Research into pain in 230 people with dementia at two hospitals, conducted by University College London, indicates that the occurrence of pain experienced in hospitals may be significantly under-reported. This observational study found around two-thirds (57%) of people with dementia experience pain, but less than 40% are able to report it.
The same researchers found an association between pain and the expression of behavioural and psychological symptoms of dementia (BPSD), such as aggression, agitation and anxiety. BPSD can reflect undetected or under-managed pain, and behaviours perceived as “difficult” can – in turn – contribute to a cycle of poor care in stressful and busy hospital environments.
“ …improving pain management for people with dementia may reduce distressing behaviours and improve the quality of hospital care they receive. If staff understand that a change in behaviour in someone with dementia might indicate they are in pain, they can take simple measures to help with this. Staff are stretched in terms of time and resources, so we need to raise awareness.” Dr Liz Sampson.
People with dementia in hospital struggling with undiagnosed pain, study finds. London: Alzheimer’s Society, March 25th 2015.
This relates to:
Sampson, EL. White, N. [and] Lord, K. [et al] (2015). Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study. PAIN®. April 2015, Vol.156(4), pp.675–683.
Background to this research:
Scott, S. Jones, L. [and] Blanchard, MR. [et al] (2011). Study protocol: the behaviour and pain in dementia study (BePAID). BMC Geriatrics, October 17th 2011, 11: 61.
Local Article (New Cross Hospital)
The following broad-ranging article touches upon these issues, at a general level, in the context of a multi-faceted dementia care bundle:
“In reality, challenging behaviour can be improved by simple measures which address the underlying cause of the patient’s agitation. As cognitively impaired patients are frequently unable to communicate their symptoms, they are less likely to receive simple but important treatments such as pain relief. There is also evidence that analgesia can be highly effective at reducing challenging behaviour, indicating that much of the agitation exhibited by confused patients arises from untreated pain”. (p.7)
Adelson, N. [and] Leung, D. (2014). Cognitive impairment in a hospital setting. QMM: the Student Magazine of the University of Birmingham College of Medical and Dental Sciences. Winter 2014. p.7.
International (EU) Research
There is interesting related research, funded by the EU COST Programme.
Australian Research into Dementia and Pain Management in Care Homes
An investigation (with recommendations for improvements) into the management of pain among older people with dementia in residential aged care facilities (RACF):
Peisah, C. Weaver, J. [and] Wong, L. [et al] (2014). Silent and suffering: a pilot study exploring gaps between theory and practice in pain management for people with severe dementia in residential aged care facilities. Clinical Interventions in Aging, October 15th 2014, Vol.9, pp.1767-74. (Click here to view the PubMed abstract).