Testing the Pain-CPG-EIT

30%到80%住在养老院的痴呆症患者会感到疼痛。对于那些

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.