The challenge of pain identification, assessment, and management in people with dementia: a qualitative study

Bullock, L; Chew-Graham, C; Bedson, J; Bartlam, B; Campbell, P

Abstract

Background Painful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pain management for community-dwelling people with dementia.

Aim To explore pain identification, assessment, and management for community-dwelling people with dementia.

Design & setting A qualitative study was undertaken, set in England.

Method Semi-structured interviews took place with people with dementia, family caregivers, GPs, and old-age psychiatrists. Data were analysed thematically.

Results Interviews were conducted with eight people with dementia, nine family caregivers, nine GPs, and five old-age psychiatrists. Three themes were identified that related to pain identification and assessment: gathering information to identify pain; the importance of knowing the person; and the use of pain assessment tools. A further three themes were identified that related to pain management: non-drug strategies; concerns related to analgesic medications; and responsibility of the caregiver to manage pain.

Conclusion Identifying and assessing the pain experienced by people with dementia was challenging. Most people with dementia, family caregivers, and healthcare professionals supported non-drug strategies to manage pain. The minimal concerns associated with non-drug strategies contrasted the multifactorial concerns associated with analgesic treatment for people with dementia. Given the complexity of pain identification, assessment, and management, primary care should work together with family caregivers and community services, with case finding for pain being considered in all assessment and management plans.

Citation

Bullock, L., Chew-Graham, C., Bedson, J., Bartlam, B., & Campbell, P. (2020). The challenge of pain identification, assessment, and management in people with dementia: a qualitative study. British Journal of General Practice Open (BJGP Open), 4(2), 1-14. https://doi.org/10.3399/bjgpopen20X101040

• Journal Article Type: Article
• Acceptance Date: Jan 10, 2020
• Online Publication Date: May 23, 2020
• Publication Date: 2020-06
• Journal: BJGP Open
• Print ISSN: 2398-3795
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 2
• Pages: 1-14
• DOI: https://doi.org/10.3399/bjgpopen20X101040
• Keywords: analgesics, primary health care, dementia,pain, pain management, community
• Publisher URL: https://doi.org/10.3399/bjgpopen20X101040