TIP OF THE WEEK

The assessment of discomfort in dementia (ADD) protocol

People with dementia have often been excluded from medical studies focused on pain and pain management, but there is evidence that they experience frequent pain, which is often poorly assessed and under-treated. University of Wisconsin researchers developed the assessment of discomfort in dementia (ADD) protocol for assessing and appropriately treating pain in patients with late-stage dementia, who typically have difficulty communicating verbally.

The ADD program is designed to help physicians and caregivers more accurately assess discomfort in people with dementia who can no longer verbally describe physical pain or emotional discomfort, more accurately and thoroughly treat physical pain or emotional discomfort, and decrease the inappropriate use of psychotropic medication, such as tranquilizers.

Common signs displayed by people with late-stage dementia who experience physical or emotional discomfort include: increased agitation, fidgeting, or repetitive movements; tense muscles, body bracing; increased calling out or repetitive verbalizations; decreased cognition, decreased functional ability or withdrawal; changes in sleep pattern; falling; increase in pulse, blood pressure, and sweating. A good deal of emotional discomfort in dementia patients comes from difficulty sorting out and negotiating everyday life activities.

THE ADD PROTOCOL

1. Physical causes for discomfort such as inflammation, infection, acute illness, chronic conditions, etc. were assessed first.
2. As part of the physical assessment, the patient's history was explored, including consultation with the patient's family regarding potential causes of pain.
3. If the physical assessment was negative and there was no apparent reason for discomfort, then non-pharmacological (non-drug) comfort interventions were used. These included soothing and supportive verbal communication, soothing and supportive touch, physical exercise and movement, and sensory stimulation including music therapy and therapeutic massage.
4. If the non-pharmacological interventions were unsuccessful in relieving the patient's discomfort, then the staff administered a non-narcotic analgesic, such as 500 milligrams of acetaminophen (e.g., Tylenol).
5. If there was not a response to trying an "as needed" analgesic, then a stronger analgesic or, sometimes, a psychotropic drug was prescribed.

TRIAL STUDY RESULTS

Results of the 1999 study indicate that the stages of assessment and treatment set forth in the ADD protocol did help to reduce the frequency of discomfort symptoms expressed by the patients. In the 7 days before the study, the patients displayed an average of 32.85 behavioral symptoms associated with discomfort. In the period following use of the ADD protocol, this was reduced to 23.47 behaviors -- a statistically significant improvement.

The protocol was associated with an increase in the use of scheduled analgesics and in the use of nonpharmacological comfort interventions, especially music therapy and therapeutic massage. However, use of the protocol was not associated with changes in use of "as needed" analgesics or in the administration of "as needed" or scheduled psychotropics. Psychotropic drugs can mask signs of physical pain and thus may contribute to undertreatment of pain.

The nurses who participated in the program were surveyed, and according to questionnaires 44% felt that it was very helpful and 44% of them felt that the protocol was somewhat helpful in aiding patients. The results of this pilot project demonstrate that the needs of this group can be recognized and treated. But the authors of the study stress that further improvement in palliative care services are needed for the silent but growing population of people with late stage dementia.

Source: Pain Management for Patients With Late-Stage Dementia, August 9, 2000

 

 

IN THE NEWS

 

RAND STUDY FINDS VACCINATION OF NURSING HOME STAFF, RESIDENTS, KEY TO REDUCING INFLUENZA OUTBREAKS

November 15, 2006 - - RAND - - How effective are influenza immunization in minimizing flu outbreaks in individuals living in close proximity? A study conducted by RAND Health on 300 nursing home residents and staff measured the effectiveness of immunizations on preventing the spread of flu in nursing facilities. Results indicated that staff and resident immunization rates independently did not predict the likelihood of an outbreak, but jointly were strong predictors. For example, facilities having more than 55% of staff and 89% of residents immunized were almost 60% less likely to have an influenza-like illness cluster outbreak. Bed and staff size did not significantly influence the likelihood of an outbreak.

 

This study concluded that both staff and residents must have high rates of vaccination to substantially alter the rate and impact of influenza outbreaks in nursing facilities. Read More >>

 

 

IHI LAUNCHES 2-YEAR CAMPAIGN TO PROTECT 5 MILLION LIVES FROM HARM

December 2006 - - IHI - - The Institute for Healthcare Improvement (IHI) today announced, with the support of prominent leaders in American health care, a national campaign to dramatically reduce incidents of medical harm in U.S. hospitals. The 5 Million Lives Campaign will ask hospitals to improve more rapidly than before the care they provide in order to protect patients from five million incidents of medical harm over a 24-month period, ending December 9, 2008. This represents a continuation of the largest improvement effort undertaken in recent history by the healthcare industry. Learn More >>

 

 

SENIORS' HEALTH AND DAILY FUNCTION IMPROVES, STUDY FINDS

December 7, 2006 - - Kaiser Network - - The health and daily function of elderly U.S. residents has improved as the incidence of chronic disability has "dropped dramatically," according to a study released Tuesday by the National Institute on Aging, the Washington Times reports. The results were based on an analysis of the National Long-Term Care Survey, a periodic survey of about 20,000 Medicare beneficiaries. Read More >>

 

 

HOSPITAL PALLIATIVE CARE PROGRAMS CONTINUE RAPID GROWTH

December 7, 2006 - - EurekAlert - - Hospitals continue to implement palliative care programs at a rapid pace, according to a Center to Advance Palliative Care (CAPC) analysis of the latest data released in the 2006 American Hospital Association (AHA) Annual Survey of Hospitals. The CAPC analysis shows that 1,240 hospitals nationwide provide palliative care programs today. This is compared to 632 programs in 2000–a five-year increase of 96%. Read More >>

 

 

CMS PUBLISHES FINAL PATIENTS' RIGHTS RULE ON USE OF RESTRAINTS AND SECLUSION

December 8, 2006 - - CMS - - Healthcare workers who employ physical restraints and seclusion when treating patients must undergo new, more rigorous training to ensure the appropriateness of the treatment and to protect patient rights, according to a regulation published in the Federal Register today by the Centers for Medicare & Medicaid Services (CMS).

 

The patients' rights regulations set forth, as a condition of participation (CoP) in the Medicare and Medicaid programs, the expectation that healthcare facilities will protect the rights of patients. These protections are part of Medicare's revised CoP requirements that hospitals must meet. The requirements apply to all participating hospitals including short-term, psychiatric, rehabilitation, long-term, children's and alcohol/drug treatment facilities. Read More >>

 

 

 

OTHER INDUSTRY EVENTS

 

Teleconference: About the Advancing Excellence in America’s Nursing Homes campaign
January 10, 2007, 1:00-2:00

 

Teleconference: Support for Nursing Homes in the Advancing Excellence in America’s Nursing Homes campaign
January 31, 2007, 1:00-2:30

 

Roadmap for Change: 2nd Annual Person Centered Care Coalition Conference
March 20, 2007 – Columbus, Ohio

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Ohio Health Care Association Events

 

OSHIIP’s Medicare and Part D Check-ups throughout Ohio until December 20, 2006 (PDF)

 

 

 

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