Pain management in community-dwelling older adults with moderate-to-severe dementia.

BACKGROUND: This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. METHODS: A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. FINDINGS: The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. CONCLUSION: Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.

Effectiveness of the Japanese DOLOPLUS-2: a pain assessment scale for patients with moderate-to-severe dementia.

BACKGROUND: This study aimed to assess whether the Japanese DOLOPLUS-2 scale could effectively identify pain in elderly individuals with moderate-to-severe dementia. METHODS: This study used a pre-test/post-test design with purposive sampling to select an experimental group and a historical control group. The inclusion criteria were a Functional Assessment Staging score of 5 or 6, a diagnosis of an orthopaedic disease that typically involves pain, the ability to say 'I am currently in pain' (to prevent medication errors), and a total DOLOPLUS-2 scale score ≥5 at the first pain assessment. In the experimental group (n = 19), each patient was assessed by the DOLOPLUS-2 scale at 2PM and 9PM each day for 5 days. If a patient's total score was ≥5, analgesics were prescribed and the patient was re-assessed approximately 3 hours later. In the control group (n = 20), data were collected from medical records over a 1-year period, and we matched the characteristics of the control group to that of the experimental group. We also reviewed nursing records to determine the number of times analgesics had been administered over the 5 days after the nurses had first recorded that the patient had experienced pain. RESULTS: Among the 19 patients in the experimental group, 15 received pain medication because of a total pain score ≥5. Before treatment, their mean DOLOPLUS-2 scale score was 7.5 ± 3.2, and their score significantly decreased to 2.9 ± 2.1 (P < 0.001) after treatment. The experimental group also received significantly more treatments with analgesic medication than the control group (χ(2) = 16.033, P < 0.001, φ = 0.641). CONCLUSION: This study's findings suggested that the Japanese DOLOPLUS-2 scale could adequately identify pain in elderly individuals with moderate-to-severe dementia.

Development of the Japanese DOLOPLUS-2: a pain assessment scale for the elderly with Alzheimer's disease.

BACKGROUND: Pain assessment in non-communicative patients relies primarily on observation scales. The DOLOPLUS-2 is a behavioral pain assessment scale for the elderly with impaired verbal communication. It rates five somatic items, two psychomotor items, and three psychosocial items as indicators of pain. The aims of the present study were to develop a Japanese version of the DOLOPLUS-2 and to apply it to elderly patients with Alzheimer's disease (AD). METHODS: The translated instrument was evaluated with reference to Japanese patients with AD experiencing pain during post-surgery rehabilitation for hip fractures and who were unable to use any self-reported pain measures. After translation and back-translation, 21 registered nurses tested 'Version 1' of the pain assessment scale on three patients. The ratings of the nurses and researcher were compared and the number of matching scores determined. Semistructured interviews were conducted with the nurses and patient case studies were recorded. The results of the interviews provided the basis for the development of 'Version 2' of the scale, which was then tested with six patients and 31 nurses using the same procedures as for the testing of Version 1. RESULTS: The intraclass correlation coefficient for inter-rater reliability for the Version 2 administrators was 0.90 (P < 0.001), with a 95% confidence interval of 0.88-0.92; the degree of agreement by items (0.67-0.90) was excellent. Nurses' comments for Version 1 revealed that it was 'difficult to use' and that 'some Japanese expressions and explanations needed improvement'. In contrast, the nurses' comments on Version 2 indicated that there were no problems. Analysis of patient case studies in Version 2 indicated that pain scores were high only when the patients clearly would have had pain, such as when they started with full weight bearing. On the basis of these results, we developed a final version of the Japanese DOLOPLUS-2. CONCLUSION: The findings of the present study suggest that Version 2 of the Japanese DOLOPLUS-2 can be used reliably in clinical settings to measure the pain AD patients may be experiencing. However, the final version of the Japanese DOLOPLUS-2 needs to be validated in a larger patient cohort in future studies.