Pain Assessment as Management for Patients with Dementia: Long-Term Training Effects of Formal Caregivers

Wednesday, 24 July 2013

Li-Chan Lin, PhD
Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan

Learning Objective 1: The learner will be able to recognize how to assess and manage patients with dementia in long-term care facilities.

Learning Objective 2: The learner will able to understand the long-term effects by way of facial expression and appropriate cues assessing pain of residents with dementia.


The aims of this study was to compare the long-term effects of a combination of pain assessment, facial expression of pain, demonstration, return demonstration and boosted training on pain detection and management for formal caregivers.


Subjects (372 residents and 162 formal caregivers) were recruited from eight nursing homes. The eight institutions were randomly assigned into experimental group I (EI), experimental group II (EII) or the control group (CG). Formal caregivers in EI received didactic training in pain assessment and the facial expression of pain, video and discussion session on facial expression of pain, demonstration and return demonstration to record the facial expression of pain. After completing the above training, formal caregivers in EI group continually received boosted training at 3-, 6-, and 9-month. Formal caregivers in EII group received didactic training in pain assessment and facial expression of pain, but no return demonstration of record facial expression and boosted training. The CG did not receive any training and conduct their routine assessment.


 Repeated measure and general estimate equation (GEE) were used to determine the long-term effects of training. Registered nurses (RNs) and nurse aids (NAs) in EI group had higher scores of identified residents’ pain than the other two groups.  Also, residents with dementia in EI group had more pain relief medication, NSAID, muscle relaxant use than the other two groups. Further analysis, general estimate equation (GEE) revealed that EI group could maintain the pain relief medication and NSAID use, but CG had the trend of decreasing pain relief medication and NSAID use in study period. However, residents with dementia at EII had higher hospitalization than that in other two groups.


Based on the above results, it is recommended that health professionals in long-term care facilities should periodically discuss residents' pain to provide appropriate pain management.