Abstract
Objective-To study under treatment of pain in dementia patients living in assisted care and nursing homes.
Design-Randomized controlled trial. Dementia patients with a pain related diagnosis once identified, ten random patients among them identified to be subjected to the study
Setting- A home for assisted living hosting dementia patients picked at random and the required study population among the patients chosen
Participants-Ten residents who have pain related diagnosis such as arthritis picked at random using the randomized controlled trial method of sampling.
Intervention- Qualify patients on a mild pain reliever dose routinely for two weeks. After the expiry of this time, check the patient behavior against the nurse’s notes to see if behavior has changed. Maintain the treatment if any changes are registered because of the treatment.
Main outcome measures- Main outcome measure was agitation, secondary outcome measures were aggression, pain, and cognizance. The state of these measures used in project success evaluation.
Results- Agitation significantly reduced in comparison to the nurse’s notes. After two weeks of administration of a mild anesthetic, aggression reduced markedly while pain control was much more effective henceforth. Cognition was however, not improved nor deteriorated because of the treatment.
Conclusion A methodical move towards the management of pain considerably reduced agitation in residents of the nursing home with moderate to severe dementia. Effective treatment of pain can play a significant part in the treatment of agitation and could lessen the unnecessary prescriptions for psychotropic drugs in these patients.
Introduction
Dementia is a term for a severe decline in mental ability enough to affect normal living. Memory loss is an example of this mental ability decline. Alzheimer’s is the major cause of dementia known accounting for 60 to 80% while vascular dementia that occurs after a stroke incidence is the second most common type. There exists other dementia causes such as thyroid and vitamin deficiencies induced dementia including some that are reversible. Main symptoms of dementia include,
- Memory
- Communication and language
- Ability to focus and pay attention
- Reasoning and judgment
- Visual perception
Dementia incidence has been on the rise among the elder citizens and expected to continue doing so over the coming years. Projections are that the number will at least triple between 2000 and 2050. Moderate to severe cases of the disease expected to be as many as 6.5 million halfway through the century (Sloaneet 2002). With increased severity of dementia cases, families encounter daunting care giving demands and usually result to long-term care giving as the best option.
The unique nature of the disease is the major constraint in its management. The advanced deterioration of cognitive functions in the patient makes the process of diagnosing pain particularly hard. The possibility of under treatment of this pain is therefore elevated in dementia patients.
This study seeks to study the under treatment of pain in dementia patients living in assisted living and nursing homes.
Pain is an individual’s distasteful sensory or emotional experience. Acute pain occurs abruptly and spirals rapidly, while chronic pain is unrelenting or recurrent.
Pain is an exceedingly prejudiced personal experience for which there are no dependable, objective biological indicators.
Section A, problem identification
Is pain mistaken with behavior?
Dementia patient suffer from reduced cognitive functioning and are therefore susceptible to behaving in odd ways. Their odd behavior is ordinarily due to their medical condition. When these patients contract other secondary illnesses that may cause pain such as arthritis, the nurses and caregivers in their care are not able to differentiate behavior as pain induced, or normal cognizance failure in dementia patients.
Pain in dementia patients is mainly undertreated. This study will try to identify ways of treating pain in dementia patients even without their input as to their diagnosis. A mild analgesic administered over a period of two weeks on the patients. Nurses report on the behavior of the patients before the research and observation over two week’s period are to act as the control group or the reference point for the findings of the research. Patient reaction to analgesic administration carefully monitored over the two weeks period and recorded. After the research period is over, evaluation of the patients change in behavior noted and compared with the initial reactions before analgesic administration.
This problem is important to the medical field as evidence abound of dementia patients getting out of hand on their caregivers. Research that would try solving the problem of restlessness and aggression in these patients would be of great help to the field of supported living and care giving homes by making the handling of dementia patients easier.
This project seeks to establish the effect of analgesic administration on dementia patients. This study seeks to establish the aggravating effect pain has on the behavior of these patients. Aggression and anxiety are some of the few behavioral traits exhibited by dementia patients. The study seeks to establish the effect of effective pain management on the behavior patterns of these patients.
Section B, solution description
The proposed remedy for this problem shall be the routine administration of analgesics to the study group over two weeks and making observations as to their reactions. Routine administration of analgesics to dementia patients managing their pain and hence improve their behavior patterns. The treatment of pain as a condition such as hypertension and diabetes keeps the pain in manageable levels.
The administration of analgesic to dementia patients has proved to be effective in calming them down. According to research submitted to the medical journal BMJ titled, Efficacy of treating pain to reduce behavioral disturbances in residents of nursing homes with dementia: cluster randomized clinical trial, the author finds that pain caused considerably higher aggression levels in dementia patients suffering from painful diagnosis like arthritis. The research found that the administration of analgesic to the patients caused led to reduced aggressiveness by the patients and reduced anxiety
Implementation of these measures is quite easy as analgesics are ready to administer. Orally administered analgesics are the most suitable for this purpose. Injections might attract rejection and due to the indefinite nature of the treatment, not effective in the long run. Drafting a regimen for the administration of the drugs tailored to coincide with meal times will prove more effective as some dementia patients detest taking medication.
The administration of palliatives to dementia patients or to any patients for that matter is not a matter in conflict with any social, cultural or even professional guidelines. The execution of these treatments therefore not only meets cultural and social approval, but its admiration as well. Minimizing the discomfort of these patients is an ethical manner to handle patients and allow them to see out their lives in a comfortable way as possible. It is also in the interest of the caregivers that the patients are as comfortable and non-irritable as possible.
Section C, research support
Dementia patients exhibit behavioral disorders such as;
- Hitting/ kicking out at staff or even other patients.
- Relentless noise nuisance
- Explicit sexual expression both physically and verbally
- Perseveration on toilet activities
- Hostility during daily care
- Exhibition of attention seeking behaviors
Pain exacerbates this behavior in the patients. Excesses of the behaviors considerably increase the amount of time expended in the care of the patient’s by their caregivers. Some behaviors also pose personal harm to others who might be in the immediate surroundings as the patient. Pain treatment on dementia patients therefore greatly reduces the possibility of occurrence of these behaviors as a way of responding to the discomfort caused by inexpressible pain.
Numerous studies have shown the existence of a link between pain management in dementia patients and psychotic tendencies in dementia patients.
Section D, implementation plan
Pain appraisal should occur regularly, as well as when residents have circumstances likely to result in pain and if residents indicate in any manner that they have pain.
Successful pain evaluation addresses:
• Spot of pain
• Nature of pain
• Consequence of pain on the individual
• Pain stimulators
• Positive and negative consequences of treatment
For those residents who cannot verbally communicate, direct observation by staff consistently working with them can help recognize pain and pain traits.
Example: Observing residents when in motion may uncover problems that may not take place when they are at rest.
The administration of the palliatives to these patients follows as medication for other long term or terminal illnesses would follow. This is to ensure that the effect of the drugs does not wear off leading to the experience of pain by the patient. Follow up on the behaviors exhibited by the patient to undergo scrutiny to ascertain the effectiveness of the treatment towards its intended end.
Section E, evaluation plan
(a) Bibliometics on the statistical data collected during the research period shall provide an in-depth look at the actual impact of the medication in quantifiable terms.
(b) A review of case studies carried out in the same subject shall be important in testing the confidence of the conclusions. These are generally multifaceted sources of information such as regular publications, government publications on the subject matter and numerous other resources such as websites and databases
(c) Peer review on the research finding is another useful way of evaluating the research findings. Experts provide an objective view on the subject and have got a good standing in validation or otherwise of the research findings resulting from their position as experts in the medical field.
(d) Conducting economic review on the social economic impact of the findings is another great way to evaluate the feasibility of implementing the findings. Comparison between input and output magnitudes is important in determining if the results will be worth the money and time invested in its implementation.
Evaluation data collection
Data used for the research project to be collected by way of deductive conclusion. The patient’s behavior under a regimen of analgesics compared to the patient’s behavior not on any regime of painkillers. The behaviors depicted by the patients during the two periods utilized to deduce the impact the analgesics are having on their wellbeing. The deductive nature of data collection results from the inability of dementia patients to communicate reliably on their state and the effect the medication has on them.
The evaluation plan is feasible on the sense that the patient participates in the study without their knowledge. Behavior patterns are therefore unlikely to alter due to the knowledge of being under study. By deducing information from an independent patient, the research avoids the highly treacherous route of involving the patients in the study given their low likelihood to cooperate or provide objective information.
The main source of medical research is the national institute on health. The research project would qualify for funding since it falls under one of their categories for funding. Such as pain in ageing, research funding opportunity.
Non-government organization too can extend funding towards the project since it involves a huge number of Americans in advanced years or approaching are at high risk of contracting this condition. Therefore, as a matter of public interest, they would well consider funding the project.
Section F, Decision-making
The project to spread to all the care giving homes as an improved method of care-giving to elder citizens living with dementia and afflicted by painful conditions. In collaboration with the various medical publications, the research findings routinely posted in the various publications to facilitate effective and quick dissemination to the various care giving centers across the United States. Regular trials with improved medication effected from time to in trying to ascertain which medicines work best with the least side effects.
Feedback to the research team is encouraged by the creation of an online forum such as a blog where the various caregivers interact with the researchers and among themselves on their experiences implementing the findings.
References
Allender, J. A., & Rector, C. L. (1998). Readings in gerontological nursing. Philadelphia: Lippincott-Raven.
Hung, W. (2010). A prospective study of symptoms, function, and medication use during acute illness in nursing home residents: design, rationale and cohort description. (BioMed Central Ltd.) BioMed Central Ltd.
Takeda, M., Hashimoto, R., Kudo, T., Okochi, M., Tagami, S., Morihara, T., . . . Tanaka, T. (2010). Laughter and humor as complementary and alternative medicines for dementia patients. BMC Complementary and Alternative Medicine. doi:10.1186/1472-6882-10-28
