Cognitive barriers, sensory problems put patients at risk of receiving sub-optimal treatment

Patients' inability to communicate because of sensory or cognitive impairment can be a significant barrier to pain management, according to researchers writing in the journal Nursing Older People.

A study of nurses working in selected long-term care homes in Ireland found that cognitive barriers, such as delirium and dementia, and sensory problems such as hearing and vision deficit, put patients at risk of receiving sub-optimal treatment.

The authors also reported that patients' attitudes, such as stoicism and the need to hide their pain from others, were perceived by nurses to be a significant barrier to providing appropriate pain relief.

'It is therefore essential that patients are encouraged to verbalise their pain to family and care staff,' the researchers said.

The study also revealed organisational and caregiver-related barriers to pain management. For example, staff might attribute the behaviour of patients with dementia to causes associated with the dementia rather than considering where the behaviour was a result of pain. This could lead to inappropriately prescribing antipsychotics.

The authors advocate ongoing education on pain for all caregivers working in long-term care facilities with particular emphasis on the practical application  of observational tools, such as the Abbey pain scale for use in patients with dementia.