Testing the Pain-CPG-EIT

在养老院中，30%至80%的痴呆症患者会经历疼痛。者 中度至重度痴呆患者口头报告疼痛可能不可靠，观察方法 建议这些人的疼痛更有可能表现为面部表情或行为， 攻击性、激动或不安。缺乏准确的疼痛评估导致未经治疗或过度- 治疗疼痛。未经治疗的疼痛会降低生活质量，对功能产生负面影响，损害睡眠，增加 抑郁、激动、攻击性、不愿接受护理和使用精神药物。此夕h 疼痛的评估、管理和治疗由于疼痛敏感性、语言和生理上的差异而变得复杂。 性别、人种和种族之间疼痛的报告或表现。虽然不一致，但在一些 研究表明，患有痴呆症的黑人更容易患抑郁症， 与白色居民相比，与疼痛相关的障碍和不太可能接受疼痛治疗。 有基于证据的过程，用于使用药理学和药理学方法评估和管理疼痛。 非药理学方法。这些已进行审查并纳入疼痛管理临床中 AMDA最近制定的实践指南（疼痛管理CPG）：急性后和 长期护理医学然而，翻译临床实践的使用存在许多挑战 临床应用指南。为了克服这些挑战，我们开发并测试了 基于理论的方法，并将这种方法与疼痛管理CPG合并， 作为PAIN-CPG-EIT。PAIN-CPG-EIT涉及一名研究护士促进者， 社区倡导者和利益相关者团队为期12个月，提供以下四个组成部分： 第一部分：建立利益攸关方小组并每月与之举行会议;第二部分： 第三部分：指导和激励工作人员解决疼痛问题;第四部分： 住院疼痛结果。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。6个社区将被随机分配至治疗组（PAIN-CPG-EIT）， 随机分配至仅接受教育（EO），这涉及向员工提供与 PAIN-CPG-EIT的组分II。本研究的主要目的是测试使用Pain的有效性， CPG-EIT改善疼痛的评估，诊断和管理，并降低疼痛强度， 在基线、4个月和12个月之间患有痴呆症的疗养院居民，并评估治疗 忠诚该研究的第二个目的是考虑测量，治疗和反应的差异， 男性和女性以及黑人和白色痴呆症患者之间的治疗。时发现的问题 这项研究将有助于建立在目前有限的信息疼痛的介绍和管理之间的老年人 老年痴呆症患者在疗养院生活，并改善健康公平的老龄人口经历的痛苦。

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.