Relevance to Clinical Practice. Staff in care homes need a better understanding of how to assess pain in their residents. The use of observational pain scales contributes to this and promotes a better understanding of how this client group expresses pain when unable to verbally communicate.