Pain and its consequences in dementia: Observing the complex relationship between pain, behaviour and ADL in nursing home residents

The primary aim of this thesis was to investigate the complex relationship between pain, neuropsychiatric symptoms, and ADL functioning in persons with dementia. Furthermore, we studied the psychometric properties of a new and universal observational pain assessment instrument Pain Assessment In Impaired Cognition: PAIC.The results of this thesis show that pain in nursing home residents with dementia is related to a decline in ADL functions, independent of dementia severity. Specifically, a decline in the ADL activities transferring and bathing.Additionally, the psychometric evaluation of the PAIC presented in this thesis not only results in a promising measurement instrument, but also provides useful information for the development and improvement of educational programmes that contribute to the utilization of the PAIC15.SBOH (werkgever van huisartsen en specialisten ouderengeneeskunde in opleiding) Stichting Zorggroep FlorenceLUMC / Geneeskund

Pain assessment in impaired cognition: observer agreement in a long-term care setting in patients with dementia

Geriatrics in primary carePublic Health and primary car

The impact of pain on the course of ADL functioning in patients with dementia

Item does not contain fulltextBACKGROUND: Understanding if and how pain influences activities of daily living (ADL) in dementia is essential to improving pain management and ADL functioning. This study examined the relationship between the course of pain and change in ADL functioning, both generally and regarding specific ADL functions. METHODS: Participants were Dutch nursing home residents (n = 229) with advanced dementia. ADL functioning was assessed with the Katz ADL scale, and pain with the Dutch version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-D). Changes of PACSLAC-D and Katz ADL scores were computed based on the difference in scores between baseline, 3-month and 6-month follow-up. Multivariate linear regression models were used to assess the relationships between change in pain score, change in total ADL score and specific ADL item scores during follow-up. RESULTS: At baseline, residents had a median ADL score of 18 (interquartile range 13-22, range 6-24) and 48% of the residents were in pain (PACSLAC-D ≥ 4). Residents with pain were more ADL dependent than residents without pain. A change in pain score within the first 3 months was a significant predictor for a decline in ADL functioning over the 6-month follow-up (B = 0.10, SE = 0.05, P = 0.045), and specifically, a decline on the items 'transferring' over the 6-month follow-up and 'feeding' during the first 3 months of follow-up. CONCLUSIONS: Pain is associated with ADL functioning cross-sectionally, and a change in pain score predicts a decline in ADL functioning, independent of dementia severity. Awareness of (changes in) ADL activities is clearly important and might result in both improved recognition of pain and improved pain management

Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis (vol 15, 49, 2015): Erratum

Geriatrics in primary car

Interventions targeting pain or behaviour in dementia: a systematic review.

Background: Both pain and challenging behaviour are highly prevalent in dementia, and multiple studies show that some of these behaviours may be correlated. Pain, especially in non-communicative patients, can cause challenging behaviour, and treatment of pain therefore may have an effect on behaviour. This review aims to provide a comprehensive overview of the current state of evidence regarding the effectiveness of interventions targeting pain on the outcome behaviour, and interventions targeting behaviour on pain, in dementia. Method: PubMed (MEDLINE), EMBASE, COCHRANE, CINAHL, PsychINFO and Web of Science were searched systematically. Studies were included if they focused on an intervention targeting a reduction in the person's distress, pain, and/or behaviour, and included adults with a main diagnosis of dementia. Results: Of a total of 893 potentially relevant publications that were identified, 16 publications met the inclusion criteria and were eligible for further analysis; 6 studies focused on a pain intervention targeting behaviour, 1 study focused on a behavioural intervention targeting pain, and 9 studies focused on an intervention targeting both pain and behaviour. Conclusion: Available evidence suggests that (pain) interventions targeting behaviour, and (behavioural) interventions targeting pain are effective in reducing pain and behavioural symptoms in dementia. (aut.ref.

Pain Assessment in Impaired Cognition (PAIC): Content validity of the Dutch version of a new and universal tool to measure pain in dementia

Objectives: Detection and measurement of pain in persons with dementia by using observational pain measurement tools is essential. However, the evidence for the psychometric properties of existing observational tools remains limited. Therefore, a new meta-tool has been developed: Pain Assessment in Impaired Cognition (PAIC), as a collaborative EU action. The aim is to describe the translation procedure and content validity of the Dutch version of the PAIC. Methods: Translation of the PAIC into Dutch followed the forward-backward approach of the Guidelines for Establishing Cultural Equivalence of Instruments. A questionnaire survey was administered to clinical nursing home experts (20 physicians and 20 nurses) to determine whether the PAIC items are indicative of pain and whether items are specific for pain or for other disorders (anxiety disorder, delirium, dementia, or depression). To quantify content validity, mean scores per item were calculated. Results: Eleven items were indicative of pain, for example, “frowning,” “freezing,” and “groaning.” Fifteen items were considered to be pain-specific, for example, “frowning,” “curling up,” and “complaining.” There were discrepancies between the notion of pain characteristics according to nurses and physicians, especially in the facial expressions domain. Discussion: Within the body movement domain, PAIC items correspond well with the clinical experience of the physicians and nurses. However, items in the facial expressions and vocalizations domains need further study with respect to item reduction. Also, differences were revealed in the notion of pain characteristics between physicians and nurses, suggesting the need for more interdisciplinary education on pain in dementia

Pijn en neurocognitieve stoornissen: Stand van zaken en de weg nog te gaan [Pain and neurocognitive disorders: Current state of the art and remaining challenges]

Cognitieve stoornissen kunnen de beleving van pijn veranderen en de diagnostiek en behandeling bemoeilijken. In deze review wordt vanuit een interdisciplinair perspectief de epidemiologie van pijn bij cognitieve stoornissen en de stand van zaken besproken, en samengevat waar de kennishiaten nog liggen. Dit wordt gedaan vanuit vier domeinen, namelijk 1) biologie en neuropathologie, 2) beoordeling en assessment, 3) behandeling en management, en 4) contextuele factoren zoals organisatie en opleiding. De kennishiaten bij deze 4 domeinen zijn: 1) (Biologie): Hoe verandert de pijnervaring en de uiting van pijn bij de verschillende vormen van cognitieve stoornissen? Wat zijn de oorzaak en de gevolgen van pijn in deze groepen? 2) (Assessment): Hoe herkennen, beoordelen en meten we pijn goed, als zelfrapportage niet betrouwbaar is? 3) (Behandeling): Welke behandelingen voor pijn zijn effectief? Hoe kun je die goed interdisciplinair uitvoeren? Hoe zorgen we voor goede implementatie van pijn meten en pijnbehandeling? Vooral ook van niet-farmacologisch behandelen, hoe kunnen we observaties tussen verschillende disciplines, of tussen familie en zorgverleners, beter communiceren zodat herkenning van pijn, en monitoring/evaluatie van behandeling wordt verbeterd? 4) (Contextueel): Wat kunnen we in het onderwijs doen om meer begrip, kennis en vaardigheden op dit gebied te ontwikkelen

The Pain Assessment in Impaired Cognition scale (PAIC15): A multidisciplinary and international approach to develop and test a meta-tool for pain assessment in impaired cognition, especially dementia

Contains fulltext : 213543.pdf (publisher's version ) (Open Access)Background: Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertise implemented in these scales to form an improved, "best-of" meta-tool. The EU-COST initiative "Pain in impaired cognition, especially dementia" aimed to do this by selecting items out of existing observational scales and critically re-assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task. Methods: Items from existing observational pain scales were tested for "frequency of occurrence (item difficulty)", "reliability", and "validity". This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions. Results: Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients, and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations). Conclusions: The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition, the PAIC-15 scale.17 p