As our society ages, the number of persons achieving old age is exploding and represent a greater portion of the population to be cared for by health care providers or family caregivers. Many are living into their 80’s and 90’s and beyond and with age, for many, comes multiple conditions that are painful and impact quality of life. Layer that with the problem of dementia—increasingly common with advancing age—that contributes to challenges with communication and expressing needs. So what about the person with pain and dementia? Is pain readily recognized and effectively treated? My assessment is that this is not consistent practice around the world. The evidence base in understanding and impacting pain in dementia has grown tremendously and we understand more about the experience of pain, the challenges in communicating with providers, approaches to identify pain and assess pain behaviors, as well as treatments that may be effective.
However, there is much yet to learn to clearly tailor pain assessment and management for this vulnerable subset of our population. Have we identified the best predictors and indicators of pain for different dementia diagnoses? Are the existing pain behavior tools refined to be reliable and valid across subgroups and settings of care? Do we have the best approaches for engaging informal or family caregivers in recognizing and treating pain? Do we know the best nonpharmacologic approaches for those with dementia, and the adaptations needed to make them feasible and useful? What about pharmacologic management and tailoring for the safest analgesic protocols? And most importantly, how well are the assessment and management practices currently recommended being implemented in caring for persons for dementia across care settings and countries? This is probably the greatest gap that continues to need thoughtful leaders and scientists to address. Education of all involved is essential, but further strategies to promote the adoption of best practices continues to be a challenge.
Keela Herr, PhD, RN, AGSF, FGSA, FAAN
Kelting Professor & Co-Director, Csomay Center for Gerontological Excellence
How You Can Help?
Would you like to share your thoughts on our See Pain More Clearly initiative and the use of social media to mobilize knowledge about pain in dementia?
We are looking for participants to participate in a study to evaluate the effectiveness of the #seepainmoreclearly social media initiative to mobilize knowledge about pain in dementia.
More about Dr. Herr
Dr. Herr presents nationally and internationally on strategies for improving the assessment and management of pain in elders and has published extensively on the topic of elder pain. She provided expert consultation to the American Geriatrics Society (AGS), the American Pain Society (APS) and the International Association for the Study of Pain (IASP) in establishing standards for pain assessment in older persons and contributing to clinical practice guideline development. Her expertise in measurement and improving practices led to involvement in national initiatives to develop quality measures for improving pain care in various settings. Dr. Herr served on national panels to examine safety issues related to pain care in older adults, including FDA Expert Panel on Analgesic Management of Pain in Older Adults, NIA/NIH Pain Consortium Expert Panel on Pharmacological Management of Chronic Pain in Older Adults, and Technical Advisory Panel for Medication Safety for Quality Innovation Network-Quality Improvement Organization. She provided national professional leadership in service on the Board of Directors for the American Geriatrics Society, the American Society for Pain Management Nursing (ASPMN), and the American Pain Society (APS). Dr. Herr was a leader in the development of national interprofessional prelicensure core pain competencies and in identifying strategies to improve health professional pain education and practices, leading a national effort to provide best practice tools and resources to improve pain care for older adults (www.GeriatricPain.org).
Dr. Herr has received numerous awards for her contributions to geriatrics and pain care for older adults with the most recent John A. Hartford Foundation/MNRS Award for Leadership in Geriatric Nursing Research, the Lifetime Achievement Award from the National Gerontological Nurses Association and the Distinguished Researcher Award from the Hospice and Palliative Nurses Association. She is a Robert Woods Johnson Executive Nurse Fellow alumni and Fellow in the American Academy of Nursing, the American Geriatric Society and the Gerontological Society of America.