27038EPSYLON, EA4556, Univ Paul Valéry Montpellier 3, F34000, Montpellier, France.
Fondation Partage et Vie, Montrouge, France.
Dementia (London). 2022 Nov;21(8):2418-2441. doi: 10.1177/14713012221117907. Epub 2022 Aug 17.
Pain of nursing homes residents with Alzheimer's disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored.
The objective of this research was to analyze whether a diagnosis label of Alzheimer's disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes.
Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer's disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer's disease (mild stage vs severe stage).
Alzheimer's disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions.
These results confirm that the Alzheimer's disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer's disease and to enhance the pain management of this frail population.
与认知功能正常的阿尔茨海默病患者相比，养老院患者的疼痛仍未被充分察觉。沟通困难可能部分解释了这种护理质量较差的原因，但耻辱感对疼痛评估的影响从未被探讨过。
本研究的目的是分析阿尔茨海默病的诊断标签或疾病阶段是否会影响养老院医护人员对疼痛的评估分数和同理心反应。
本研究基于类似的实验性被试间设计进行了两项研究，视频展示了一位老年女性经历了未定义的疼痛。通过不同的标签和情景来描述视频中的主题。在第一项研究中，84 名认证护士助理被要求观看视频，然后评估疼痛强度和同理心反应。参与者随机分为两种条件，即疾病标签（阿尔茨海默病与无诊断）不同。在第二项研究中，招募了 67 名未参与第一项研究的认证护士助理。他们观看了与第一项研究相同的视频，并评估了疼痛强度和同理心反应。他们随机分为两种条件，即阿尔茨海默病阶段（轻度阶段与重度阶段）不同。
阿尔茨海默病标签对评估分数没有影响。相比之下，疾病阶段对医护人员的评估有显著影响，重度阶段与疼痛强度评分和同理心反应较低相关。
这些结果证实了阿尔茨海默病的耻辱感是一种真实存在的现象，主要由疾病的急性期症状引起。这些发现对于更好地理解与阿尔茨海默病相关的耻辱感以及加强这一脆弱人群的疼痛管理至关重要。
