Dementia Care: Addressing Pain and Maximizing Comfort

Pain is common in older people who have Dementia, and is associated with a number of chronic and acute conditions. There is evidence that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated. Pain has a powerful effect on mood, sleep quality, functional ability, and overall quality of life. Rejecting care due to pain is very common among patients with Dementia. An association between pain and increased agitation has been noted, Significant reduction of agitation and psychotropic usage have been demonstrated by pain treatment in patients with moderate to severe dementia. This project was conducted in six memory care units with 150 residents at 815 bedded long-term geriatric care facility. All residents in memory care units from May 2018 to December 2019 were individually assessed for pain management, rejection of care, usage of psychotropics, falls and physical altercations. Trained interdisciplinary staff to evaluate pain by using PAIN AD. Educated interdisciplinary team on pharmacological and non-pharmacological pain management, and Pain management has improved from 40% to 90%, Rejection of care reduced from 80% to 30%. Usage of antipsychotics reduced by 12%. Falls reduced from 12% to 2%. Physical altercations reduced to zero. Staff call out due to work related injury significantly reduced. Staff verbalized improved job satisfaction and increased morale.

Adolescent High-Risk Behaviors and Orofacial Trauma

Aim: The objective of the study was to investigate if there was a relationship between high risk behaviors among adolescents and orofacial trauma. Material and Methods: The study used a cross-sectional retrospective design with data collected from electronic health records of over 4,000 patients treated in the Department of Pediatric Dentistry at the University of Pittsburgh School of Dental Medicine from May 2009 through September 2013. This study was approved by the University of Pittsburgh Institutional Review Board. Risk factors for trauma were obtained from each patient’s medical and social history and included tobacco, alcohol and illicit drug use, tattoos, piercings, and mouthguard use during sports. Outcome measures used were history of broken bones or orofacial trauma. The odds ratios (OR) and 95% confidence intervals (CI) of each risk factor in increasing risk for trauma outcomes were calculated. Chi-square tests were also performed with an alpha of 0.05. Results and Conclusions: A total of 2,609 patients were included in this study. Males (N=1,340) had statistically more often orofacial trauma than females, and were statistically more often exposed to all risk factors (tobacco, alcohol and illicit drug use, tattoos, and physical altercations) than females with the exception of using piercings in body parts other than the ears and not wearing mouthguard for sports. Wearing mouthguard for sports decreased in 50% the risk of orofacial trauma (OR=0.53; 95% CI 0.42-0.68; p=0.00000001). Tobacco use and physical altercations increased the chance of broken bone, fractured tooth, and orofacial trauma in 2-fold (smoking, OR=1.85-2.28, 95% CI 1.3-2.96; physical altercations, OR=1.9-2.34; p=0.0005). Drinking and using illicit drugs increased the risk of broken bone (OR=1.9, 95% CI 1.37- 2.64; p=0.0001). Use of mouthguards for sports dramatically reduced the risk of orofacial trauma. Tobacco, alcohol and illicit drug use, and getting into physical altercations increased the risk of orofacial trauma.