Pain experience in immigrants living with dementia in residential aged care homes: A study from an Australian dementia behavior support service
Mustafa Atee, Thomas Morris, Daniel Whiting, Pelden Chejor, Trish Cain, Bridget Laging, Davina Porock- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
Untreated pain in aged care residents living with dementia has been linked to delirium, hospitalizations, inappropriate pharmacotherapy, disrupted activities of daily living, and reduced quality of life. Pain experiences and expressions are subjective and to a large extent culturally driven. As dementia advances, older immigrants living with dementia may revert to their culture and language of origin and may experience pain differently. Further, there is limited studies on the pain experience of immigrant residents living with dementia. This study aims to describe the pain experience in immigrants living with dementia in Australian residential aged care homes (RACHs).
Methods
A sample of residents who were referred to Dementia Support Australia (DSA, a national behavior support service) for the period 01/06/2018‐30/06/2022 was eligible to be included in the study. Pain was assessed using PainChek®, a validated point‐of‐care medical device for non‐verbal adults living with dementia. PainChek® consists of six domains: Face (9 items), Voice (9 items), Movement (7 items), Behavior (7 items), Activity (4 items) and Body (6 items). The sum of domain scores produces a final score that match the following pain levels: 0‐6 (no pain), 7‐11 (mild pain), 12‐15 (moderate pain) and 16‐42 (severe pain). Immigration status was defined as country or place of birth reported other than Australia.
Results
The eligible sample [n = 8607, 84.5 (7.0) y, 55.4% female, Alzheimer’s disease = 37.8%, vascular dementia = 12.9%, mixed dementia = 9.5%] had 4411 pain assessments completed, with an average total pain score of 9.4 (5.1). The prevalence of pain was 68.4% in the sample, with over one‐third of episodes represent mild pain (36.0%), and almost one‐third in moderate‐severe pain (20.1% and 12.2%, respectively). Among other factors, pain was the primary contributing factor (60.1%) in causing neuropsychiatric symptoms of dementia, such as agitation/aggression and depression. Top five countries of birth for DSA referrals were England, Italy, Greece, Scotland, and Germany.
Conclusion
Pain is a prevalent clinical problem in immigrants living with dementia in Australian RACHs, who were seeking external behavior support for their neuropsychiatric symptoms.