Evidence-Based Nursing Report: Pain Management in Dementia

This nursing report addresses the critical issue of pain management in dementia patients. It begins with an executive summary and table of contents, followed by an introduction to the topic and its significance. The core of the report presents four pieces of evidence, categorized by levels of evidence hierarchy, and includes descriptions, evaluations, and recommendations for each. The report then applies this evidence to a clinical situation involving a patient with vascular dementia, detailing the challenges of pain assessment and management in this context. The report references the Guideline Adaptation Committee's clinical practice guidelines, systematic reviews, randomized controlled trials, and other relevant research. The assignment concludes with a summary of the evidence and a comprehensive reference list.

Running head: NURSING
Pain management in dementia
Name of the Student
Name of the University
Author note

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Executive summary
One of the most prevalent symptoms reported by dementia patients include an experience of
pain. However, it is not adequately recognised, thus often left untreated, which deteriorates
the health and wellbeing of the patients. The report identified four scientific evidences based
on pain management, and categorised them into levels 1, 2 and 3 of the evidence hierarchy.
This was followed by reflection on a clinical encounter, following which necessary
recommendations were made, in relation to all four evidences.

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Table of Contents
Topic..........................................................................................................................................3
Significance................................................................................................................................3
Evidence description, evaluation and recommendation.............................................................4
Clinical situation......................................................................................................................15
Application of evidence to clinical situation............................................................................16
Summary of evidence...............................................................................................................16
References................................................................................................................................18

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Topic
Dementia is an umbrella term and encompass several disease that are found to create a
long-term impact on the ability to remember and think, among older individuals. The
condition affects the ability of the affected individuals to conduct activities of daily living and
also gives rise to emotional problems, and gradual deterioration of consciousness (Livingston
et al., 2017). The assignment will focus on evidences that are based on caring for older
people with dementia.
Significance
With an increase in age, people suffer from a range of health problems that create a
substantial burden on their wellbeing. Persistent pain is commonly experienced by older
adults, and elderly patients with dementia often experience similar prevalence of pain
conditions, as their non-dementia affected counterparts (Hadjistavropoulos et al., 2014).
Persistent pain also creates significant negative impact by resulting in depressed mood,
decreased ambulation, and sleep disturbances, exacerbation of cognitive functioning,
increased fall risks and impaired appetite (Hendriks et al., 2014). Despite the difficulty in
diagnosing, and identifying the presence of persistent pain among dementia patients, the
condition has been found to create profound implications on the psychosocial and functional
domains of their lives (Giebel, Sutcliffe & Challis, 2015). Healthcare professionals also
demonstrate an absence of skills and time required for the accurate assessment of patients, in
order to implement care plans for pain management.
Evidence description, evaluation and recommendation
Issue: Pain Management for older people with dementia

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Source of
Evidence
Description of Evidence Evaluate Evidence Recommendatio
ns
Guideline
Adaptation
Committee.
(2016).
Clinical
Practice
Guidelines
and Principles
of Care for
People with
Dementia-
Recommendati
ons. Retrieved
from
https://sydney.
edu.au/medicin
e/cdpc/docume
nts/resources/L
AVER_Demen
tia_Guidleines
_recommendat
ions_PRVW5.
Under circumstances when
person diagnosed with
dementia has been
suspected to suffer from
pain based on signs and
symptoms of distress or
allied behaviour, there is a
need for the staff to
recognise, monitor and
address all physical,
psychosocial and
environmental health factors
that might elevate the
likelihood of pain. Non-
pharmacological approaches
must be implemented first
for reducing pain distress,
which if not addressed
adequately, would be
subjected to analgesic
medication application.
a. Quality/Level-
Level 2 (University of
Canberra, 2018)
This level evidence is
based on an extensive
information that has
been collected from
several renowned
global healthcare
organisations and
clinical reviews
conducted by
specialists of this
domain, based on
which statements have
been proposed to
optimise dementia
patient care, in
relation to pain
management.
b. Relevance- The
primary purpose of
I would endorse
showing
adherence to this
evidence for all
elderly patients
affected with
dementia. Time
and again it has
been found that
older people with
dementia find it
difficult to report
their pain
feelings and
severity that acts
as an impediment
to the process of
caregiving. This
evidence
provides the
guideline to
nurses that upon
suspecting pain

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pdf clinical guidelines is
to enhance the quality
of care delivered to
patients, in order to
increase the clinical
effectiveness of
evidence-based
interventions that are
applied in daily
practice. Rather than
adopting a one-size-
fits-all method to
dementia patient care,
the clinical practice
guideline offers an
assessment of the
class of the pertinent
scientific evidences,
and an evaluation of
the probable
advantages and harms
of the proposed
interventions. This
information would
enable all healthcare
among the
patients, with the
use of pain
assessment tool,
the impacts of
medications on
behaviour must
be immediately
assessed. This
will form a
crucial aspect of
caregiving owing
to the fact that if
the medications
are found to not
work, as per the
anticipated goals,
alternative or
revised non-
therapeutic
strategies must be
implemented for
address pain
behaviour.

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professionals to
choose best care
approach for pain
management
of dementia patients,
based on their
preferences.
This is a new clinical
guideline that contains
an overview of up-to-
date evidences to
provide direction to
Australian healthcare
professionals for
guiding their practice.
It is extremely
applicable to pain
management in
elderly patients with
dementia.
c. Applicability-
Owing the recent
publication of this
Australian clinical
guideline, it is

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applicable to all older
people diagnosed with
dementia, residing in
Australia.
Flo, E., Gulla,
C., & Husebo,
B. S. (2014).
Effective pain
management in
patients with
dementia:
benefits
beyond
pain?. Drugs
&
aging, 31(12),
863-871.
There occurs an overlap
between neuropsychiatric
symptoms and pain among
people who have been
diagnosed with dementia.
Hence, there is a need to
conduct a differential
assessment of dementia
among the affected patients,
in relation to the presenting
neuropsychiatric complaints
and the potential
manifestation of pain, with
the aim of providing correct
interventions. In order to
ensure a sound
differentiation and
understanding of the
neuropsychiatric and pain
symptoms, more trials need
to be conducted.
a. Quality/Level-
Level 1 University of
Canberra, 2018);
This evidence is a
systematic review that
is based on
information collected
from several primary
research based pieces
of scholarly evidences
that focus on the need
of pain assessments
among older dementia
patients, and also
contain exhaustive
information on the
strategies that need to
be adopted for
providing relief from
the pain symptoms.
b. Relevance- This is a
I would
recommend
showing
adherence to the
suggestions
postulated by the
panel of experts,
in order to
provide pain
relief to older
patients suffering
from dementia.
Common causes
for pain in
dementia include
joint pressure,
sores, leg ulcer,
skin tears,
osteoarthritis or
cellulitis. Hence,
implementation

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systematic review that
has synthesised
contemporary
scientific evidences to
provide guidance to
the healthcare
professionals in their
dementia practice. The
exhaustive summary
of a range of articles
will also act crucial in
evidence-based
medicine practice,
thus considered the
highest form of
evidence. Taking into
consideration the fact
that it pools in
analyses from
research studies
having similar design,
and has been
conducted by a panel
of experts, it will help
medical professionals
of individual pain
treatment
interventions,
based on the pain
severity and
presenting
complaints of the
patients is
imperative for
enhancing their
health and
wellbeing. In
addition, efforts
must also be
taken to identify
the behavioural
disturbances that
are caused due to
pain such as,
verbal
aggression,
restlessness,
physical
aggression,
complaints and

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to reach an agreement
on the best treatment
modalities for pain
management amid
dementia patients.
c. Applicability-
Although the panel of
experts who have
presented their
opinion on effective
pain management in
dementia belong to
Norway population,
owing to the global
prevalence of
dementia, the findings
can be applied to the
local Australian
population, since
similar clinical and
methodological
challenges are
encountered by
healthcare
professionals, while
negativism.
Besides
implementing
non-
pharmacological
interventions,
severe pain must
also be treated
with the
administration of
analgesics like
paracetamol, as
recommended by
the experts.

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distinguishing
between the
symptoms of pain and
neuropsychiatric
abnormalities.
Lukas, A.,
Hagg-Grün,
U., Mayer, B.,
Fischer, T., &
Schuler, M.
(2019). Pain
assessment in
advanced
dementia.
Validity of the
German
PAINAD—a
prospective
double-blind
randomised
placebo-
controlled
trial. Pain, 160
Underreporting and
inadequate treatment of pain
among dementia patients
can be accredited to an
impairment in verbal
communication and absence
of adequate pain assessment
instruments. This calls for
the need of assessing pain in
an accurate manner, with
the use of Pain Assessment
in Advanced Dementia
(PAINAD) scale, based on
which dementia patients can
be offered pain relief.
a. Quality/Level-
Level 4 (University of
Canberra, 2018);
This evidence is a
randomised controlled
trial for determining
the reliability and
validity of PAINAD
tool for pain
assessment in
advanced dementia.
b. Relevance- This is a
recent piece of
scholarly evidence
that determined the
effects of pain
assessment tool on
I would suggest
that all healthcare
professionals
involved in
caring for
moderate
dementia patients
must utilise the
PAINAD scale
for detection of
signs and
symptoms of
pain, experienced
by the patients.
However, further
research needs to
be conducted to
determine the

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(3), 742-753. advanced dementia
patients who reported
pain symptoms, in
comparison to a
placebo group. This
experimental
procedure reduced
bias while testing the
efficacy of the
assessment tool and
allowed all patients to
have an equal chance
of getting subjected to
the intervention.
However, no major
differences were
observed in the tool
scores between
placebo patients, and
those subjected to
oxycodone treatment.
c. Applicability-
Owing to the fact that
assessment tool was
not able to elucidate
efficacy and
validity of the
tool among
advanced
dementia
patients, prior to
implementing
them in real-time
settings.