Despite myriad barriers, ongoing education is the best way to ensure aged care staff can adequately identify and treat pain in people living with dementia and improve their outcomes, according to an expert appearing in a new educational video out today.
Clinical nurse consultant Bronwyn Arthur is one of four experts in See Change. Think Pain. Pain management for people with dementia, a free 30-minute program produced by the Aged Care Channel in association with the Australian Pain Society.
In her consultancy role in aged and extended care at NSW Health, Ms Arthur works with a multidisciplinary team in the management of behavioural and psychological symptoms of dementia (BPSD) and delirium.
“All education is important and it is one of the most direct ways of improving patient and resident outcomes,” Ms Arthur told Australian Ageing Agenda.
She said they did a lot of education on the 3Ds – dementia, delirium and depression – and BPSD.
“The most common reason why people have misconceptions about BPSD, in my experience, is still due to the fact that people are not aware of what it is. The next thing I find is that staff are often not able to distinguish between the behavioural issues versus psychological issues in BPSD.
“I notice that there is often a poor understanding of the core symptoms of dementia, versus BPSD, and then BPSD versus delirium – this is an area where we need to assist staff in being able to better distinguish between these,” Ms Arthur said.
“The other common misperception that I find is that a lot of staff feel that the best way of managing BPSD is with antipsychotic medications.”
She said case studies and case reviews were effective for clinical education, and provided opportunity for staff discussion and reflection on what went well and what could be improved in different situations.
However, among the challenges preventing aged care staff from identifying and treating pain in people living with dementia and those with BPSD was the variable quality of education, she said.
“Although education is vital, there is often a very high turnover of staff in organisations that care for older people, so if education is not ongoing and repetitive at a basic level, then new staff do not get the benefit of this information to begin with and to build on,” said Ms Arthur.
Limited staff resources in organisations, staff needing to attend education in their own time and at their own expense, staff relying on verbal communication and the misconception that pain is a normal process of ageing, are among other barriers, she said.
Improving awareness, treatment
To promote better awareness of care for people with dementia and the treatment of pain, Ms Arthur said aged care staff and clinicians should have “a high index of suspicion around pain” when seeing changes in behaviours. She provided the following advice:
- do not be afraid to medicate for pain using appropriate doses and medications
- start low, and go slow
- be aware of poly-pharmacy, drug interactions with the various pain medications and side effects of medications versus allergic reactions, and then educate the person with dementia and families
- use validated tools like the ABBEY Pain Scale, the PAINAD, the Modified Resident’s Brief Pain Inventory, or the Brief Pain Inventory to assess for pain
- document observations well and descriptively so that anyone reading the notes can actually vividly imagine what the person documenting saw
- develop a non-pharmacological toolkit with a variety of strategies to distract when BPSD is at its worst, such as when “sundowning”
- keep families and carers informed of what is happening, educate where possible to maintain integrity and transparency of care plans and management strategies, and get them involved in care strategies where appropriate and relevant
- keep up to date with new practice
See Change. Think Pain. Pain management for people with dementia features a 20-minute presentation followed by a 10-minute discussion by a panel of experts.
Along with Ms Arthur, panellists include consultant geriatrician and pain specialist Associate Professor Benny Katz, Dr Steve Macfarlane, an Associate Professor of Aged Psychiatry, and general practitioner Dr Peter Piazza.
The program identifies barriers to pain management and explains how to assess and manage pain for people with dementia and is suitable for registered nurses, enrolled nurses, assistants in nursing, and professional aged care staff.
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