The Assignment on Developing End of Life Healthcare

Running head: LITERATURE REVIEW
LITERATURE REVIEW
Name of the student
Name of the university
Author’s name

LITERATURE REVIEW
Abstract:
In recent times, substantial progress has been made in developing end-of-life healthcare, but
individuals suffering from dementia still die with inadequate pain control, feed tubes in place
and hospice care. Individuals of neurological conditions like dementia are vulnerable classes of
people in which the discomfort is often under recognized, misunderstood and undertreated. A
major barrier to effective treatment is the failure to effectively express pain in moderate-severe
dementia, and several observational studies have shown that pain is being undertreated in
elderly people with cognitive issues. Neuropsychiatric dementia signs such as anxiety, assault
and mood disturbance, as well as issues with sleep have associated discomfort. Successful pain
management has been shown to be effective to mediate or relieve these effects. This review thus
focuses on exploring the barriers to pain management in these patients and also provides
recommendation to improve care and treatment plan for these patients and improve their overall
health outcome.

LITERATURE REVIEW
Introduction:
Patient suffering from dementia are at a high risk of experiencing pain as they are unable
to express or communicate about their problems as a result of their cognitive impairment.
Therefore, this population group is more susceptible to pain because of their inability to self-
report. Their pain is often left undertreated and under assessed and therefore, for these patients, a
comprehensive and palliative care is needed by addressing and accessing their health concerns.
Studies show that self-reporting is an important factor to manage as well as assess the pain, and
incapacity to communicate is a significant barrier in effective pain management in older patients
with dementia. Dementia belongs to a group of diseases characterised with a gradual and
progressive and in certain cases an irreversible deterioration in mental functioning. It is mainly
characterised by a reduced cognitive abilities due to damage in the neurons in some areas of the
brain complemented by a deteriorated emotional control, motivation and social behaviour which
over time intensifies and increases. In Ireland, it has been reported that the prevalence of
dementia is exponentially increasing with age and are almost doubling every five years. Females
are found to be more prevalent to suffer fromdementia in their old age. It has been reported that
about 35 million people worldwide, are affected by dementia. The increasing rate of older people
suffering from dementia, pressurizes the healthcare providers and healthcare services to meet the
need for treatment and care for these people since pain management is a significant challenge in
patients with dementia.
Search strategy:
For conducting this literature review several online databases such as CINAHL, Pub Med
and Google Scholar were searched to find the appropriate articles relevant to the research area. A

LITERATURE REVIEW
total of 25 articles were found to be relevant to the topic, however, out of those 25 articles, only
10 articles were found to be matching with the inclusion criteria. All the papers which did not
have conclusive research findings and lack proper analysis and supporting studies were
excluded. The articles extracted or filtered based on the information they have which could be
accessed by skimming through the abstract of the articles. Each articles were analysed based on
the criteria of including and the articles that did not match the criteria were excluded from the
study. Certain keywords like “Dementia”, “Dementia and pain”, “Pain management in older
patients”, “Barriers to pain management in older dementia patients:’ “causes of pain in dementia
patients”, “Chronic pain in older patients with dementia”, “barriers to pain management”, “older
patients and dementia” were searched. The studies that were included in the review were
conducted from 2010-19 to get the current findings on this topic.
Critical appraisal:
Corbett, A., Nunez, K.M., Smeaton, E., Testad, I., Thomas, A.J., Closs, S.J., Briggs, M.,
Clifton, L., Gjestsen, M.T. and Lawrence, V., 2016. The landscape of pain management in
people with dementia living in care homes: A mixed methods study. International journal of
geriatric psychiatry, 31(12), pp.1354-1370.
Questions/Criteria Response and Justification
Was there a clear statement of the
aims of the research?
Yes. The study aims to approach the current pain
management landscape in the homecare providing
places for the people with dementia.
Is a qualitative methodology Yes. Stakeholder consultation triangulation and pain
management advice standard assurance have been

LITERATURE REVIEW
appropriate? conducted.
Was the research design appropriate to
address the aims of the research?
Yes.
Was the recruitment strategy
appropriate to the aims of the
research?
No such strategies have been mentioned in the study.
Was the data collected in a way that
addressed the research issue?
Yes. In order to identify themes and sub-themes, the
data is subjected to thematic review. Reports were
checked and suggestions were provided by an expert
panel.
Has the relationship between
researcher and participants been
adequately considered?
No such information has been provided.
Have ethical issues been taken into
consideration?
Yes.
Was the data analysis sufficiently Yes. There have been 15 existing guidelines, three
designed for dementia use and no adapted to the

LITERATURE REVIEW
rigorous? home setting. Six main trends of pain management in
dementia were observed in the area of thematic
analysis: significance of personal centering, current
pain sensitivity of staff empathy as a central element,
difference of staffing accountability and confidence,
need for consistent treatment and the lack of training
for workers currently in progress. The expert panel
identified promising candidates for pharmacological
therapy in relation to the medical requirements that
require clinical evaluation.
Is there a clear statement of findings? Yes. The findings of this study clearly explain the
need for a pain management system based on
evidence for nursing homes that is centered on
stakeholder feedback and on a conceptual framework
for this purpose.
How valuable is the research? The aim of this study is to explore the present pain
management landscape in people living in health care
facilities with dementia. In this patient group, pain is
very common, but health professionals are guided by
very little.