Madushika Wishvanie Kodagoda Gamage

Aim: Pain is under‐assessed and under‐treated among people living with dementia. This study aims to explore the perspectives of people with dementia, family carers, and healthcare professionals regarding their experiences and needs for pain assessment and management.Design: A qualitative descriptive approach.Methods: Between May and August 2023, people with early‐stage dementia (n = 6), their family carers (n = 7), and healthcare professionals (n = 10) from four Australian states participated in semi‐structured interviews, online or by telephone. Most of the participants were female. Work experience of healthcare professionals and caring experience of carers ranged from 3–40 and 2–8 years, respectively. Following transcription, the data were analysed using inductive thematic analysis.Results: Four main themes and 10 subthemes were identified. Main themes were (1) communications to identify pain in people with dementia, (2) pain assessment in people with dementia, (3) pain management strategies, and (4) training in pain and dementia care. Healthcare professionals and family carers reported challenges in pain identification. People with dementia also mentioned their pain being unrecognised by carers. Facilitators included familiarity and communication with people with dementia and family carers. Non‐verbal cues and unusual behaviours were commonly used to identify pain, and a personalised pain assessment approach was highlighted. Non‐pharmacological strategies were used as the first‐line therapy to manage pain. However, a lack of knowledge and training in pain and dementia care indicated the need for a training program (e.g., a self‐paced online short course).Conclusions: Pain assessment and management in people with dementia is challenging, primarily due to communication barriers and a lack of skill training. Formal pain assessment and management training and efficient, easy‐to‐use pain assessment tools are needed to address this.Implications for the Profession and/or Patient Care: Limited communication capacity in people with dementia and lack of training in carers are key challenges regarding pain assessment and management in people with dementia. Improved training in communication, pain assessment, and management skills may help to address these challenges.Impact: This study addressed a lack of knowledge and skills for healthcare professionals and family carers in effective pain assessment and management in people with dementia. Collaborative communication among different stakeholders and skills training may overcome the challenges and barriers.Reporting Method: COREQ guidelines were followed when reporting this study.Patient or Public Contribution: Healthcare professionals, people with dementia, and family carers contributed to the design of interview questions and data collection.

Aim: To explore registered nurses' beliefs regarding pain assessment in people living with dementia.Design: A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour.Methods: Online semi‐structured in‐depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis.Findings: Registered nurses believe pain assessment improves the well‐being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments.Conclusion: Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices.Implications for the Profession and/or Patient Care: Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices.Impact: Pain is underassessed in dementia, and this could stem from registered nurses' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices.Reporting Method: This study adhered to the COREQ criteria.Patient or Public Contribution: Registered nurses caring for people living with dementia participated as interview respondents.

Aim: To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia.Design: A descriptive cross‐sectional survey was conducted between July 2022 and April 2023.Methods: An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia.Results: RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self‐identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge).Conclusion: The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia.Implications for the profession and/or patient care: Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes.Impact: Some RNs' beliefs about pain assessment in dementia were not evidence‐based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia.Reporting Method: This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist.Patient or Public Contribution: RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre‐testing of the study's survey instrument.

Objective: Quality of care determines the physical and psychological wellbeing of aged care residents. The study aims to explore barriers and facilitators of quality of care in aged care homes (ACHs) in Sri Lanka from the perspective of older adults and caregivers. Methods: This qualitative descriptive exploratory study was conducted in selected five ACHs in Galle District, Sri Lanka, from May 2021 to January 2022. We recruited a purposive sample of residents and caregivers and conducted ten in-depth interviews with ten caregivers and nine focus group discussions with forty-five residents. The data were analysed using the thematic analysis. Results: The majority of caregivers and residents were females. Caregivers and residents were aged 25-35 years and 70-80 years, respectively. Two major themes emerged: (a) barriers of quality of care and (b) facilitators of quality of care. Both residents and caregivers reported a lack of referring system facilities; a lack of financial support on the infrastructure; a lack of financial support in supplying medication and employing human resources; insufficient knowledge of gerontological care and geriatric syndromes for both caregivers and residents; and lack of interest in being a caregiver at the ACHs as barriers in providing quality care. Moreover, caregivers and older people reported donations by philanthropists; supportive leadership; and welfare benefits from the government authorities as facilitators of quality care. Additionally, caregivers reported a lack of in-service programmes for caregivers as a barrier and positive institutional values as a facilitator for providing quality care. Conclusion: The available human and physical resources are insufficient to address the demanding needs of residents in ACHs, apart from the received donations. There is a simultaneous need for healthcare policymakers' and social welfare authorities' attention to implementing necessary measures to uplift the quality of care for residents in ACHs to enhance their quality of life.

As the elderly population and prevalence of dementia is increasing, it is necessary to have a better comprehension of the influence of specific factors on cognitive function. Dementia is not an inevitable consequence of ageing. Lifestyle factors might either increase or decrease the risk. Even though different studies have focused on individual factors, only a few studies are available which assess all these factors as a whole. Available evidence on these factors is mainly from high income countries and much less evidence is available from low and middle income countries. As cognition is critical for elderly people to engage in a physically independent life, we aimed to identify the associated factors of cognition. This was a descriptive cross sectional study performed with 421 elderly people dwelling in residential care facilities for the aged in two selected districts in the Southern Province of Sri Lanka. Cognition was assessed using the Mini Mental State Examination (MMSE). Independent sample t test, ANOVA and regression analyses were used to explore associated factors for cognition. The statistical significance was kept at bonferroni adjusted p < 0.004. The study included elderly people with a mean age of 71.9 ± 6.7 years and of them 65.8% were females. Factors affecting higher level of cognition were, having upper secondary, advanced and higher education; being married; arriving at the facility on one’s own accord; being visited by family members; higher physical activity levels and engaging in social and leisure activities (p < 0.004). The factors, namely physical activity level, educational status, visits by family members and engaging in leisure activities were the predictors of cognition in the regression model. Though there were several factors that associated with the level of cognition such as educational status, marital status, reason for attending the facility, visits by family members, physical activity levels and participation in social and leisure activities, only the factors, such as physical activity levels, visits by family members, educational status and engaging in leisure activities were the predictors of cognition.

Although cognitive functions affect the health related quality of life (QoL), the relationship between perceived QoL and cognition including executive functions has not been studied adequately. Available studies show moderate to weak correlations. We evaluated the association of cognition and executive functions, namely working memory (WM) and inhibitory control (IC) with the perceived QoL of a sample of elderly people dwelling in residential aged care facilities (RACFs) in Southern Province of Sri Lanka. Cognition was assessed using Mini-Mental State Examination (MMSE), while verbal WM (VWM), visuo-spatial WM (VSWM) and IC (interference control, inhibition of pre potent and ongoing responses) were assessed using VWM, VSWM tasks, colour word Stroop (CWS), go/no-go (GNG) and stop signal (SS) tasks respectively. WHOQoL-Bref (Total score and domain scores) were used to assess QoL. The relationship was analysed using Pearson correlation and hierarchical multiple regression analysis. Study included 237 elderly people with a mean age of 71.11 ± 6.44 years. Participants scored the highest in the domain of environment (63.48 ± 10.63) and lowest in the domain of social relationships (55.43 ± 21.84) of QoL. Psychological health domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS, SS and GNG task errors. Both physical health domain and total QoL demonstrated positive correlations with MMSE, VSWM and VWM scores, while negative correlations were observed with CWS task errors. Social relationships domain demonstrated a significant positive correlation with VSWM score. Environment domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS and SS task errors. All were significant but weak correlations. When controlled for covariates, such as educational status, physical activity and marital status, cognition was a predictor of the domain of environment of QoL, while executive functions were not predictors of total QoL and domains of QoL. Cognition and executive functions weakly but significantly correlated with different domains of QoL. Only the level of cognition measured by MMSE was a predictor of the domain of environment of QoL and executive functions were not predictors of total QoL and domains of QoL in elderly people with normal cognitive functions dwelling in RACFs.