Pain management ommited from RC final report

The aged care royal commission failed to make any recommendations regarding pain management despite the subject being much discussed during its hours of hearings, researchers have found.

Analysing the Royal Commission into Aged Care Quality and Safety’s reports, researchers at HammondCare’s Dementia Centre found the word “pain” was mentioned often – 245 times in all. However, pain management wasn’t included anywhere in the commission’s 148 recommendations to government to improve the country’s aged care sector.

“The testimonial and submitted evidence on recipients’ experience of pain obtained during the [royal commission have not translated to actionable recommendations,” reads the report. “No clear pathway to pain management-specific outcomes was mapped.”

By omitting the topic from its recommendations, the royal commission showed “a lack of attention to the presented evidence,” say the researchers.

Without any actionable recommendations, the researchers – headed by Dr Mustafa Atee, who helped develop electronic pain management tool PainChek – are concerned pain management in aged care settings will remain “under-recognised and untreated.”

“A disconnection may arise between targeted policies, programs and funding schemes, and the clinical practice,” say the researchers, “thus older adults living in the community and residential aged care homes may remain vulnerable.”

Inadequate pain assessment and management is all too commonplace in aged care facilities, say the researchers. “Pain remains poorly documented, assessed and managed in Australian residential aged care homes.”

Marie Alford of Dementia Support Australia told Australian Ageing Agenda the prevalence of pain is particularly problematic for residents who are no longer able to articulate the presence, nature or intensity of pain – such as those living with dementia or cognitive impairment.

“DSA has responded to more than 65,000 cases during the past five years of people living with dementia who are experiencing behaviours and psychological symptoms. Ongoing analysis of these client cases consistently shows that the leading contributing factor to these behavioural and psychological changes is undiagnosed pain.”

Ms Alford – who also co-authored the research paper – added: “The aged care sector needs to do better in diagnosing and managing pain in people living with dementia to relieve unnecessary suffering and improve quality of life.”

In its submission to the royal commission, the Australian Pain Society provided the following recommendations:

• encourage evidence-based strategies of pain management
• facilitate a government or publicly funded multidisciplinary care in aged care homes
• restructure existing aged care funding towards evidence-based multidisciplinary pain management.

Recognising and managing pain “is a fundamental human right for all individuals,” say the researchers, “regardless of their age, gender, and cognitive status.”

Policy makers “must act now,” conclude the researchers “to restore adequate and appropriate pain management to some of Australia’s must vulnerable citizens.”

The research Does pain matter in the Australian Royal Commission into Aged Care Quality and Safety? A text mining study is published in Aging in Health Research.

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