Living With dementia

Understanding how pain affects daily functioning for people living with dementia is critical to improving pain management and treatment outcomes for these individuals.

A recent study published in the peer-reviewed medical journal Age and Ageing examined the relationship between pain and change in activities of daily living (ADL) for people with dementia. The study found that pain significantly contributes to a decline in a person’s ability to carry out daily functional tasks, regardless of their dementia severity.

Below, we explore the study findings in more detail, and how comprehensive and regular pain assessment can help improve quality of life for those living with dementia.

The relationship between pain and activities of daily living (ADL) for people with dementia

In dementia, activities of daily living (ADL)—such as personal hygiene, getting dressed, eating and walking—are negatively impacted by the progressive neuropathological decline associated with the disease.

However, functional decline in people with dementia is complex and can be influenced by coexisting age-related diseases such as osteoporosis, arthritis and depression, and the use of medication such as psychotropic drugs.

The study The impact of pain on the course of ADL functioning in patients with dementia sought to better understand the relationship between pain and change in ADL functioning for people with dementia, independent of neuropathological decline. This was the first study to examine the long-term relationship between pain and ADL functioning in people with moderate to severe dementia.

Over a period of six months, researchers assessed pain in Dutch nursing home residents with dementia, using the Dutch version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-D). In addition, ADL functioning was measured with the Katz ADL scale, and data was analysed to study the relationship between pain, a change in pain score and  a change in ADL functioning.

Key findings from the study include:

    • Recognition of pain in dementia is challenging and often leads to undertreatment, with negative consequences for quality of life.
    • People with dementia and pain were more ADL dependent compared with residents without pain.
    • Pain and a change in pain affect ADL functioning in dementia, independent of dementia severity.
    • Changes in ADL functioning could serve as a red flag for the presence of pain.

The study’s researchers concluded that, “Recognising a decline in ADL functioning, both in general and in specific ADL activities, may serve as an important cue for the presence of pain. Consequently, we urge healthcare workers to focus on regular assessment of pain and ADL functions.”

A path to better pain management

These findings highlight the need for frequent and accurate pain assessment to assist in reducing, and even avoiding, functional loss in people living with dementia. Concurrently, there is a growing emphasis on care recipients being able to act independently, make their own choices and take part in their community.

Modern pain assessment tools, such as PainChek®, are designed to address these needs in two ways by:

    1. Facilitating regular, accurate pain assessment to help reduce functional loss for residents with dementia.
    2. Enabling monitoring, reporting and continuous improvement for aged care providers.

PainChek’s pain assessment app enables best-practice pain management for people who cannot reliably verbalise their pain – particularly those living with dementia and cognitive impairment. Automated trend analysis supports clinicians to identify increases in pain early, supporting proactive pain management to minimise the impact of pain on ADLs.

Demonstrated benefits include:

    • Managing medication safety – Multidisciplinary teams can analyse resident pain levels and their trends when medications have been altered.
    • Managing pressure injuries – Pain associated with skin breakdown can be assessed at the point of care.
    • Minimising restrictive practices – Clinicians can identify the presence of pain to treat it accordingly and potentially minimise unnecessary prescription and administration of psychotropic medications.
    • Enabling pain assessment for people unable to reliably communicate their pain – AI, facial analysis and smartphone technology facilitates accurate pain assessment for people with dementia or cognitive impairments.
    • Managing delirium – Pain can be a contributing factor for consumers presenting with delirium, and frequent pain assessments are key to effectively managing delirium.

Aged care provider Orchard Care Homes recently reported that, since implementing PainChek®’s pain assessment app, they have achieved:

    • 100% increase in frequency of pain assessments
    • 50% reduction in distressed behaviours thought to be associated with pain
    • 50% increase in number of residents on regular pain relief as a result of newly identified pain
    • Decrease in the use and dosage of antipsychotics, as a result of effectively managed pain

Read the full case study here.

To learn more about integrating PainChek® with your existing care systems, submit your enquiry and a member of our team will be in touch.

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