Non-Pharmacological Interventions for Pain Management of Cognitively Impaired Nursing Home Residents: A Systematic Review

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Last Modified
  • February 22, 2019
Creator
  • Allen, Elizabeth
    • Affiliation: School of Nursing
  • Beeber, Anna
    • Affiliation: Cecil G. Sheps Center for Health Services Research
Abstract
  • Background: Greater than 50% of nursing home (NH) residents are cognitively impaired, of which 45-80% experience pain on a daily basis. • Current evidence indicates suboptimal pain management of cognitively impaired older adults. • As residents with moderate to severe cognitive impairment are often unable to self-report pain, this subpopulation is at high risk for suffering. • This problem paired with age-related physiological changes that place older adults at risk for adverse reactions to pain medication suggests a need for non-pharmacological interventions. Purpose: In this systematic review, studies of non pharmacological interventions to reduce pain in cognitively impaired NH residents were reviewed. Study findings were assessed 1) to determine what interventions to reduce pain have been studied in cognitively impaired NH residents 2) to evaluate the effectiveness of these interventions, and 3) to assess the potential for these interventions to be implemented in NHs. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this systematic review. • Included studies were published in English after January 1, 2001, as JCAHO first established standards for pain assessment and treatment in 2001. • End of life interventions, single case studies, and dissertations were excluded. • PubMed, CINAHL, and Embase databases were searched on September 19, 2016. • A standardized data abstraction tool was utilized. • The quality of each study was evaluated regarding sample size, attrition, randomization, control, and blinding. • Data synthesis was conducted by using standardized vote counting within themes. Results: Across the 9 studies, there were 7 different measures of cognitive impairment and 8 different measures of pain. Studies reported 3 different categories of interventions: specialized dementia care units, training and tools to support pain assessment, and non-pharmacological therapies. Both studies of specialized dementia care units reported that residents on these units receive less pain medication than residents on open units. 2 of 4 interventions involving training and tools to support assessment were associated with deceased pain. The nonpharmacological therapies of reflexology, Passive Movement Therapy (PMT), and Namaste were all associated with a decrease in pain, but long-term maintenance of efficacy is unknown. The Namaste study was the only study to require nursing staff reorganization. In addition to the training required to implement pain assessment systems, interventionists of the 3 non-pharmacological therapies required training. No study noted the cost of implementation.
Date of publication
Keyword
DOI
Resource type
Rights statement
  • In Copyright
Conference name
  • Academy Health. Annual Research Meeting (2017: New Orleans, LA)
Language

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details Allen_NusringHome.pdf 2019-04-30 Public Download