PAIN ASSESSMENT IN PEOPLE WITH SEVERE COGNITIVE IMPAIRMENTS—DO NURSES USE OBSERVATIONAL INSTRUMENTS? Open Access

Many nursing home residents with cognitive impairments (CI) suffer from chronic pain, which is also discussed as a reason for challenging behavior. Because of their impaired communication abilities it is recommended to use an observational pain-instrument for the assessment. It is not known, if in German nursing homes the pain assessment for residents with severe CI is performed with the help of observational instruments or if also self-rating instruments are used. We assumed that in Dementia Care Units (DCU) observational pain instruments should be used more often than in Traditional Care Units (TCU). To find this out, we analyzed cross-sectional data from n=1397 residents living in n=75 care units (n=30 DCUs and n=45 TCUs). Descriptive statistics showed that in DCUs 82% of their residents with severe CI were assessed with an observational instrument; in TCUs this applied to only 42%. The differences were statistically significant (p<.001); a mixed model that adjusts for the nested data structure confirmed this result. We conclude that the use of observational instruments to assess pain in residents with severe cognitive impairments is not the standard in TCUs in German nursing homes. There is an urgent need to improve the knowledge about pain assessment in residents with severe cognitive impairments in TCUs to enhance the choice of the most suitable instrument.