Research - Cognitively Impaired Older People in ED

Research Project Overview

Assessment and management of the cognitively impaired older person presenting to ED with musculokeletal conditions or injuries.

Synopsis

We know very little about how ED clinicians adjust care practices to accommodate for the needs of the cognitively impaired older Australian experiencing pain. Ensuring timely pain assessment and appropriate analgesic interventions for older people with cognitive impairment is a challenge.

International studies have demonstrated the benefits of the Pain in Advanced Dementia Screening Tool (PAINAD), but no study has taken place in Australasian EDs. This research program proposes to explore musculoskeletal conditions or injuries in older Australians and to randomize the use of the PAINAD tool. The objectives include:

  • To determine the prevalence of older people presenting to EDs with painful musculoskeletal conditions or injuries.

  • To determine how emergency nurses currently assess, monitor and manage cognitively impaired and or cognitively intact older persons with painful conditions or injuries.

  • To conduct a comparative study assessing pain scores and analgesic administration in cognitively impaired and cognitively intact older people diagnosed with a long bone fracture.

  • To conduct a cluster randomised controlled trial of the PAINAD screening tool for cognitively impaired older people presenting with suspected long bone fracture.

  • To determine if the PAINAD screening tool assists emergency nurses’ pain assessment and facilitates timely analgesic responses

Publications

1. Fry M, Chenoweth L, Arendts G (2017) Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial, Emergency Medicine Journal, 5 August 2017, doi: 10.1136/emermed-2016-206065

2. Fry M, Arendts G, Chenoweth L, et al. (2016) Evaluation of an observational pain assessment tool for older people with cognitive impairment, Journal of Clinical Nursing, vol. 26, no. 9-10, pp. 1281-1290.

3. Fry M, Arendts G, Chenoweth L, (2015) Assessment and management of pain in the older person with cognitive impairment: a qualitative studyInternational Emergency Nursing Journal, 23 June 2015, article in press.

4. Fry M, Chenoweth L, MacGregor C, Arendts G. (2015) Emergency nurses perceptions of the role of family/carers in caring for cognitively impaired older persons in pain: A descriptive qualitative studyInternational Journal of Nursing Studies, August 2015, vol. 52, no. 8, pp. 1323-1331.

5. Fry M, MacGregor C. Hyland S, Payne B, Chenoweth L. (2015) Emergency nurses’ perceptions of the role of confidence, self-efficacy and reflexivity in managing the cognitively impaired older person in painJournal of Clinical Nursing, (11-12), pp. 1622-9.

6. Fry M, Arendts G, Chenoweth L, MacGregor C. (2014) Cognitive impairment is a risk factor for delayed analgesia in older people with long bone fracture: a multicentre exploratory study, International Psychogeriatrics, vol. 27, no. 2, pp. 323-328.

Conference Presentations

2015

Fry M, Arendts G, Chenoweth L. 2015 Acute pain management in the cognitively impaired older person- can we do better? 13th ICEN Emergency Care: Accept the challenge, Lead the change 7-9th October abstract accepted

  • Fry M, Arendts G, Chenoweth L. 2015 The role of family and carers acute pain management for the cognitively impaired older persons: A qualitative study. 13th ICEN Emergency Care: Accept the challenge, Lead the change 7-9th October abstract accepted

  • Fry M, Arendts G, Chenoweth L. 2015 Emergency nurses’ perceptions of the barriers and challenges to the assessment and management of acute pain in the older person with cognitive impairment: a qualitative study 13th ICEN Emergency Care: Accept the challenge, Lead the change 7-9th October abstract accepted

  • Fry M, Pain assessment and the cognitively impaired – can we do better NSLHD Nursing and Midwifery Conference 15th of May 2015

  • Fry M, Emergency nurses’ perceptions of pain management and the role of families / carers for cognitively impaired older persons: a descriptive qualitative study NSLHD Nursing and Midwifery Conference 15th of May 2015

  • Fry M, Arendts G, Chenoweth L. Nurse initiated analgesia could reduce cognitive impairment as a risk factor for delayed analgesia in older people: A multicentre study 3rd Annual Worldwide Nursing Conference Singapore 29th – 30th June 2015 Submitted Abstract- accepted

  • Fry M, Chenoweth L, Arendts G. Emergency nurses perceptions of the role of family/carers in pain management practices for cognitively impaired older persons: A descriptive qualitative study Australian Nursing and Midwifery Conference 15th-16th October Newcastle

2014

  • Fry M, Arendt G, Chenoweth L, MacGregor C. Do observational pain assessment tools improve the timeliness of analgesia for cognitively impaired older persons. Australasian College of Emergency Medicine 31st Annual Scientific Conference, 7-11th December Victoria (Invited speaker)

  • Fry M, Arendt G, Chenoweth L, MacGregor C. Cognitive impairment is a risk factor for delayed analgesia in older people with long bone fracture. The 1st Global emergency and trauma conference 18-21st September 2014 Dublin Ireland

2013

  • Fry M, Arendts G, A Chenoweth L, MacGregor C. Cognitive impairment is a risk factor for delayed analgesia in older people with long bone fracture. New Horizons 2013, 30th Combined Health Science Conference, to be held from 18–20th November 2013 at The Kolling Building, RNSH, Sydney, NSW.

Further References and Resources

© Agency for Clinical Innovation 2017

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