References
Appropriate pain assessment tools for use in patients with dementia in the out-of-hospital environment
Abstract
There is substantial evidence to suggest adults with cognitive impairment, caused by degenerative conditions such as dementia, are at a significantly higher risk of suboptimal pain assessment and management in the acute care setting when compared to adults without cognitive impairment. This paper aims to assess the pain assessment tools most appropriate for use in adults with cognitive impairment as a result of dementia within the out-of-hospital setting.
A search of the literature was conducted in May 2016. The databases searched were Pubmed (Medline) and Embase. The primary types of literature retrieved were meta-reviews, systematic reviews or reviews. All subcategories of dementia were included in this review. From the search strategies, 12 relevant articles and 35 pain assessment tools for use in patients with dementia were identified.
In this review, the Abbey Pain Scale and PAINAD have been identified as tools substantiated in the literature for use in detecting pain in adults with dementia, which likely have applications in the out-of-hospital environment. A trial of either the Abbey Pain Scale or PAINAD in an emergency ambulance service is appropriate and likely warranted to assess their impact on pain assessment in this vulnerable patient group.
Pain is recognised as the leading cause of presentation to acute medical services, whether in an Accident and Emergency (A&E) setting or an out-of-hospital setting (De Barardinis et al, 2013; Motov and Nelson, 2016). Optimal management involves the rapid assessment and recognition of the causative agent, with subsequent removal if possible, and appropriate analgesic administration (De Barardinis et al, 2013; Motov and Nelson, 2016). There is substantial evidence to suggest adults with cognitive impairment, caused by degenerative conditions such as dementia, are at a significantly higher risk of suboptimal pain assessment and management in the acute care setting, when compared to adults without cognitive impairment (Hwang et al, 2010; Somes and Donatelli, 2013). Evolving methods in the diagnosis of conditions such as dementia over the past two decades have seen significant variances in their projected incidence (Matthews et al, 2016). However, with up to 849 000 adults living with cognitive impairment in the UK alone the importance of addressing this key area of clinical practice cannot be understated (Luengo-Fernandez et al, 2012). A variety of tools have been developed to assist in detecting the presence of pain in the cognitively impaired adult (Somes and Donatelli, 2013), although minimal literature exists examining their usefulness in an out-of-hospital setting. This paper aims to assess the pain assessment tools most appropriate for use in adults with cognitive impairment as a result of dementia within the out-of-hospital setting.
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