Cargivers\u27 Pain Recognition in Older Adults with Chronic Pain and Dementia

Problem: Older adults with pain and dementia often are cared for by informal caregivers. Persons with dementia may not always be able to verbally communicate when they experience pain and inaccurate pain identification can result in adverse outcomes. Informal caregivers, typically spouses/family members, are tasked with accurately identifying pain for care recipients that cannot verbally communicate their pain, making their assessment skills and use of pain relieving strategies important. The purpose of this study was to examine the feasibility of an informal caregiver pain management intervention (education about pain and pain management strategies and training of how to use a pain assessment a structured scale; PASS) when caring for older adults with dementia and arthritis. Methods: The design was a single-group design with two intervention sessions and a two week follow-up. Informal caregivers of care recipients with arthritis and moderate/severe dementia were recruited from an existing memory assessment disorder clinic database. Measures included daily diary for recording structured pain scale scores, pain intensity scores, pain management strategies and care recipient negative behaviors. Additional standard instrument measured care recipient negative behaviors, and caregiver confidence and knowledge in pain assessment and management. An exit interview about using PASS was done. Results: A total of four informal caregiver/patient dyads were enrolled and received the PASS intervention. All four caregivers completed the study and used the structured pain assessment daily except for 4 days. Pain intensity on average was mild 1.8± 1.9. Descriptively, care recipients had low pain scores and caregivers used few nonpharmacological pain management strategies. After the PASS intervention caregivers reported fewer care recipients’ negative behaviors and these behaviors were less bothersome to caregivers. Caregivers’ confidence and knowledge in assessing and managing pain was slightly higher after the PASS intervention. Conclusions: Informal caregivers and care recipients may benefit from pain management interventions. The current study was a first step in examining the feasibility of informal caregivers learning more about pain management including using a structured assessment pain tool as part of pain management. A larger study is needed to further refine the PASS intervention and examine its effect on caregiver and care recipient outcomes