• Carmelle Peisah, Judith Weaver, Lisa Wong, and Julie-Anne Strukovski.
• Behaviour Assessment Management Service, Specialist Mental Health Services for Older People, Mental Health Drug and Alcohol, Northern Sydney Local Health District, Sydney, NSW, Australia ; University of Sydney, Sydney, NSW, Australia ; University of NSW, Sydney, NSW, Australia.
• Clin Interv Aging. 2014 Jan 1;9:1767-74.

BackgroundPain is common in older people, particularly those in residential aged care facilities (RACF) and those with dementia. However, despite 20 years of discourse on pain and dementia, pain is still undetected or misinterpreted in people with dementia in residential aged care facilities, particularly those with communication difficulties.MethodsA topical survey typology with semistructured interviews was used to gather attitudes and experiences of staff from 15 RACF across Northern Sydney Local Health District.ResultsWhile pain is proactively assessed and pain charts are used in RACF, this is more often regulatory-driven than patient-driven (eg, prior to accreditation). Identification of pain and need for pain relief was ill defined and poorly understood. Both pharmacological and non-pharmacological regimes were used, but in an ad hoc, variable and unsystematic manner, with patient, staff, and attitudinal obstacles between the experience of pain and its relief.ConclusionA laborious "pain communication chain" exists between the experience of pain and its relief for people with severe dementia within RACF. Given the salience of pain for older people with dementia, we recommend early, proactive consideration and management of pain in the approach to behaviors of concern. Individualized pain measures for such residents; empowerment of nursing staff as "needs interpreters"; collaborative partnerships with common care goals between patients where possible; RACF staff, doctors, and family carers; and more meaningful use of pain charts to map response to stepped pain protocols may be useful strategies to explore in clinical settings.

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