Testing the Pain-CPG-EIT

养老院中30%至80%的痴呆症患者会经历疼痛。对于那些拥有 中度至重度痴呆症口头报告疼痛可能不可靠，观察方法是 因为这些人的疼痛更有可能表现为面部表情或行为，如 作为攻击性的、激动的或不安的。缺乏准确的疼痛评估导致未得到治疗或过度- 治疗过的疼痛。未经治疗的疼痛会降低生活质量，负面影响功能，损害睡眠，增加 抑郁、激动、攻击性、对护理和使用精神药物的抵抗力。此外， 疼痛的评估、管理和治疗因疼痛敏感性、言语和语言方面的差异而复杂化 报告或陈述不同性别、种族和民族之间的痛苦。尽管不一致，但在一些 研究发现，患有痴呆症的黑人更有可能患有抑郁症和睡眠 与疼痛相关的干扰，与白人居民相比，不太可能因疼痛而接受治疗。 有基于证据的过程来评估和管理疼痛，使用药理学和 非药理学方法。对这些进行了审查，并将其纳入疼痛管理临床 AMDA最近开发的实践指南(疼痛管理CPG)：急性后和慢性疾病学会 长期护理医学。然而，翻译临床实践的使用存在许多挑战 将指导方针纳入临床环境。为了克服这些挑战，我们开发并先前测试了 基于理论的方法，并将该方法与疼痛管理CPG相结合，参考 作为疼痛-CPG-EIT。Pain-CPG-EIT涉及一名研究护士协调人与一名已确定的 社区冠军(S)和利益相关者团队为期12个月，提供以下四个组成部分： 构成部分一：建立利益攸关方团队并每月与其举行会议；构成部分二：培训 工作人员；构成部分三：指导和激励工作人员解决痛苦；构成部分四：持续评价 常住疼痛结果。12个社区将包括25名患有痴呆症和疼痛的居民 从每个社区招募。六个社区将随机接受治疗(疼痛-CPG-EIT)和六个社区 随机到纯教育(EO)，包括向员工提供与 疼痛成分II-CPG-EIT。这项研究的主要目的是测试使用疼痛的有效性- CPG-EIT将改进疼痛的评估、诊断和管理，并在 疗养院居民生活在基线、4至12个月的痴呆症患者和评估治疗 富达。这项研究的第二个目的是考虑在测量、治疗和反应方面的差异。 男性和女性以及患有痴呆症的黑人和白人居民之间的治疗。由此得出的结论 这项研究将有助于在目前关于老年人疼痛表现和管理的有限信息的基础上 在养老院中生活的痴呆症成年人，并改善遭受痛苦的老龄人口的健康公平。

Pain is experienced by 30% to 80% of residents living with dementia in nursing homes. For those with moderate to severe dementia verbal reporting of pain may not be reliable and observational approaches are recommended as pain in these individuals is more likely to present with facial expressions or behaviors such as aggression, agitation, or restlessness. Lack of accurate pain assessment results in untreated or over- treated pain. Untreated pain can lower quality of life, negatively impact function, impair sleep, increase depression, agitation, aggression, resistiveness to care and use of psychotropic medications. Further, the evaluation, management and treatment of pain are complicated by differences in pain sensitivity, verbal reporting or presentation of pain between genders, races and ethnicities. Although inconsistent, in some studies individuals living with dementia who were Black were more likely to have depression and sleep disturbances associated with pain and less likely to be treated for pain when compared to White residents. There are evidence based processes for assessment and management of pain using pharmacologic and nonpharmacological approaches. These were reviewed and included within the Pain Management Clinical Practice Guideline (Pain Management CPG) recently developed by AMDA: The Society for Post-Acute and Long-Term Care Medicine. There are, however, many challenges to translating the use of Clinical Practice Guidelines into clinical settings. To overcome these challenges we developed and previously tested a theoretically based approach and merged this approach with the Pain Management CPG, which is referred to as the PAIN-CPG-EIT. The PAIN-CPG-EIT involves a research nurse facilitator working with an identified community champion(s) and stakeholder team for 12 months to provide the following four components: Component I: Establishing and meeting monthly with a Stakeholder Team; Component II: Education of the staff; Component III: Mentoring and motivating the staff to address pain; Component IV: Ongoing evaluation of resident pain outcomes. Twelve communities will be included with 25 residents living with dementia and pain recruited from each community. Six communities will be randomized to treatment (PAIN-CPG-EIT) and six randomized to education only (EO) which involves providing the same education to staff as is done in Component II of PAIN-CPG-EIT. The primary aim of this study is to test the effectiveness of use of the PAIN- CPG-EIT to improve the assessment, diagnosis and management of pain and decrease pain intensity among nursing home residents living with dementia between baseline, 4 and 12 months and evaluate treatment fidelity. A secondary aim of the study is to consider differences in measurement, treatment and response to treatment between male and female and Black versus White residents living with dementia. Findings from this study will help build on the currently limited information about pain presentation and management among older adults living with dementia in nursing homes and improve health equity of aging populations experiencing pain.