Chronic and persistent pain in later life is a worldwide problem. Of those people living in care homes, it is estimated that over 50% experience persistent or chronic pain1.
People living with dementia or cognitive impairment are particularly vulnerable to pain being poorly managed as they may not always be able to self-report pain effectively, resulting in it going untreated.
Dementia affects around 850,000 people in the UK and was the country’s leading cause of death in 20222. It is estimated that 70% of people in care homes have dementia or severe memory problems3, and it is thought that at least 50% of them regularly experience pain4.
The need for best practice pain management also extends to older people living at home with access to home care packages that enable long-term home living. These populations include people living with dementia, suffering with multiple chronic pain conditions, as well as those with sensory, cognitive and mental health impairments and who have difficulties in self-reporting pain.
People living with dementia can experience difficulties in verbally communicating that they are experiencing pain, along with the severity and location of that pain. To compensate, they become more reliant on non-verbal communication, through behaviour, which may include anger, frustration, restlessness, withdrawal and changes in body language, speech and sleep patterns, appetite and facial expressions.
Moreover, with over 90% of people living with dementia affected by behavioural and psychological symptoms (BPSD)5, pain is often missed and may remain untreated and unrecognised. This can result in inappropriate prescribing of psychotropic medication.
A Department of Health study found that of 180,000 antipsychotic prescriptions, the majority (140,000) were prescribed inappropriately to people living with dementia6. This is particularly concerning as antipsychotic medications can increase the risk of stroke nine-fold and double the risk of death7,8.
People living with dementia are susceptible to increased levels of pain compared to others as they have decreased mobility and therefore a high risk of falls, accidents and injury, and like others, may also experience age-related conditions such as osteoarthritis, pressure sores, skin tears, stiffening of joints, muscle rigidity and constipation.
Effective assessment and management of pain are therefore crucial to supporting high-quality care for this patient population.
Benefits of digital pain assessment
The social care sector is rapidly evolving, driven by technological advancements and the overarching digitisation of care. Care providers can harness the power of technology to overcome gaps in care documentation and give them the means to better plan care according to evidence-based practices.
Technology-enabled pain assessment can play a critical role in facilitating better health outcomes for care home residents. Point-of-care assessment facilitates documentation, hence reducing associated administrative burden.
This has the potential to equip carers with information to better care for residents whilst meeting the requirements of Care Quality Commission regulators regarding auditing and personalising care9. Moreover, the collection of data allows for a broader and more accurate analysis of issues affecting the entire care home population.
Technology in action
Further evidence of the benefits of embedding technology into everyday operations and the care plans of residents living with dementia comes directly from carers on the ground.
A leading care provider, Orchard Care Homes, has been running care homes across the UK for over a decade and has established a strong reputation in the care industry for providing quality care for older people.
To more effectively meet the needs of people living with advanced dementia in Orchard Care Homes’ properties, the provider established a multi-faceted psychosocial intervention programme called ‘Reconnect’. This offered enriched psycho-social care to reduce people’s distress and thus enhance their quality of life and wellbeing. The programme also incorporated the use of a digital pain assessment tool.
A recent study10 published in the peer-reviewed journal Frontiers in Psychiatry, reviewed the impact of this programme on people living with dementia who had not previously responded to support in alternative settings or found previous care ineffective in relieving their distress and reducing risks they posed to themselves or others.
The study identified that the introduction of the Reconnect programme, through its interventions based around meaningful activity engagement, pain management and constipation relief, resulted in significant improvements related to people’s distress, psychotropic use and safeguarding, with a 91.7% reduction (i.e., from 36 to three events) in safeguarding events related to behaviours observed.
Additional analysis recently carried out at Orchard Care Homes’ properties has also linked use of a digital pain assessment tool to a 91% drop in significant injuries and a 20% reduction in falls since it was added to Orchard’s falls prevention policy and post-falls protocol 12 months ago11.
Hannah Miller, Head of Dementia at Orchard Care Homes, said, ‘It is well known that failure to recognise and treat pain effectively is a problem amongst people living with dementia. Pain is a trigger of distress, yet often overlooked as a contributing factor, and the person is not only left to suffer unnecessarily in pain, but also to be prescribed psychotropic agents to manage their behaviours.
‘Integration of a digital pain assessment tool has been a real game changer, enabling our care teams to closely monitor and assess the pain experience of individuals in their care using a mobile care device, providing staff with a long-term view of when a resident is likely to experience pain.
‘Orchard strives to incorporate technological advances and put them into practice to ensure we are enabling all people living in our care homes to achieve good outcomes and be afforded equitable care regardless of their cognitive ability or ability to self-report health concerns such as pain.
‘Individuals who are not able to effectively verbally communicate pain who were previously disadvantaged are now on an equal footing with those that can communicate effectively.’
Looking to the future
Access to effective pain management is important for everyone and is widely accepted as a human right12, so it is crucially important that those unable to reliably self-report can have their pain accurately identified and assessed, and effectively managed.
With an ageing global population, and 1.7 million people projected to be living with dementia in England and Wales by 204013 – over 40% more than previously forecast – digital technology is becoming an integral strategy for improving care standards for people living with dementia in care homes of all sizes and handling the increasing costs associated14.
What is your experience of implementing technology to provide care and support to people living with dementia? Leave a comment on this article or join the conversation to share your thoughts.
Dr Kreshnik Hoti is Senior Research Scientist at PainChek. X: @PainChek Email: [email protected]
References
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9Regulations for service providers and managers (2023), Care Quality Commission, [available from: https://www.cqc.org.uk/guidance-providers/regulations].
10Baird C, Miller H, Hoti K and Hughes J (2023), Clinical impact of a multifaceted intervention aimed at decreasing distress in people living with dementia: evaluating the Reconnect program. Front. Psychiatry 14:1191105, doi: 10.3389/fpsyt.2023.1191105.
11Peart, L. (2023), Orchard Care Homes achieves 91% drop in significant injuries after Painchek Investment, Caring Times, [available from: https://caring-times.co.uk/orchard-care-home-achieves-91-drop-in-significant-injuries-after-painchek-investment/].
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13Chen, Y. et al (2023), Dementia incidence trend in England and Wales, 2002–19, and projection for dementia burden to 2040: Analysis of data from the English Longitudinal Study of Ageing, The Lancet Public Health, 8(11), doi:10.1016/s2468-2667(23)00214-1.
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