Paper
Saturday, July 24, 2004
Physical and Affective Pain in People with Late-Stage Dementia
Christine Kovach, PhD, College of Nursing, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
Physical and affective pain in people with late-stage dementia are poorly assessed and inadequately treated (Feldt, Ryden, & Miles, 1998; Kovach, Weissman, Griffie, Matson, & Muchka 1999; Roberts & Gold, 1998). Unresolved physical pain is linked to numerous negative sequelae including increased morbidity and mortality, sleep disturbances, decreased socialization, malnutrition, depression, impaired immune function, impaired ambulation, and increased health care use and costs (Chang, Dunlop, Gibbs, & Hughes, 1995; Cousins, 1991; Ferrell, 1995; Liebeskind, 1991; Moss, 1997; Won et al., 1999). Likewise, affective pain has been linked to cognitive, social and functional decline (Kitwood & Bredin, 1992; Taft, Fazio, Seman, & Stansell, 1997). To address the problems of physical and affective pain in people with dementia residing in nursing homes, an innovative clinical protocol, the Assessment of Discomfort in Dementia (ADD) Protocol, for comfort assessment and management was developed. This study tests the effectiveness of the ADD Protocol under real clinical conditions as an intervention for management of discomfort in 100 people with dementia. A double-blinded randomized experimental design was used. Significant differences between the treatment and control groups included: a) physical assessment scope, procedures and findings; b) use of analgesics and non-pharmacological comfort interventions; c) nurse tenacilty to assess and intervene; and d) level of discomfort. In addition, nurses responses to behavioral symptoms will be described and include: dismissive, episodic treatment, static trialing and serial trialing. This project fills a large research gap by examining a mechanism by which differential assessment and treatment of both physical and affective pain may be realized. The results of this study have the potential to radically advance comfort care given to an undertreated population. No person should be left in pain. The ADD Protocol is unique in using analgesics as a part of the assessment process and treating both physical and affective pain.
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Sigma Theta Tau International
July 22-24, 2004