Dementia care
which in turn has a negative impact on aspects of daily living in people with dementia.12 A recent study found that, in
addition to association of pain with more neuropsychiatric behaviours, people living with dementia who were in pain also had higher severity of these behaviours.13
In such cases, effective pain
management is needed to reduce BPSD such as depressive symptoms, anxiety, stress, or agitation. Furthermore, BPSD have been
reported to be a major source of distress for caregivers and family members.13,14 These symptoms are also often associated with the declining relationship between the person with dementia and the family members, also indicating deterioration of the person’s condition.15
Common challenges of pain assessment and management Carers are constantly grappling with the identification, management, and treatment of pain, and this can be particularly challenging among care home residents living with dementia or cognitive impairments that affect their ability to communicate. When residents have any form of cognitive impairment, it is challenging and sometimes impossible to carry out an accurate pain assessment with verbal or numerical pain scales. Everyone’s pain experience is subjective, and these methods require patients to understand questions to articulate or demonstrate the correct response. Assessing pain is most accurate when the carer has a high familiarity
with the resident, as they can pick up on changes in behaviour. In care homes, however, there are often multiple staff members caring for a single patient, meaning residents may receive a variety of different pain assessments throughout an average week. Current pain assessment methods
are predominantly paper-based and rely on caregivers to correctly identify the presence and severity of pain. Though observational pain assessments can be useful to assess changes in severity of pain over time,16
pain is a largely
subjective experience, and so the process is subject to bias.17
Using medtech to tackle the pain assessment problem Embracing the power of AI, PainChek has been developed to provide a potential
solution to the pain assessment problem in people unable to communicate. A smartphone-based medical device
operated at the point-of-care, PainChek uses facial recognition to automatically analyse and detect in real-time facial micro-expressions called action units (AUs), which are indicative of pain. This helps to limit some of the factors that could potentially limit objective pain assessment,18
including bias and human
error when assessing facial cues of pain. After detecting pain specific AUs, the user goes through a digital checklist that includes pain-specific, non-facial features observed. Following this, the app uses smart automation to calculate a total pain score and the assignment of a pain intensity level. These scores have been calibrated against the Abbey pain scale (APS), which is a standardised pain scale to assess pain for people with dementia who are unable to verbalise their needs in a meaningful way. Some 18 months since its arrival in the UK, and with over 2,000 UK care home residents currently using PainChek’s pain assessment, we undertook a recent study to investigate the validity and reliability of PainChek among a British cohort of individuals living with moderate-to- severe dementia in a UK care home. Importantly, the study set out to address the concerns around observational pain assessment instruments, and the need for a highly valid means of assessing pain in people with advanced dementia.
Methodology To conduct the study, a nurse was recruited from a care home to assess
14
www.thecarehomeenvironment.com • December 2021
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48
