Pain Assessment for Individuals with Advanced Dementia in Care Homes: A Systematic Review

Nansi Felton*, Jenny Lewis, Sarah-Jane Cockburn, Margot Hodgson, Shoba Dawson

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

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Pain is prevalent in older people, especially in those with advanced dementia who have communication impairments. Although pain is recognised to be present in this population, it is often under-assessed and ineffectively managed. The assessment of pain in advanced dementia is extremely challenging and complex, particularly in institutional settings such as care homes. This study systematically reviews the literature to examine and characterise the evidence for the use of pain assessment tools in care homes with individuals living with advanced dementia. Relevant publications were sourced from electronic bibliometric medical databases including AMED, CINAHL Plus, Medline, PsycINFO, EMBASE, TRIP Pro, Google Scholar, and HINARI. The database search was supplemented by screening citations and reference lists, in addition to a grey literature searches. The search identified 2221 studies, among which 26 were included in the review. The majority of the studies were observational, which created a rich source of data to create four major themes. The findings were informed and shaped by working with key stakeholders to develop a conceptual model that can contribute to developing evidence-based practice. This highlights the importance of a comprehensive, multi-disciplinary approach to pain assessment in this population, which is beyond the use of tools. View Full-Text
Original languageEnglish
Article number101
Number of pages22
Issue number4
Publication statusPublished - 19 Oct 2021

Bibliographical note

Funding Information:
We would like to thank the following for their valuable contributions to this project: The Dementia Health Integration Team (HIT), especially to Richard Cheston, Patricia Schofield, the Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) Library service, AWP South Gloucestershire Care Home Liaison Team, and Bristol Dementia Well-being Service Care Home Liaison Team.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • systematic review
  • pain assessment
  • advanced dementia
  • care homes


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