000097338 001__ 97338 000097338 005__ 20210902121909.0 000097338 0247_ $$2doi$$a10.3389/fneur.2020.592366 000097338 0248_ $$2sideral$$a120406 000097338 037__ $$aART-2020-120406 000097338 041__ $$aeng 000097338 100__ $$aGimenez-Llort, L. 000097338 245__ $$aPain in Older Adults With Dementia: A survey in Spain 000097338 260__ $$c2020 000097338 5060_ $$aAccess copy available to the general public$$fUnrestricted 000097338 5203_ $$aThe risk of suffering pain increases significantly throughout life, reaching the highest levels in its latest years. Prevalence of pain in nursing homes is estimated to range from 40 to 80% of residents, most of them old adults affected with dementia. It is already known that pain is under-diagnosed and under-treated in patients with severe cognitive impairment and poor/absent verbal communication, resulting in a serious impact on their quality of life, psychosocial, and physical functioning. Under-treated pain is commonly the cause of behavioral symptoms, which can lead to misuse of antipsychotic treatments. Here, we present two Regional and National Surveys in Spain (2015–2017) on the current practices, use of observational tools for pain assessment, guidelines, and policies. Results, discussed as compared to the survey across central/north Europe, confirm the professional concerns on pain in severe dementia, due to poor standardization and lack of guidelines/recommendations. In Spain, observational tools are scarcely used because of their difficulty and low reliability in severe dementia, since the poor/absent verbal communication and comprehension are considered limiting factors. Behavioral observation tools should be used while attending the patients, in a situation including rest and movement, should be short (3–5 min) and scored using a numeric scale. Among the pain items to score, “Facial expression” and “Verbalization” were considered essential and very useful, respectively. This was in contrast to “Body movements” and “Vocalizations,” respectively, according to the survey in central/north Europe. Scarce time availability for pain assessment and monitoring, together with low feasible and time-consuming tools, can make pain assessment a challenge. The presence of confounding factors, the low awareness and poor knowledge/education of specific tools for this population are worrisome. These complaints draw future directions to improve pain assessment. More time available, awareness, and involvement of the teams would also benefit pain assessment and management in cognitive impairment. The experiences and opinions recorded in these surveys in Spain and other E.U. countries were considered sources of knowledge for designing the “PAIC-15 scale,” a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition and the “Observational pain assessment” in older persons with dementia. 000097338 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/ 000097338 590__ $$a4.003$$b2020 000097338 591__ $$aNEUROSCIENCES$$b117 / 273 = 0.429$$c2020$$dQ2$$eT2 000097338 591__ $$aCLINICAL NEUROLOGY$$b72 / 208 = 0.346$$c2020$$dQ2$$eT2 000097338 592__ $$a1.23$$b2020 000097338 593__ $$aNeurology (clinical)$$c2020$$dQ2 000097338 593__ $$aNeurology$$c2020$$dQ2 000097338 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000097338 700__ $$0(orcid)0000-0002-8222-1418$$aBernal Ruiz, María Luisa$$uUniversidad de Zaragoza 000097338 700__ $$aDocking, R. 000097338 700__ $$aMunstant-Soria, A. 000097338 700__ $$aTorres-Lista, V. 000097338 700__ $$aBulbena, A. 000097338 700__ $$aSchofield, P. 000097338 7102_ $$11012$$2315$$aUniversidad de Zaragoza$$bDpto. Farmac.Fisiol.y Med.L.F.$$cÁrea Farmacología 000097338 773__ $$g11 (2020), 592366 1-11$$pFront. neurol.$$tFrontiers in Neurology$$x1664-2295 000097338 85641 $$uhttps://www.frontiersin.org/articles/10.3389/fneur.2020.592366/abstract$$zTexto completo de la revista 000097338 8564_ $$s2364124$$uhttps://zaguan.unizar.es/record/97338/files/texto_completo.pdf$$yVersión publicada 000097338 8564_ $$s29206$$uhttps://zaguan.unizar.es/record/97338/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000097338 909CO $$ooai:zaguan.unizar.es:97338$$particulos$$pdriver 000097338 951__ $$a2021-09-02-10:41:10 000097338 980__ $$aARTICLE