Year: 2007-09 (current)

Staff: Associate Professor Stephen Gibson, Kay Ledgerwood (NARI), Prof Rhonda Nay (Australian Centre for Evidence Based Aged Care), Prof Jenny Abbey (Queensland Dementia Collaborative Research Centre), Dr Roger Goucke (Sir Charles Gairdner Hospital), Associate Professor Chris Toye (Edith Cowan University), Prof Linda Kristjanson (Curtin University), Dr Sam Scherer (Royal Freemasons Homes of Victoria)

Summary:

International and Australian studies have shown that pain in older people in residential aged care is often unrecognized and under treated, particularly for those with dementia. In response to this problem the Australian Pain Society (APS), initiated a project in 2002 to develop guidelines to improve the assessment and management of pain in residential aged care facilities. NARI played an important role in the development of these guidelines entitled “Pain in Residential Aged – Care Facilities: Management Strategies” and with support from the department of Health and Ageing (DoHA) piloted the recommended assessment tools at the Royal Freemasons Homes of Victoria. A further grant from DoHA to Edith Cowan University has supported the subsequent development of a user-friendly toolkit version of this guideline and these resources have been distributed to every residential aged care facility in Australia.

Now that the necessary evidence based documents and tools are available there is an urgent need to establish an effective and sustainable implementation strategy for pain assessment and management for the residential aged care setting.

This new project is aimed at achieving this outcome and is to be conducted for the Australian Government Department of Health and Ageing as part of the “Encouraging Best Practice in Residential Aged Care” program. NARI is the lead organisation in a multi-disciplinary partnership of six research organisations, and five residential aged care facilities across Victoria, Western Australia and Queensland.  The participating residential aged care facilities include a mix of high and low care, small and large facilities, metropolitan and regional facilities.
The project will include an initial facility specific audit which will involve collection and analysis of current pain incidence and management practice, description of pain documentation and management protocols and a survey of staff, residents and family. This will be followed by 1:1 on the job education and training aimed at improving the knowledge base of all staff in assessment and management of pain as well as the appointment and professional development of an expert in house “pain champion” nurse at each facility. The final phase of the project will address the issue of practicability and sustainability of the newly developed implementation approach and development of system wide strategies throughout the residential aged care sector.

Funding source: Australian Government Department of Health and Ageing under the Encouraging Best Practice in Residential Aged Care (EBPRAC) Program

Year: 2005-06

Summary: Undetected or under-treated pain can have serious adverse effects on frail older adults, and may contribute to greater demands for daily nursing care and a corresponding increase in health costs. In response to this growing problem, the Australian Pain Society commissioned a special working party to develop best practice guidelines for assessing and managing pain in this highly dependent and vulnerable group. The study’s major aim was to do limited field-testing of the draft pain management guidelines in selected residential care facilities.

After training, 20 staff in two long-term care facilities assessed 82 residents, using several self-report brief pain scales and also non-verbal pain behavioural rating scales. Rate of completion for the verbal self-report scales was higher than for numeric versions. When comparing the behavioural scales, the ABBEY showed marginally better utility, reliability and validity, and greater acceptance by staff, than the Pain Assessment in Advanced Dementia (PAINAD) scale. Particularly high levels of inter-rater agreement and internal consistency were achieved when applied during a movement-based pain assessment protocol.

Concurrent validity was high between the two versions of the self-report scales as well as between the ABBEY and PAINAD. Aged care staff members were positive about the applicability and relevance of the guideline. Implementation of the identification and assessment sections of the APS guidelines into residential aged care appears feasible.

The selected tools show good evidence of clinical relevance, reliability and validity, and the guidelines are now being refined to incorporate the study findings.

Funding source: Australian Government Department of Health and Ageing

Summary: This ongoing research program aims to investigate the most appropriate questionnaire instruments for monitoring levels of pain, mood disturbance, functional disability, coping mechanisms, pain attitudes and quality of life in patients suffering from chronic pain. Psychometric parameters of scale retest reliability, discriminative, concurrent and construct validity as well as item internal consistency are being examined.

Year: 2005-06 (current)

Summary: Pain is very common among older hospitalised patients, but is apparently under-treated. This study aims to undertake a randomised controlled implementation of a structured educational nursing intervention for best practice in pain assessment and management. It also seeks to describe barriers and enablers for effective management, and test the effectiveness of a standardised pain management program in the acute hospital sector.

This project has full ethics approval across two health care networks (St Vincent’s Hospital and St Georges Hospital) and participants are currently being recruited.

Funding source: Nurses Board of Victoria, Mona Menzies Research Grant

Year: 2005-06 (current)

Summary: The present study aimed to identify empirically derived subgroups of chronic pain patients, based on the multidimensional patterns of treatment response, and examine socio-demographic and clinical characteristics associated with treatment success.

A total of 432 patients, aged 19-96 years, completed a comprehensive battery of self-report measures on admission and discharge, from three different multidisciplinary pain management programs. Cluster analysis of the post-treatment change scores in pain, depression and functional disability revealed four basic subgroups relating to treatment outcome. These comprised patients showing markedly improved pain (15.3%), much better self-rated depression and limited improvement in pain and disability (18.5%), improved disability and depression but worse pain (30.1%), and a relatively large group who was actually worse on all measures at discharge (36.1%). The worse group was younger and characterised by less disability and coping strategy use on admission, while the better pain group was significantly older than all other groups, had higher pain on admission and suffered more often from neuropathic pain. Several other socio-demographic factors (work status, litigation, WorkCover and use of orthopaedic aids) were also found to differ between clusters.

Summary: A continuing series of studies have been investigating the most effective types of pain management strategies for older persons with chronic pain. Treatment methods under investigation have included self-help methods, analgesic use, community health centre pain programs and multidisciplinary outpatient pain management clinics.

Summary: The objective of this study is to evaluate patient knowledge on basic pain mechanisms, differences between acute and chronic pain, available pain management techniques and the prognosis for pain resolution. A comparison will be made before and after attendance at a multidisciplinary pain management clinic. The relationship between pain knowledge and patient improvement over the course of treatment will also be investigated.