Improving the Delivery of Pain Management for People Living with Dementia

Pain has the potential to be a traumatic experience for anyone affected, however this is exacerbated when the person experiencing pain has a weakened ability to verbalise their severity of pain experience. The World Health Organisation, along with other leading groups, widely accept that access to effective pain relief is a human right.

To add further emphasis to this point, in their guidance on dementia care, HIQA are quoted saying “Older people with dementia have an inherent dignity, value and personhood which remains with them throughout the whole course of the disease and should be respected at all times. It is important that staff caring for people with dementia see the person and not the condition and residents are listened to and their perspectives and choices are honoured”.

Quoting HIQA’s Safer Better Healthcare Standards, “Service providers [should] have arrangements in place to identify, respond to, manage, monitor and review the pain and symptom needs of service users, including those who are unable to articulate verbally or express their needs, for example a child with special needs, or an adult with dementia.”

With this in mind, this post will set out to cover 3 key areas;

Antipsychotics and Benzodiazepine Use

Antipsychotic and benzodiazepine medicines are widely used among people living with dementia. However, there is evidence that they are widely misused. To start, it is worthwhile asking ‘why’?

Around 90% of people living with dementia will experience Behavioural & Psychological Symptoms of dementia (BPSD). Antipsychotic medicines are often used to minimise these episodes of BPSD to lower a person’s distress. However, historically it has been difficult to identify the drivers of these distress response behaviours. A common misconception is that

A study looking at 180,000 antipsychotic prescriptions for people living with dementia found that 140,000 of them were made inappropriately. This highlights the scale in which antipsychotics are not being used optimally. To shine a further light on the issue, antipsychotics can induce nasty side effects such as:

• Higher risk of infection
• Unsteadiness on their feet (contributing to falls risk)
• Confusion
• Drowsiness
• Swelling in lower limbs

Unrecognised and untreated pain is a leading cause of BPSD. This occurs when a person’s ability to self-report their pain is affected, putting a barrier in place to fast, effective pain relief. Effective delivery of pain management cannot be achieved unless effective pain assessments are in place.

PainChek client, Orchard Care Homes, managed to better identify and treat pain in their residents living with dementia. Since using a point-of-care assessment tool, they have better identification of pain, the number of residents on regular pain relief increased by 50%, driving a 50% reduction in distress response behaviours thought to be driven by pain. Driving an increase in regular pain relief for some residents (as opposed to PRN pain relief), and as a result drove a decrease in the use of antipsychotics and benzodiazepines. Aside from the changes to resident’s prescriptions, Orchard Care Homes also found that residents were more socially engaged in their care homes, behaviour driven safeguarding incidents had reduced and staff felt more in control of their resident’s pain experience.

Regular Pain Relief versus PRN and other Non-Pharmaceutical Therapy

Connectivity Through Data

There is a clear vision for integrated care systems that connect the world of health and care. Aged care facilities have always been data rich, however due to the legacy of paper-based systems, this data has been locked away and hard to manage. Nevertheless, as digital care management systems become more widespread and the availability of integrations between systems improving, the world of joining up care digitally is upon us.

Having integrated care systems at the heart of its operations, care providers are now in the position to facilitate a shared care model. This means GPs, Pharmacists and other allied healthcare professionals can access data relating to a persons care within the home. This reduces delays in accessing data and enables more responsive reviews of a person’s condition and medications.

It also empowers care teams in having confidence when speaking to GPs about changing a person’s pain relief. Delivering good pain management requires reliable assessment of pain, but also thorough documentation of pain. Having the ability to demonstrate a person’s pain experience through historical pain charts and reports, care teams have the necessary evidence to show GPs to justify making changes to a person’s prescription.

This effective documentation of pain also allows care providers to identify correlations between a persons pain and their behaviours. As discussed earlier, pain and BPSD have a complex relationship. Distressed responses from pain are often misdiagnosed as BPSD, but by having these chronological records of a person’s pain score over time, care providers can rule pain as the driver of these behaviours, whilst also being able to rule pain out.

If you want to learn more about how improving your pain management could help your organisation, reach out to us on 091336565