Implementing Pain Management Approaches Among Patients With Dementia in an Acute Hospital Setting: A Scoping Review.

aimTo determine which pain management approaches have been implemented in an acute hospital setting and gauge the extent to which they effectively assess and manage pain among patients with dementia.

designThe review followed the Joanna Briggs Institute framework, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR).

methodThe search strategy was designed to locate published and unpublished studies through online databases such as MEDLINE (Ovid) and CINAHL, as well as relevant grey literature sources, such as the WHO database. The review included primary and secondary research publications from 2005 to 2023 relating to patients with dementia in an acute hospital setting. The study focused on overall pain management approaches, including pain assessment, processes, and interventions to manage pain. Tables were used to extract and synthesise results using descriptive statistics.

resultsFourteen studies met the inclusion criteria. They included a range of designs: five cross-sectional and two cohort studies; five interventional studies; one action research project; and one quality improvement programme. The interventions identified in the review mainly involved validating pre-existing pain assessment tools, such as the Pain Assessment in Advanced Dementia Scale (PAINAD). Overall, the authors' primary strategy for implementing their respective interventions was organising participant awareness-raising and training sessions.

conclusionsThere is a lack of standardised, person-centred protocols for managing pain in patients with dementia and a dearth of evidence relating to pain reduction among this client group. While valid pain assessment tools exist, their use alone does not guarantee timely or effective pain relief. Although studies reported the development of interventions to promote effective pain management, they did not consistently demonstrate a systematic reduction in pain among the patient groups. Whilst education on pain management is vital, it has been shown that education alone is insufficient to improve care. IMPLICATIONS FOR PRACTICE: The review identified several validated instruments for assessing pain in people living with dementia; however, the availability of tools alone is not enough to change practice. A broader shift in pain management is required. Nurses need organisational support not only to incorporate observational pain assessment tools into routine workflows but also to connect assessments to clear clinical actions and adopt a proactive, holistic approach. This includes preventing diagnostic overshadowing by recognising pain as a potential cause of behavioural change and ensuring that pain management strategies go beyond assessment to deliver timely, person-centred interventions. Health care providers need to support nursing staff beyond providing training and updates to encourage evidence-based practice and to engender a culture in which pain management is a priority. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was made towards this review.