Systematic Pain Assessment in Nursing Home Residents With Advanced Dementia

Oslo Metropolitan University

Status: Completed

Conditions: Quality of Life; Dementia; Pain

Treatments: Other: Pain assessment

Study type: Interventional

Funder types: Other

Identifiers

NCT02945865

REK 2014/1431

Details and patient eligibility

About

It is estimated that 45-80 % of nursing home residents have substantial pain at any given time. Residents with impaired cognition have been found to report chronic pain more often, more frequent and more severe, compared to residents with normal cognition. Approximately 3/4 of permanent residents in nursing homes in Norway have developed dementia. The burden of dementia is often compounded by painful conditions. Despite over a decade of research on the subject, inadequate pain assessment and management remain significant problems among institutionalized older adults, with and without dementia. The poor pain management in patients with dementia has been attributed, at least in part, to difficulties with, and lack of, pain assessment in this population. Therefore, this study seek to determine the effect of regular pain assessment.

Full description

The aim of the study is to determine the effect of regular pain assessment on pain management interventions applied and patient outcomes among patient with severe dementia.

A cluster randomized controlled trial will be conducted. A cluster is defined as a single independent nursing home. The clusters will be randomly assigned to either the experimental or control condition. Appropriate information will be given to both the intervention and the control group. All nurses in the experimental conditions will be taught how to administer the DOLOPLUS-2. The study will start after the initial education session. During the 3-month study period, the participating nursing staff will be asked to complete the DOLOPLUS-2 regularly. The control groups will receive standard methods of care. Data collection at baseline and at 4, 8 and 12 months.

Enrollment: 112 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ≥ 65 years old
• Dementia diagnosis
• Severe language impairment/non-communicative
• Clinically significant pain and/or behavioral symptoms: a score of at least 44 on the Norwegian version of the Cohen-Mansfield Agitation Inventory (CMAI),
• or a score of at least 4 (frequency × severity) on items of the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH),
• or an indication of clinically significant pain (≥ 5) according to the DOLOPLUS-2 at baseline

Exclusion criteria

• Short term stay, < 4 weeks
• Primary psychiatric diagnosis
• Delirium

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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112 participants in 2 patient groups

ITreatment arm: Pain Assessment

Experimental group

Description:

Pain assessment by Doloplus-2 pain scale regularly and additional pain assessment in situations where pain is suspected.

Treatment:

Other: Pain assessment

Control arm: No treatment

No Intervention group

Description:

Treatment us usual