Pain Assessment in Nursing Home Residents Living with Dementia: Current Findings and Concerns

Prior research has noted that pain has a significant impact on quality of life, behavioral symptoms, and disease progression among older adults living with dementia. There are many factors associated with pain, and challenges to identifying pain. The purpose of this study was to describe current findings related to pain assessment among residents living with dementia in nursing homes and consider if pain is optimally evaluated. This was a descriptive cross-sectional study using baseline data from an ongoing cluster randomized trial testing the implementation of the Pain Management Clinical Practice Guideline in nursing homes. Descriptive data and medication and nonpharmacologic treatments were obtained from the Electronic Health Record. Pain assessments were obtained from the Minimum Data Set and the Pain Assessment in Alzheimer’s Disease was obtained by research evaluators. A total of 156 residents from 7 nursing homes were included. Evidence of pain ranged from 13% (verbal report) to 27% (objective assessment). The majority of assessments by staff used verbal MDS assessments. Only cognition, neurological, and musculoskeletal conditions were associated with pain. The findings from this study reinforce the challenges in measurement of pain among older adults living with dementia, support the possible benefit of using an objective measure of pain, and serve as a reminder to not only evaluate pain but to manage it with nonpharmacologic and pharmacologic interventions.