Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis

Abstract Background Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. Methods Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. Results Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. Conclusion The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.

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Mapping Research Conducted on Long-Term Care Facilities for Older People in Brazil: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041522 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1522

Author(s):

Patrick Alexander Wachholz ◽

Deborah Cristina De Oliveira ◽

Kathryn Hinsliff-Smith ◽

Reena Devi ◽

Paulo José Fortes Villas Boas ◽

...

Keyword(s):

Mixed Methods ◽

Older People ◽

Study Design ◽

Scoping Review ◽

Long Term Care ◽

Assessment Tools ◽

Small Scale ◽

Term Care ◽

Care Facilities

This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured.

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Barriers and Facilitators of Pain Management in Persons With Dementia in Long-Term Care: A Scoping Review

Innovation in Aging ◽

10.1093/geroni/igab046.629 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 166-166

Author(s):

Yo-Jen Liao ◽

Ying-Ling Jao ◽

Diane Berish ◽

Lisa Kitko

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Long Term Care ◽

Care Quality ◽

Assessment Tools ◽

Barriers And Facilitators ◽

Current Evidence ◽

Original Research ◽

Term Care

Abstract Approximately 50% of individuals with dementia regularly experience moderate to severe pain, which is largely undermanaged. Several studies have explored the barriers and facilitators of pain management for persons with dementia; yet the evidence has not been systematically reviewed. This review aimed to synthesize current evidence on the barriers and facilitators of pain management in persons with dementia in long-term care. A PRISMA guided literature search was conducted in PubMed, CINAHL, and PsycINFO. Titles, abstracts, and full texts were screened. Included articles were original research examining the barriers or facilitators of pain assessment and treatment in individuals with dementia in long-term care. Quality assessment was conducted using the Risk of Bias tool and Johns Hopkins Level of Evidence. Ten studies were identified, including four quantitative studies, five qualitative studies, and one with both quantitative and qualitative research. Barriers of pain management identified include residents’ ability to self-report pain, pain medication side effects, need discrepancy among residents and their families, reluctance in administering analgesics, lack of pain assessment tools, lack of guidance in providing nonpharmacological interventions, and lack of clinical guidelines. Facilitators of pain management include clinicians with caring and enthusiastic characteristics, clinicians’ knowledge of residents, positive relationships among clinicians, good communication skills, using validated pain assessment tools, understanding pain indicators, clinical experience, and need-driven continuing education. These results can guide clinical practice in long-term care. Interventions should be developed to target these barriers and facilitators and improve pain management in persons with dementia.

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Pain assessment tools for older adults with dementia in long-term care facilities: a systematic review

Neurodegenerative Disease Management ◽

10.2217/nmt-2016-0033 ◽

2016 ◽

Vol 6 (6) ◽

pp. 525-538 ◽

Cited By ~ 14

Author(s):

Selina Chow ◽

Ronald Chow ◽

Michael Lam ◽

Leigha Rowbottom ◽

Drew Hollenberg ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Pain Assessment ◽

Long Term Care ◽

Assessment Tools ◽

Term Care ◽

Care Facilities

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A Comparison Between Behavioral and Verbal Report Pain Assessment Tools for Use with Residents in Long Term Care

Pain Management Nursing ◽

10.1016/j.pmn.2011.08.006 ◽

2013 ◽

Vol 14 (4) ◽

pp. e106-e114 ◽

Cited By ~ 17

Author(s):

Sharon Kaasalainen ◽

Noori Akhtar-Danesh ◽

Thomas Hadjistavropoulos ◽

Sandra Zwakhalen ◽

Rene Verreault

Keyword(s):

Pain Assessment ◽

Long Term Care ◽

Verbal Report ◽

Assessment Tools ◽

Term Care

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Design and Development of a Web-based Delirium Preventive Application for Long-term Care Facilities: A Methodological Study (Preprint)

10.2196/preprints.26092 ◽

2020 ◽

Author(s):

Kyoung Ja Moon ◽

Chang-Sik Son ◽

Jong-Ha Lee ◽

Mina Park

Keyword(s):

Risk Factors ◽

Long Term Care ◽

Cloud System ◽

Evidence Based ◽

Methodological Study ◽

Term Care ◽

Web Based ◽

Care Facilities ◽

Delirium Prevention

BACKGROUND Long-term care facilities demonstrate low levels of knowledge and care for patients with delirium and are often not properly equipped with an electronic medical record system, thereby hindering systematic approaches to delirium monitoring. OBJECTIVE This study aims to develop a web-based delirium preventive application (app), with an integrated predictive model, for long-term care (LTC) facilities using artificial intelligence (AI). METHODS This methodological study was conducted to develop an app and link it with the Amazon cloud system. The app was developed based on an evidence-based literature review and the validity of the AI prediction model algorithm. Participants comprised 206 persons admitted to LTC facilities. The app was developed in 5 phases. First, through a review of evidence-based literature, risk factors for predicting delirium and non-pharmaceutical contents for preventive intervention were identified. Second, the app, consisting of several screens, was designed; this involved providing basic information, predicting the onset of delirium according to risk factors, assessing delirium, and intervening for prevention. Third, based on the existing data, predictive analysis was performed, and the algorithm developed through this was calculated at the site linked to the web through the Amazon cloud system and sent back to the app. Fourth, a pilot test using the developed app was conducted with 33 patients. Fifth, the app was finalized. RESULTS We developed the Web_DeliPREVENT_4LCF for patients of LTC facilities. This app provides information on delirium, inputs risk factors, predicts and informs the degree of delirium risk, and enables delirium measurement or delirium prevention interventions to be immediately implemented with a verified tool. CONCLUSIONS This web-based application is evidence-based and offers easy mobilization and care to patients with delirium in LTC facilities. Therefore, the use of this app improves the unrecognized of delirium and predicts the degree of delirium risk, thereby helping initiatives for delirium prevention and providing interventions. This would ultimately improve patient safety and quality of care. CLINICALTRIAL none

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The psychometric properties, feasibility and utility of behavioural-observation methods in pain assessment of cognitively impaired elderly people in acute and long-term care: A systematic review

JBI Library of Systematic Reviews ◽

10.11124/jbisrir-2010-644 ◽

2010 ◽

Vol 8 (Supplement) ◽

pp. 1-33

Keyword(s):

Systematic Review ◽

Psychometric Properties ◽

Elderly People ◽

Pain Assessment ◽

Long Term Care ◽

Cognitively Impaired ◽

Term Care ◽

Behavioural Observation ◽

Observation Methods

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Issues Related to Late-Life Sexuality: Sex in Long-Term Care

Innovation in Aging ◽

10.1093/geroni/igaa057.2030 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 602-602

Author(s):

Rachael Spalding ◽

Peter Lichtenberg

Keyword(s):

Best Practice ◽

Long Term Care ◽

Social Stigma ◽

Late Life ◽

Assessment Tools ◽

Geographical Differences ◽

Term Care ◽

Practical Applications ◽

Ethical And Legal Issues

Abstract Despite surrounding social stigma and stereotypes of the “asexual older adult,” older adults, including those residing in long-term care facilities, indicate that expressing their sexuality continues to be important to them (Doll, 2013). This presentation will feature presentations regarding recent research and perspectives relevant to late-life sexuality with a focus on how issues of sexual expression may particularly emerge in long-term care settings. Dr. Maggie Syme will present findings from mixed-methods, consumer-based approaches that elucidate how current and future long-term care residents view late-life sexuality, with a focus on the practical applications of these findings to inform facility administration and policies. Ethical and legal issues surrounding sexuality in long-term care will be discussed by Dr. Pamela Teaster, who will present ethical models that can translate into potential best-practice recommendations and strategies. Rachael Spalding will discuss the paucity of psychometrically sound assessment tools for measuring attitudes towards late-life sexuality and discuss their development of such a measure. Finally, Dr. Lilanta Bradley and Dr. Pamela Payne-Foster will present a framework for sexual agency in late-life and identify relevant gaps in the literature regarding gender, ethnicity/race, and geographical differences. Ultimately, this presentation will offer a forum for lively discussion among attendees regarding these pertinent topics.

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