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Introduction Chronic pain is often under diagnosed and inadequately managed in the elderly, particularly in care home residents, many of whom may have dementia with associated psycho-behavioural disturbance. Studies have shown a link between effective pain management and improvement in behavioural symptoms of dementia.
Methods As part of routine practice, we carried out a Comprehensive Geriatric Assessment with a focus on pain prevalence and management in 105 patients in Leicester City Care Homes. Patients were assessed for undiagnosed pain and behavioural disturbance, and pain therapy was optimised. After a minimum of three months, we looked at pain scores, behaviour and other health outcomes for these patients.
Results The majority of patients (72%) were known to have chronic pain yet 31% had uncontrolled pain; only 5 of the 22 care homes involved routinely used pain tools. 86% of patients had a dementia diagnosis, with two-thirds of these patients also having BPSD (behavioural and psychological symptoms of dementia). Approximately 10% of patients showed a possible link between increased BSPD and pain.
At follow-up, 16 patients had received treatment intervention. 94% of these patients had reduced pain, and there was an 89% improvement in BSPD. The number of both hospital admissions and falls were reduced. All care homes visited at follow-up showed an improvement in pain assessment.
Conclusions Chronic pain is poorly assessed and managed in care home residents, where there is a high burden of dementia. Providing education for care homes on the importance of managing pain resulted in significant improvements in pain assessment. Effective management of pain can reduce pain scores.