773 BARRIERS TO RECOGNISING PAIN IN PATIENTS WITH DEMENTIA AND DELIRIUM ON A HEALTHCARE OF THE ELDERLY INPATIENT WARD

• Published in: Age and ageing 2022-03, Vol.51 (Supplement_1)
• Main Authors: Stokes, R, Philpott, R
• Format: Article
• Language: English
• Subjects: Acknowledgment; Analgesia; Analgesics; Chronic pain; Cognitive ability; Cognitive impairment; Communication; Delirium; Dementia; Dementia disorders; Diabetics; Discomfort; Health care; Inpatient care; Layout; Medical diagnosis; Older people; Pain; Pain perception; Patient satisfaction; Patients; Physical symptoms; Prescribing; Psychological distress
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afac034.773

Abstract Introduction Pain is often poorly recognised and remains under-treated in older patients, especially those who are unable to articulate their discomfort. In those with severe cognitive impairment or communication difficulties, recognition of the non-verbal manifestations of pain is needed to ensure patient comfort. Understanding how likely these patients are to have pain, how we improve recognition of the signs of discomfort, and encouraging doctors to think about prescribing analgesics will allow these patients to retain their dignity, and reduce their physical and psychological distress during their inpatient stays. Method Over two periods in 2019–2020, pre and post introduction of Abbey Pain Scale. Inpatients on a HCE ward >65 years old Diagnosis of dementia and/or delirium Review of pain scores on the observation charts, analgesia and documentation of sources of pain. Results 75 patients were reviewed, 39% with delirium, 45% with dementia Pain was often not considered during medical assessments, even if patients had presented with a fall 56% had a potential source of pain identified either in their medical or nursing notes, however there was disparity between these The majority of sources of pain were chronic joint issues or injuries sustained from falls Patients had their observations checked 2–4 times/day. A pain score was entered 56% of the time and less frequently in: diabetics (due to chart layout), long-stayers and those who refused their observations Use of the Abbey Pain Scale made no significant difference. Conclusion (s). Disparity between notes highlighted a gap in communication. There is a risk of complacency with long-staying patients. Ketone readings are recorded over the pain score area on the observation charts, this needs to change. Refusing observations may be a sign of pain and staff should be more vigilant in these cases. A more integrative tool to monitor pain is required.