Pain management for individuals living with a dementia is one area of nursing care which
needs improved. As a dementia progresses, verbal language skills can deteriorate and
individuals rely more on non-verbal ways of communicating. It can become difficult, if not
impossible, for individuals living with dementia to use words to explain their pain to
someone else. Individuals living with a dementia then become at high risk of living with
chronic pain. And, not unsurprisingly, this has a negative effect on their quality of life which
in turn causes further deterioration of an individual’s dementia and high levels of stress for
family and healthcare professionals providing care.
It is estimated up to 80% of older people living in nursing homes experience chronic pain and
in Australia more than half of these older people (52%) have a diagnosis of dementia while
two in three (67%) require high-level care to manage distress situation (Gibson, 2007;
Zwakhalen, 2006). We can therefore assume that a high proportion of people with chronic
pain also have cognitive impairment and will have difficulties in verbally expressing their
pain. The Australian Pain Society (2005) reported that individuals living with a dementia
who experience pain have their pain left untreated at higher rates that those without dementia.
In one study, pain was detected in just 31.5% of cognitively-impaired residents compared to
61% of cognitively-intact residents, despite both groups being equally afflicted with
potentially painful disease (Proctor & Hirdes, 2001).
This situation can be avoided using close observation of non-verbal expressions of pain and
responding to the other signs of pain. For those individuals living with dementia who cannot
clearly verbalise their pain there is an ‘Gold Standard’ observational pain assessment tool
known as the ‘Abbey Pain Scale’. The Abbey Pain Scale can be used to assess levels of pain
and develop a pain management plan for individuals living with dementia. Despite the
abundant evidence of the effectiveness of the Abbey Pain Scale for detecting and managing
pain it remains largely unused in everyday clinical practice. The Aged and Dementia Care
Health Research and Education (ADHERe) team at UOW wanted to address this gap and
developed an Abbey Pain Scale filmed vignette educational resource. Three videos
demonstrate a nurse practitioner providing education to a family carer and registered nurses
in acute care and nursing home settings on how to use the Abbey Pain Scale.
If a person with dementia experiences unexplained changes and/ or shows signs of distress,
healthcare professionals should assess whether the person is in pain but without a tool like the
Abbey Pain Scale this is difficult to do achieve. The Abbey Pain Scale filmed vignettes
demonstrate how to assess pain experienced by individuals living with a dementia in their
own home, in hospital and in a nursing home. The videos can be used to assist healthcare
professionals learn how to better detect and manage pain experienced individuals living with
dementia who cannot easily express their pain verbally.