Attitudinal & Knowledge Barriers Towards Effective Pain Assessment & Management in Dementia: A Narrative Synthesis
Rebecca C. Chandler,
Sandra M.G. Zwakhalen,
Under-assessment and inadequate treatment of pain is a common problem for older adults,
particularly those with dementia. This may be in part attributed to knowledge deficits and negative
attitudes among healthcare staff and informal caregivers towards pain, its assessment and its management
in dementia. Knowledge and attitudes have a significant predictive relationship with behavior,
potentially impacting pain assessment and management practices. Despite this there remains a
paucity of research in the area and a lack of clarity about existing knowledge levels and attitudes
among dementia caregivers. Therefore, the aims of this review were to: identify what knowledge
deficits and attitudinal barriers exist amongst dementia caregivers; and identify the scales available to
measure these. A search was carried out in the following electronic databases: Academic Search Premier;
CINAHL; Education Research Complete; Humanities International Journals; Psychology and
Behavioral Sciences Collection; PsychINFO; PsychArticles; Teacher Reference Center; and MEDLINE.
A total of 13 articles met the inclusion criteria. A number of knowledge deficits and negative
attitudes were identified, particularly in the use self-reports and pain assessment tools in dementia,
and the safety of opioids. Understanding and positive attitudes were demonstrated in some areas, such
as non-narcotic pain medications and identifying behavioral pain indicators. Of the 4 scales identified,
positive results were found for internal consistency and content validity, however further refinement
and testing is necessary. It was concluded attitudinal and knowledge barriers exist which
should be addressed given their influence over practice behavior, however, there is a willingness and
knowledge base from which progress can build.
Keywords: Attitudes, barriers, dementia, education, knowledge, pain assessment, pain management, scales.
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