Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada.
Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, Phoenix, AZ, 85004, USA.
BMC Geriatr. 2020 Nov 9;20(1):458. doi: 10.1186/s12877-020-01758-7.
Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts.
Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations.
Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain.
The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.
在加拿大长期护理（LTC）机构中居住的居民中，尤其是那些由于痴呆而沟通能力有限的居民，疼痛仍然评估不足和管理不善。尽管有评估和管理疼痛的循证临床指南，但这些临床指南在 LTC 机构中并未广泛实施。一个相对未被探索的变革途径是法规和条例对 LTC 中疼痛实践的影响。因此，本次审查旨在确定加拿大各地用于评估和管理长期护理居民疼痛的政策手段，并评估它们与由老年疼痛和公共政策专家组成的国际共识小组提出的循证临床指南的一致性程度。
使用范围综述方法，对涉及加拿大 LTC 设施中疼痛的同行评审期刊文章和政府文件进行了检索。本范围综述辅以对艾伯塔省、萨斯喀彻温省和安大略省法规的深入案例分析。
在各省，疼痛在 LTC 居民中普遍存在，并与不良后果相关。确定了使用标准化疼痛评估协议的巨大好处，以及实施该协议的障碍。对于大多数省份，其法规或条例并未专门针对 LTC 居民的疼痛评估和管理做出规定。在艾伯塔省、萨斯喀彻温省和安大略省，法规要求使用 interRAI 评估工具套件来评估和报告疼痛。
研究文献已经报道了疼痛的普遍性和实施标准化疼痛评估协议的好处。然而，尽管偶尔提到疼痛，但现有法规并未建议按照专家规定的频率评估疼痛。在现行法规中，还发现缺乏关于专门疼痛评估工具（尤其是在那些沟通能力有限的情况下）使用的指导，这些工具可尽量减少对主观判断的依赖。因此，现有政策未能以符合专家共识的方式充分解决老年人在 LTC 机构中疼痛评估不足和管理不善的问题。
