Event 6: Conclusions

Summary of Evidence

Let’s take a close look at each tool or intervention that was covered in Margaret’s case and how it’s ranked according to the level of evidence.

PAINAD is a tool that can be used in adults with limited communication to assess pain. It is a tool that utilized five indicators to assess pain: breathing, negative vocalization, facial expression, body language and consolability. There is moderate evidence supporting the use of PAINAD as a tool in adults with limited communication skills.

The Mini-Cog™ is a tool that assesses cognition in adults. The Mini-Cog™ which consists of two questions. The questions consist of delayed three word recall and the clock drawing test. The score ranges from 0 to 5. A score of 0, 1, or 2 suggests cognitive impairment and a score of 3, 4 or 5 suggests a lower likelihood of cognitive impairment.

Oral health promotion in older adults with limited communication has strong and moderate evidence. This population may have behavior changes that do not always indicate the problem. Regular oral assessment and dental examination is an important step in health promotion. In addition, daily activities of brushing teeth, removing dentures and keep the mouth moist all contribute to good oral health.

Behavior changes with dementia related to dental or oral pain is challenging to study due to limited communication. The evidence is rated as weak due to a lack of evidence due to the difficulties completing more rigorous studies in this population.

Take Home Messages for Older Adults with Limited Communication

Pain Assessment

Utilize a valid and reliable pain assessment for older adults with limited communication; reassess over time; utilize the hierarchy of pain assessment as a guide. Oral pain can go unrecognized due to the individual’s limited communication.

Behavior Changes

Behaviors can change in adults with dementia and a comprehensive assessment is needed to assist in identification of a cause.

Oral Care

Oral care is an important part of a treatment plan in older adults with limited communication. Daily care is needed with support of caregivers with periodic assessment by a dentist.

Caregiver Education

Caregivers and family members may need education regarding behavior, pain, oral care and the needs of individuals with dementia.

Multidisciplinary Treatment Plan

A multidisciplinary treatment plan is needed to assist in providing care for individuals with dementia.

Coordinating Communication

One of the challenges in providing interdisciplinary care is coordinating communication between caregivers, the patient and family. In the module you saw examples of written and oral communication between caregivers as well as between caregivers and family.

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