Behavioural pain assessment and management tools for people with advanced dementia
1. Behavioural pain assessment for people with advanced dementia Jo Hockley RN PhD MSc SCM Nurse Consultant for Care Homes, St Christopher’s Hospice, London Honorary Fellow, University of Edinburgh
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4. Most common symptoms identified during the last year of life among people with dementia. [McCarthy et al, 1997] SYMPTOMS PERCENTAGE Mental confusion 83% Urinary incontinence 72% Pain* 64% Low mood 61% Constipation* 59% Loss of appetite* 57%
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21. GERIATRIC DEPRESSION SCALE (GDS) NAME: DATE: 1 Are you basically satisfied with your life? Yes No 2 Have you dropped many of your activities or interests? Yes No 3 Do you feel that your life is empty? Yes No 4 Do you often feel bored? Yes No 5 Are you in good spirits most of the time? Yes No 6 Are you afraid that something bad is going to happen to you? Yes No 7 Do you feel happy most of the time? Yes No 8 Do you often feel helpless? Yes No 9 Do you prefer to stay at home, rather than going out and doing new things? Yes No 10 Do you feel you have more problems with your memory than most? Yes No 11 Do you think it is wonderful to be alive? Yes No 12 Do you feel pretty worthless the way you are now Yes No 13 Do you feel full of energy? Yes No 14 Do you feel that your situation is hopeless? Yes No 15 Do you think that most people are better off than you are? Yes No > 5 problems (answers in BOLD) indicates probable depression TOTAL:
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Notes de l'éditeur
Different CONTEXT in which to die + Different DYING TRAJECTORY NHs - £460/week HOSPICES - £1700/week (then 2/3rds of that is fund raised)
A survey of 13,625 elderly cancer patients in NHs across the US revealed that 26% of all those with daily pain received no analgesics, and that a disproportionate number of this group were cognitively impaired (Bernabei et al 1998) Most pain is related to musculoskeletal problems and neuropathies – also cancer, but number of residents dying of a known cancer in NHs across Lothian is limited.
McCarthy’s paper from the Int. J. Geriatric Psychiatry (1997) What this paper also showed was the longer palliative care trajectory compared to that of cancer patients. For too long ‘dementia’ has been seen as a social disease. Often dementia is not put down on a death certificate as though it is not a bona fide disease to be dying from. Just like any other disease people with dementia will die – I will end my talk with a reference to the last few days of life with an adult suffering far advanced, incurable dementia Before closing with slide I would like to say that urinary incontinence is obviously prelavent in end stage dementia. Suffice it to say that often I have seen excellent care assistants ignorant of washing people after incontinence – and the importance of not increasing the incident of urinary tract infection especially in women because they don’t know how easy it is to contaminate the urine by not washing properly. What this paper does not report is the increase in falls as a natural part of the progression of dementia. What we are seeing in Reversed development of the first 5 years
Usual questions that any pain tool might have + the simple NUMERICAL pain intensity scale TO BE USED as an INITIAL ASSESSMENT
Common signs & symptoms of physical or affective discomfort in late-stage dementia increased agitation, fidgeting & repetitive movements tense muscles, body bracing increased call out, repetitive verbalizations decreased functional ability, withdrawal changes in sleep pattern increase in pulse, blood pressure & sweating
BEHAVOURAL ASSESSMENT - divided into 3 sections for staff to assess SOMATIC REACTIONS; PSYCHOMOTOR REACTIONS; PSYCHOSOCIAL REACTIONS - and how much these are different from the resident’s normal behaviour.
Morphine is much less nauseating than ‘codeine’ – and much less sedating that Co-codamol 30mg/500