Abstract
Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to interventions within the scope of occupational therapy to manage pain in individuals with dementia.
Full Systematic Review Question
This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for people living with Alzheimer’s disease and other related neurological conditions and their care partners?”
Current Theme Reported
This systematic review brief focuses on interventions to manage pain in individuals with dementia.
Clinical Scenario
There are currently 54.1 million adults living in the United States aged 65 or older, of which 6.2 million have a diagnosis of Alzheimer’s disease (Centers for Disease Control and Prevention, 2022). With the prevalence of chronic pain being highest among those 65 and older, it is feasible to say that individuals with dementia are greatly impacted (Achterberg et al., 2013; Zelaya et al., 2020); however, accurate assessment and treatment of pain in individuals with dementia poses a challenge due to the difficulties with communication associated with dementia (Corbett et al., 2012). Adding to the challenge, individuals with dementia often process pain differently than those without, and the type of dementia can further differentiate this (Corbett et al., 2012; International Association for the Study of Pain [IASP], 2021). Pain in individuals with dementia can often present as negative behaviors and consequently be treated with antipsychotic medications (Achterberg et al., 2013; IASP, 2021). Therefore, it is important to gain an understanding of the most effective ways to manage pain in individuals with dementia (Corbett et al., 2012). Even when the presence of pain is correctly assessed, adverse reactions to pharmacological management are common in individuals with dementia, given the typical age of diagnosis; therefore, nonpharmacological management should be attempted first (IASP, 2021). Of particular importance to occupational therapy practitioners, the presence of pain often leads to decreased participation in meaningful occupations, which already poses difficulty in individuals with dementia.
Summary of Key Findings
One Level 1a systematic review related to interventions addressing pain management in individuals with dementia was included. Interventions included reflexology, massage, ear acupressure, music, showering, tai chi, and passive movement therapy (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).
Evidence Table for Interventions to Manage Pain in Individuals with Dementia
Note. LTC = long-term care; RCT = randomized controlled trial; RoB = risk of bias.
Bottom Line for Occupational Therapy Practice
Occupational therapy practitioners inherently focus on an individual’s ability to maximize the potential to participate in meaningful and necessary occupations to fulfill life roles. In addition to the difficulties individuals experience because of the typical symptoms associated with dementia, pain can be an additional limiting factor in an individual’s ability to participate in meaningful occupations. The systematic review provides moderate strength of evidence from one Level 1a study that psychosocial interventions can significantly reduce observed pain in individuals with dementia (Pu et al., 2019). Occupational therapy practitioners could consider providing one-on-one psychosocial interventions, like sensory-based activities, within their scope of practice to help individuals with dementia who are experiencing pain and to facilitate improved participation in meaningful occupations.
Footnotes
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Indicates articles included in the brief systematic review.
Acknowledgment
The authors thank Payton Swanson and Danielle Adams, University of Nebraska Medical Center’s occupational therapy doctoral students, for research assistance to prepare this brief.