Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2020

Open Access 01-12-2020 | Care | Research article

Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis

Authors: Natasha L. Gallant, Allie Peckham, Gregory Marchildon, Thomas Hadjistavropoulos, Blair Roblin, Rhonda J. N. Stopyn

Published in: BMC Geriatrics | Issue 1/2020

Login to get access

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
Appendix
Available only for authorised users
Literature
1.
Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manag. 1995;10(8):591–8.CrossRef
2.
Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, Knaggs R, Martin D, Sampson L, Schofield P. Guidance on the management of pain in older people. Age Ageing. 2013;42:i1–i57.CrossRefPubMed
3.
Ferrell BA. Pain evaluation and management in the nursing home. Ann Intern Med. 1995;123(9):681–7.CrossRefPubMed
4.
Cowan DT, Fitzpatrick JM, Roberts JD, While AE, Baldwin J. The assessment and management of pain among older people in care homes: current status and future directions. Int J Nurs Stud. 2003;40(3):291–8.CrossRefPubMed
5.
Sengstaken EA, King SA. The problems of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc. 1993;41(5):541–4.CrossRefPubMed
6.
Hadjistavropoulos T, Kaasalainen S, Williams J, Zacharias R. Improving pain assessment practices and outcomes in long-term care facilities: a mixed methods investigation. Pain Manag Nurs. 2014;15(4):748–59.CrossRefPubMed
7.
Hanlon JT, Wang X, Castle NG, Stone RA, Handler SM, Semla TP, Pugh MJ, Berlowitz DR, Dysken MW. Potential underuse, overuse, and inappropriate use of antidepressants in older veteran nursing home residents. J Am Geriatr Soc. 2011;59(8):1412–20.CrossRefPubMedPubMedCentral
8.
Martin R, Williams J, Hadjistavropoulos T, Hadjistavropoulos HD, MacLean M. A qualitative investigation of seniors' and caregivers' views on pain assessment and management. Can J Nurs Res. 2005;37(2):142–65.PubMed
9.
Kaasalainen S, Middleton J, Knezacek S, Hartley T, Stewart N, Ife C, Robinson L. Pain and cognitive status in the institutionalized elderly. J Gerontol Nurs. 1998;24(8):24–31.CrossRefPubMed
10.
Zwakhalen SMG, Hamers JPH, Abu-Saad HH, Berger MPF. Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools. BMC Geriatr. 2006;6:Article 3.CrossRef
11.
Scherder E, Oosterman J, Swaab D, Herr K, Ooms M, Ribbe M, Segeant J, Pickering G, Benedetti F. Recent developments in pain in dementia. Br Med J. 2005;330:461–4.CrossRef
12.
Bauer U, Pitzer S, Schreier MM, Osterbrink J, Alzner R, Iglseder B. Pain treatment for nursing home residents differs according to cognitive state–a cross-sectional study. BMC Geriatr. 2016;16(1):124.CrossRefPubMedPubMedCentral
13.
McAuliffe L, Nay R, O’Donnell M, Fetherstonhaugh D. Pain assessment in older people with dementia: literature review. J Adv Nurs. 2009;65(1):2–10.CrossRefPubMed
14.
AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(6 suppl):S205–24.
15.
Parmelee PA, Katz IR, Lawton MP. The relation of pain to depression among institutionalized aged. J Gerontol. 1991;46(1):15–21.CrossRef
16.
Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA. Medical illness and the risk of suicide in the elderly. Arch Intern Med. 2004;164(11):1179–84.CrossRefPubMed
17.
Vohra JU, Brazil K, Hanna S, Abelson J. Family perceptions of end-of-life care in long-term care facilities. J Palliat Care. 2004;20(4):297–302.CrossRefPubMed
18.
Organization for Economic Co-operation and Development. Ensuring quality long-term care for older people. OECD Observer. 2005:1–8.
19.
Achterberg WP, Pieper MJ, van Dalen-Kok AH, de Waal MW, Husebo BS, Lautenbacher S, Kunz M, Scherder EJ, Corbett A. Pain management in patients with dementia. Clin Inter Aging. 2013;8:1471–82.CrossRef
20.
Achterberg W. Pain management in long-term care: are we finally on the right track? Age Ageing. 2016;45(1):7–8.CrossRefPubMed
21.
Watt-Watson J, Peter E, Clark AJ, Dewar A, Hadjistavropoulos T, Morley-Forster P, O'Leary C, Raman-Wilms L, Unruh A, Webber K, Campbell-Yeo M. The ethics of Canadian entry-to-practice pain competencies: how are we doing? Pain Res Manag. 2013;13:25–32.CrossRef
22.
Herr K, Bursch H, Ersek M, Miller LL, Swafford K. Use of pain-behavioral assessment tools in the nursing home: expert consensus recommendations for practice. J Gerontol Nurs. 2010;36(3):18–29.CrossRefPubMed
23.
Hadjistavropoulos T, Fitzgerald TD, Marchildon GP. Practice guidelines for assessing pain in older persons with dementia residing in long-term care facilities. Physiother Can. 2010;62(2):104–13.CrossRefPubMedPubMedCentral
24.
American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57:1331–46.CrossRef
25.
Australian Pain Society. Pain in residential aged care facilities: management strategies. North Sydney, Australia: Australian Pain Society; 2005.
26.
27.
Hadjistavropoulos T, LaChapelle DL, Hadjistavropoulos HD, Green S, Asmundson GJG. Using facial expressions to assess musculoskeletal pain in older persons. Eur J Pain. 2002;6:179–87.CrossRefPubMed
28.
Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12(4):230–50.CrossRefPubMed
29.
Corbett A, Achterberg W, Husebo B, Lobbezo F, de Vet H, Kunz M, Constantinou M, Tudose C, Kappesser J, de Waal M, Lautenbacher S. An international road map to improve pain assessment in people with impaired cognition: the development of the Pain Assessment in Impaired Cognition (PAIC) meta-tool. BMC Neurol. 2014;14:229.CrossRefPubMedPubMedCentral
30.
Hadjistavropoulos T, Herr K, Prkachin K, Craig K, Gibson S, Lukas L, Smith J. Pain assessment in elderly adults with dementia. Lancet Neurol. 2014;13:1216–27.CrossRefPubMed
31.
Herr K, Coyne PJ, Ely E, Gélinas C, Manworren RCB. Pain assessment in the patient unable to self-report: clinical practice recommendations in support of the ASPMN 2019 position statement. Pain Manag Nurs. 2019;20(5):404–17.CrossRefPubMed
32.
Hadjistavropoulos T, Janzen Claude JA, Hadjistavropoulos HD, Marchildon GP, Kaasalainen S, Gallagher R, Beattie BL. Stakeholder opinions on a transformational model of pain management in long-term care. J Gerontol Nurs. 2011;37:40–51.PubMed
33.
Hadjistavropoulos T, Williams J, Kaasalainen S, Hunter PV, Savoie ML, Wickson-Griffiths A. Increasing the frequency and timeliness of pain assessment and management in long-term care: knowledge transfer and sustained implementation. Pain Res Manag. 2016;2016:6493463.
34.
Fuchs-Lacelle S, Hadjistavropoulos T, Lix L. Pain assessment as intervention: a study of older adults with severe dementia. Clin J Pain. 2008;24(8):697–707.CrossRefPubMed
35.
Rovner BW, Edelman BA, Cox MP, Schmuely Y. The impact of antipsychotic drug regulations on psychotropic prescribing practices in nursing homes. Am J Psychiatry. 1992;149:1390–2.CrossRefPubMed
36.
Semla TP, Palla K, Poddig B, Brauner DJ. Effect of the omnibus reconciliation act 1987 on antipsychotic prescribing in nursing home residents. J Am Geriatr Soc. 1994;42:648–52.CrossRefPubMed
37.
Shorr RI, Fought RL, Ray WA. Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations. JAMA. 1994;271:358–62.CrossRefPubMed
38.
Howlett M. Policy tools and their role in policy formulation: dealing with procedural and substantive instruments. In: Howlett M, Mukherjee I, editors. Handbook of policy formulation. Cheltenham: Edward Elgar; 2017. p. 96–111.CrossRef
39.
40.
Estabrooks CA, Poss JW, Squires JE, Teare GF, Morgan DG, Stewart N, Doupe MB, Cummings GG, Norton PG. A profile of residents in prairie nursing homes. Can J Aging. 2013;32(3):223–31.CrossRefPubMed
41.
Government of Alberta. Long-term care accommodation standards and checklist. Edmonton: Alberta Health; 2010.
42.
Government of Alberta. Continuing care health service standards. Edmonton: Alberta Health; 2018.
43.
Carpenter I, Hirdes JP. Using interRAI assessment systems to measure and maintain quality of long-term care. In OECD/European Commission, editors. A good life in old age? Monitoring and improving quality in long-term care. Paris: OECD Publishing; 2013.
44.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.CrossRef
45.
Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, Kastner M, Moder D. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291–4.CrossRefPubMed
46.
Bainbridge D, Seow H. Palliative care experience in the last 3 months of life: a quantitative comparison of care provided in residential hospices, hospitals and the home from the perspectives of bereaved caregivers. Am J Hosp Palliat Me. 2018;35(3):456–63.
47.
Cheung ENM, Benjamin S, Heckman G, Ho JM-W, Lee L, Sinha SK, Costa AP. Clinical characteristics associated with the onset of delirium among long-term care nursing home residents. BMC Geriatr. 2018;18(39):1–7.
48.
Gagnon MM, Hadjistavropoulos T, Williams J. Development and mixed-methods evaluation of a pain assessment video training program for long-term care staff. Pain Res Manag. 2013;18(6):307–12.CrossRefPubMedPubMedCentral
49.
Ghandehari OO, Hadjistavropoulos T, Williams J, Thorpe L, Alfano DP, Bello-Haas VD, Malloy DC, Martin RR, Rahaman O, Zwakhalen SM, et al. A controlled investigation of continuing pain education for long-term care staff. Pain Res Manag. 2013;18(1):11–8.CrossRefPubMedPubMedCentral
50.
Helmer-Smith M, Fung C, Afkham A, Crowe L, Gazarin M, Keely E, Moroz I, Liddy C. The feasibility of using electronic consultation in long-term care homes. J Am Med Dir Assoc. 2020;21(8):1166–70.
51.
Hirdes JP, Mitchell L, Maxwell CJ, White N. Beyond the ‘iron lungs of gerontology’: using evidence to shape the future of nursing homes in Canada. Can J Aging. 2011;30(3):371–90.CrossRefPubMed
52.
Hunter PV, McCleary L, Akhtar-Danesh N, Goodridge D, Hadjistavropoulos T, Kaasalainen S, Sussman T, Thompson G, Venturato L, Wickson-Griffiths A. Mind the gap: is the Canadian long-term care workforce ready for a palliative care mandate? Ageing Soc. 2020;40:1223–43.CrossRef
53.
Kaasalainen S, Brazil K, Coker E, Ploeg J, Martin-Milsener R, Donald F, DiCenso A, Hadjistavropoulos T, Dolovich L, Papaioannou A, Emili A, Burns T. An action-based approach to improving pain management in long-term care. Can J Aging. 2010;29(4):503–17.CrossRefPubMed
54.
Kaasalainen S, Wickson-Griffiths A, Akhtar-Danesh N, Brazil K, Donald F, Martin-Misener R, DiCenso A, Hadjistavropoulos T, Dolovich L. The effectiveness of a nurse practitioner-led pain management team in long-term care: a mixed methods study. Int J Nurs. 2016;62:156–67.CrossRef
55.
Lane NE, Stukel TA, Boyd CM, Wodchis WP. Long-term care residents' geriatric syndromes at admission and disablement over time: an observational cohort study. J Gerontol A Biol Sci Med Sci. 2019;74(6):917–23.
56.
Mashouri P, Taati B, Quirt H, Iaboni A. Quality indicators as predictors of future inspection performance in Ontario nursing homes. JAMDA. 2020;21:793–8.PubMed
57.
McArthur C, Saari M, Northwood M, Taucar LS, Boscart VM. Profiling the characteristics of people who are comatose in long-term and complex continuing care settings. JAMDA. 2019;20:1331–4.
58.
McCleary L, Thompson GN, Venturato L, Wickson-Griffiths A, Hunter P, Sussman T, Kaasalainen S. Meaninful connections in dementia end of life care in long term care homes. BMC Psychiatry. 2018;18:307.
59.
Nemiroff L, Marshall EG, Jensen JL, Clarke B, Andrew MK. Adherence to “no transfer to hospital” advance directives among nursing home residents. J Am Med Dir Assoc. 2019;20:1373–81.CrossRefPubMed
60.
Ramage-Morin PL. Chronic pain in Canadian seniors. Health Rep. 2008;19(1):37–52.PubMed
61.
Rosenberg T, Montgomery P, Hay V, Lattimer R. Using frailty and quality of life measures in clinical care of the elderly in Canada to predict death, nursing home transfer and hospitalisation - the frailty and ageing cohort study. BMJ Open. 2019;9:e032712.
62.
Senderovich H, Grewal J, Mujtaba M. Herpes zoster cavvination efficacy in long-term care facility population: A qualitative systematic review. Curr Med Res Opin. 2019;35(8):1451–62.
63.
Tadrous M, Fung K, Desveaux L, Gomes T, Taljaard M, Grimshaw JM, Bell CM, Ivers NM. Effect of academic detailing on promoting appropriate prescribing of antipsychotic medication in nursing homes: a cluster randomized clinical trial. JAMA Netw Open. 2020;3(5):e205724.
64.
Turcotte LA, Marrie RA, Patten SB, Hirdes JP. Clinical profile of persons with multiple sclerosis across the continuum of care. Can J Neurol Sci. 2018;45:188–98.CrossRefPubMed
65.
Wilchesky M, Mueller G, Morin M, Marcote M, Voyer P, Aubin M, Carmichael P-H, Champoux N, monette J, Giguère A, Durand P, Verreault R, Arcand M, Kröger E. The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasiexperimental feasibility pilot study. BMC Geriatr. 2018;18:204.
66.
Wilkinson A, Haroun V, Wong T, Cooper N, Chignell M. Overall quality performance of long-term care homes in Ontario. Healthc Q. 2019;22(2):55–62.CrossRefPubMed
67.
Yoon MN, Ickert C, Slaughter SE, Lengyel C, Carrier N, Keller H. Oral health status of long-term care residents in Canada: results of a national crosssectional study. Gerodontology. 2018;35:359–64.
68.
Yoon MN, Lu L, Ickert C, Estabrooks CA, Hoben M. If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes. Gerodontology. 2020;37:164–76.
69.
Yu AYX, Maclagan LC, Diong C, Austin PC, Kapral MK, Swartz RH, Bronskill SE. Sex differences in care need and survival in patients admitted to nursing home poststroke. Can J Neurol Sci. 2020;47:153–9.CrossRefPubMed
70.
Fitzgerald C. RAI-MDS guidelines and FAM. London: Western University’s Canadian Centre for Activity and Aging; 2016.
71.
Hill C, Duggleby W, Venturato L, Durepos P, Kulasegaram P, Hunter P, McCleary L, Sussman T, Thompson G, Surtees D, Wickson-Griffiths A, Kaasalainen S. An analysis of documents guiding palliative care in five Canadian provinces. CJA. 2019;38(3):281–95.PubMed
72.
Government of Newfoundland and Labrador. Long Term Care Facilities in Newfoundland and Labrador: Operational Standards. St. John’s: Newfoundland and Labrador Department of Health and Community Services; 2005.
73.
Government of New Brunswick. Standards manual: nursing home services. Fredericton: Department of Social Development; 2019.
74.
Government of Nova Scotia. Long term care program requirements: nursing homes & residential care facilities. Halifax: Health & Wellness; 2019.
75.
Government of British Columbia. Home and community care policy manual: long-term care services. Vancouver: Ministry of Health; 2019.
76.
Government of Manitoba. The health services insurance act: personal care homes standards regulation. Winnipeg: Ministry of Health; 2020.
77.
Government of Prince Edward Island. Community care facilities and nursing homes act. Charlottetown: Legislative Counsel Office; 2019.
78.
79.
Fisher SE, Burgio LD, Thorn BE, Allen-Burge R, Gerstle J, Roth DL, Allen SJ. J Am Geriatr Soc. 2002;50(1):152–6.CrossRefPubMed
80.
Government of Ontario. Home, community and residential care services: long-term care home service accountability agreement. Toronto: Ministry of Health and Long-Term Care; 2019.
81.
Choiniere JA, Doupe M, Goldmann M, Harrington C, Jacobsen FF, Llyod L, Rootham M, Szebehely M. Mapping nursing home inspections & audits in six countries. Ageing Int. 2016;41(1):40–61.CrossRef
82.
Ombudsman Saskatchewan. Taking care: an ombudsman investigation into the care provided to Margaret Warholm while a resident of the Santa Maria senior citizens home. Regina: Ombudsman Saskatchewan; 2015.
83.
Government of Saskatchewan. Special care-home program guidelines manual. Regina: Ministry of Health; 2016.
84.
Provincial Auditor of Saskatchewan. Saskatoon Regional Health Authority—Overseeing Contracted Special-Care Homes. Regina: Provincial Auditor of Saskatchewan; 2017:161–180.
85.
Government of Ontario. Guide to the long-term care homes act, 2007 and regulation 79/10. Toronto: Ministry of Health and Long-Term Care; 2011.
86.
Registered Nurses’ Association of Ontario. Assessment and Management of Pain. Toronto: Registered Nurses’ Association of Ontario; 2013.
87.
Ontario Association of Non-Profit Homes & Services for Seniors. Pain management program policy, procedures, and training package. Woodbridge: Ontario Association of Non-Profit Homes & Services for Seniors; 2010.
88.
Reid MC, O’Neil KW, Dancy J, Berry CA, Stowell SA. Pain management in long-term care communities: a quality improvement initiative. J Am Med Dir Assoc. 2015;23(2):29–35.
89.
90.
Resident Assessment Instrument—Minimum Data Set (RAI-MDS) User’s Manual 2.0 (Canadian version). Washington, DC: interRAI; 2012.
91.
Fries BE, Simon SE, Morris JN, Flodstrom C, Bookstein FL. Pain in U.S. nursing homes: Validating a pain scale for the minimum data set. Gerontologist. 2001;41:173–9.CrossRefPubMed
92.
Lukas A, Mayer B, Fiavolá D, Topinkova E, Gindin J, Onder G, Bernabei R, Nikolaus T, Denkinger MD. Pain characteristics and pain control in European nursing homes: cross-sectional and longitudinal results from the services and health for elderly in long TERm care (SHELTER) study. J Am Med Dir Assoc. 2013;14:421–8.CrossRefPubMed
93.
Lukas A, Mayer B, Fiavolá D, Topinkova E, Gindin J, Onder G, Bernabei R, Nikolaus T, Denkinger MD. Treatment of pain in European nursing homes: results from the services and health for elderly in long TERm care (SHELTER) study. J Am Med Dir Assoc. 2013;14:821–31.CrossRefPubMed
94.
Tosato M, Lukas A, van der Roest HG, Danese P, Antocicco M, Finne-Soveri H, Nikolaus T, Landi F, Bernabei R, Onder G. Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain. 2012;153:305–10.CrossRefPubMed
95.
Morris JN, Berg K, Björkgren M, Costa AP, Declerq A, Finne-Soveri UH, Fries BE, Frijters D, Gray L, Head MJ, Heckman G, Henrard J-C, Hirdes JP, James ML, Ljunggren G, Meehan B, Stewart SL, Szczerbinska K, & Topinková E. interRAI long-term care facilities (LTCF) assessment form and User’s manual (version 10.0, interRAI standard edition). Washington, DC: interRAI.
96.
Cohen-Mansfield J. The adequacy of the minimum data set assessment of pain in cognitively impaired nursing home residents. J Pain Symptom Manag. 2004;27(4):343–51.CrossRef
97.
Wu N, Miller SC, Lapane K, Roy J, Mor V. The quality of the quality indicator of pain derived from the minimum data set. Health Serv Res. 2005;40(4):1197–216.CrossRefPubMedPubMedCentral
98.
Proctor WR, Hirdes JP. Pain and cognitive status among nursing home residents in Canada. Pain Res Manag. 2001;6(3):119–25.CrossRefPubMed
99.
Hadjistavropoulos T, Marchildon GP, Fine PG, Herr K, Palley HA, Kaasalainen S, Béland F. Transforming long-term care pain management in North America: the policy-clinical interface. Pain Med. 2009;10(3):506–20.CrossRefPubMed
100.
Cadogan MP, Schnelle JF, Yamamoto-Mitani N, Cabrera G, Simmons SF. A minimum data set prevalence of pain quality indicator: is it accurate and does it reflect differences in care processes? J Gerontol A Biol Sci Med Sci. 2004;59(3):M281–5.CrossRef
101.
Fuchs-Lacelle S, Hadjistavropoulos T. Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Manag Nurs. 2004;5:37–49.CrossRefPubMed
102.
Chan S, Hadjistavropoulos T. Evidence-based development and initial validation of the pain assessment checklist for seniors with limited ability to communicate-II (PACSLAC-II). Proceedings of the Canadian Pain Society’s annual conference; 2013; Toronto. ON. .
103.
Warden V, Hurley AC, Volicer V. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4:9–15.CrossRefPubMed
104.
Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, Lowcay B. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004;10(1):6–13.CrossRefPubMed
105.
Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, Jackson K, Parmelee PA, Rudy TE, Beattie BL, Chibnall JT, Craig KD, Ferrell B, Ferrell B, Fillingim RB, Gagliese L, Gallagher R, Gibson SG, Harisson L, Katz B, Keefe F, Lieber SJ, Lussier D, Schmader KE, Tait RC, Weiner DK, Williams J. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain. 2007;23:S1–S43.CrossRefPubMed
106.
Zwakhalen SMG, Hamers JPH, Peijnenburg RHA, Berger MPF. Nursing staff knowledge and beliefs about pain in elderly nursing home residents with dementia. Pain Res Manag. 2007;12(3):177–84.CrossRefPubMedPubMedCentral
Metadata
Title
Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis
Authors
Natasha L. Gallant
Allie Peckham
Gregory Marchildon
Thomas Hadjistavropoulos
Blair Roblin
Rhonda J. N. Stopyn
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-01758-7

Other articles of this Issue 1/2020

BMC Geriatrics 1/2020 Go to the issue

Research article

Length of hospital stay after hip fracture and readmission rates of persons with and without Alzheimer’s disease: a matched cohort study

Research article

Developing evidence-based guidance for assessment of suspected infections in care home residents

Research article

Identifying elderly patients at risk of readmission after discharge from a short-stay unit in the emergency department using performance-based tests of daily activities

Research article

An investigation and analysis of the activities of daily living of older adults living at home in Ningxia Hui Autonomous Region of China: a cross-sectional study

Research article

A balance between meaningfulness and risk of harm – frail elderly patients’ perceptions of physical activity and exercise – an interview study

Research article

Exercise interveNtion outdoor proJect in the cOmmunitY for older people – results from the ENJOY Seniors Exercise Park project translation research in the community

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits