Comparative differences in musculoskeletal pain consultation and analgesic prescription for people with dementia: a UK-wide matched cohort study

Exploring the complexities of symptom recognition and management in older people with dementia and multimorbidity

Many older people living with dementia experience multimorbidity, which has been described as the presence of two or more long-term conditions, such as congestive heart failure, type 2 diabetes or stroke. Each of these long-term conditions can cause a wide range of symptoms and almost all can involve pain. Older people may also experience sensory impairments, such as hearing and vision loss, which in those with dementia can lead to symptoms similar to the behavioural and psychological symptoms of dementia. In addition, older people with dementia can experience challenges with expressive and receptive communication. All these factors can make it challenging for nurses to effectively identify and manage symptoms related to long-term conditions in older people with dementia. This article provides an overview of multimorbidity in older people with dementia, using pain as an example of a symptom associated with multiple long-term conditions to illustrate the complexities of symptom recognition and management in this population. The authors also consider how communication issues, sensory impairment and diagnostic overshadowing can add to the complexities of symptom recognition and management, and outline some of the implications for nursing practice.

Family Involvement in Pain Management for People Living With Dementia: An Integrative Review

This review aimed to synthesize current evidence on family involvement in pain management for people living with dementia from the perceptions of family carers and health care professionals. An integrative review was conducted using CINAHL, Embase, PubMed, PsycINFO and Cochrane Library electronic databases. The Mixed Methods Appraisal Tool was used to appraise the articles, followed by thematic analysis. Twelve studies were included and four themes were identified: (1) The roles and responsibilities of family carers; (2) Enablers and barriers for pain identification; (3) Strategies and concerns for pain management; and (4) Lack of staff education and communication with health care providers. Family carers play an important role in pain assessment and management for people living with dementia, but they cannot be actively involved in this process due to a lack of communication with health care providers. An integrated approach that includes education and communication with family carers and health care providers is needed.