I. Gnass

Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe

ZusammenfassungDerzeit liegen für den deutschsprachigen Raum keine Leitlinien zum Schmerzassessment speziell bei älteren Menschen vor. Dabei wird ein systematisches Schmerzmanagement in Einrichtungen der Altenhilfe durch den Gesetzgeber gefordert. Für diese spezielle Gruppe, insbesondere für Menschen mit Demenz, fehlt es allerdings in Deutschland an geeigneten interdisziplinären Orientierungen für die Versorgungspraxis. Der Arbeitskreis „Schmerz und Alter“ der Deutschen Schmerzgesellschaft hat daher gemeinsam mit dem Deutschen Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, die Entwicklung einer interdisziplinären S3-Leitline zum „Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe“ initiiert. Das durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V. (AWMF) und das Ärztliche Zentrum für Qualität in der Medizin (ÄZQ) sowie im Deutschen Leitlinien-Bewertungsinstrument (DELBI) beschriebene Prozedere liegt dieser Arbeit zugrunde. Auf 3xa0unterschiedlichen Ebenen können sich die Delegierten der derzeit 38xa0beteiligten wissenschaftlichen Fachgesellschaften und Interessengruppen an der inhaltlichen Arbeit beteiligen. Dieser Artikel beschreibt das methodische Vorgehen der Leitlinienentwicklung.AbstractIn Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group “Pain and Age” of the German Pain Society (“Deutschen Schmerzgesellschaft”) in conjunction with the German Centre for Neurodegenerative Diseases (“Deutschen Zentrum für Neurodegenerative Erkrankungen”), Witten, has embarked on the development of interdisciplinary S3-Guideline for “Pain Assessment in Elderly People in Nursing Homes”, based on the methodology suggested by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V.”), the German Agency for Quality in Medicine (“Ärztliche Zentrum für Qualität in der Medizin”), and that described in the DELBI (“Deutschen Leitlinien-Bewertungsinstrument”). Delegates of the 38xa0scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group Pain and Age of the German Pain Society (Deutschen Schmerzgesellschaft) in conjunction with the German Centre for Neurodegenerative Diseases (Deutschen Zentrum für Neurodegenerative Erkrankungen), Witten, has embarked on the development of interdisciplinary S3-Guideline for Pain Assessment in Elderly People in Nursing Homes, based on the methodology suggested by the Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V.), the German Agency for Quality in Medicine (Ärztliche Zentrum für Qualität in der Medizin), and that described in the DELBI (Deutschen Leitlinien-Bewertungsinstrument). Delegates of the 38xa0scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.

Drug-based pain management for people with dementia after hip or pelvic fractures: a systematic review

BackgroundStudies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture.The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings. Treatment could be surgical or conservative. We also analysed study designs, methods and variables, as well as which assessments were applied to measure pain management and mental status.Method/designThe development of this systematic review protocol was guided by the PRISMA-P requirements, which were taken into consideration during the review procedures. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect were searched. Studies published up to January 2016 were included. The data extraction, content and quantitative descriptive analysis were carried out systematically, followed by a critical appraisal.ResultsEight of the 13 included studies focusing on patient data showed that people with dementia received less drug-based pain management than people without cognitive impairment. Four studies based on surveys of healthcare professionals stated that cognitive impairment is a major barrier for effective pain management. There was heterogeneity regarding the assessment of the mental status and the pain assessment of the patients. The assessment of the drugs administered in all of the studies working with patient data was achieved through chart reviews.ConclusionPeople with dementia do not seem to receive the same amount of opioid analgesics after hip fracture as people without cognitive impairment. There is need to enhance pain assessment and management for these patients. Future research should pay more attention to the use of the appropriate items for assessing cognitive impairment and pain in people with dementia.Trial registrationThis systematic review was registered at Prospero (CRD42016037309); on 11 April 2016, and the systematic review protocol was publishedxa0(Syst Rev. 5(1):1, 2016).

[Pain assessment in elderly nursing home residents: methods paper for the S3-guideline development].

ZusammenfassungDerzeit liegen für den deutschsprachigen Raum keine Leitlinien zum Schmerzassessment speziell bei älteren Menschen vor. Dabei wird ein systematisches Schmerzmanagement in Einrichtungen der Altenhilfe durch den Gesetzgeber gefordert. Für diese spezielle Gruppe, insbesondere für Menschen mit Demenz, fehlt es allerdings in Deutschland an geeigneten interdisziplinären Orientierungen für die Versorgungspraxis. Der Arbeitskreis „Schmerz und Alter“ der Deutschen Schmerzgesellschaft hat daher gemeinsam mit dem Deutschen Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, die Entwicklung einer interdisziplinären S3-Leitline zum „Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe“ initiiert. Das durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V. (AWMF) und das Ärztliche Zentrum für Qualität in der Medizin (ÄZQ) sowie im Deutschen Leitlinien-Bewertungsinstrument (DELBI) beschriebene Prozedere liegt dieser Arbeit zugrunde. Auf 3xa0unterschiedlichen Ebenen können sich die Delegierten der derzeit 38xa0beteiligten wissenschaftlichen Fachgesellschaften und Interessengruppen an der inhaltlichen Arbeit beteiligen. Dieser Artikel beschreibt das methodische Vorgehen der Leitlinienentwicklung.AbstractIn Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group “Pain and Age” of the German Pain Society (“Deutschen Schmerzgesellschaft”) in conjunction with the German Centre for Neurodegenerative Diseases (“Deutschen Zentrum für Neurodegenerative Erkrankungen”), Witten, has embarked on the development of interdisciplinary S3-Guideline for “Pain Assessment in Elderly People in Nursing Homes”, based on the methodology suggested by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V.”), the German Agency for Quality in Medicine (“Ärztliche Zentrum für Qualität in der Medizin”), and that described in the DELBI (“Deutschen Leitlinien-Bewertungsinstrument”). Delegates of the 38xa0scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group Pain and Age of the German Pain Society (Deutschen Schmerzgesellschaft) in conjunction with the German Centre for Neurodegenerative Diseases (Deutschen Zentrum für Neurodegenerative Erkrankungen), Witten, has embarked on the development of interdisciplinary S3-Guideline for Pain Assessment in Elderly People in Nursing Homes, based on the methodology suggested by the Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V.), the German Agency for Quality in Medicine (Ärztliche Zentrum für Qualität in der Medizin), and that described in the DELBI (Deutschen Leitlinien-Bewertungsinstrument). Delegates of the 38xa0scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.

Drug-based pain management in people with dementia after hip or pelvic fractures: a systematic review protocol

BackgroundStudies show that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent and how drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review is to identify studies addressing drug-based pain management for people with dementia who have had a hip or pelvic fracture for which they had either an operation or conservative treatment. We will analyse to what extent and how the drug-based pain treatment for people with dementia is performed across all settings and how it is assessed in the studies.MethodsThe development of this systematic review protocol was guided by the PRISMA-P requirements, which will be taken into consideration during the review procedure. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect will be searched, using keywords such as “analgesia”, “dementia”, “cognitive impairment”, “pain treatment”, “hip fracture” or “pelvic fracture”. Publications published up to January 2016 will be included. The data extraction and a content analysis will be carried out systematically, followed by a critical appraisal.DiscussionThis review will provide a valuable overview on the current evidence on drug-based pain management for PwD in all settings who were conservatively treated after a hip or pelvic fracture. The review may expose a need to enhance pain management for PwD. It may also provide motivation for healthcare providers and policymakers to give this topic their attention and to facilitate further research by considering aspects of care transitions in all settings.Systematic review registrationPROSPERO CRD42016037309

Diagnostik von Schmerzen im Alter

Die Situation alter Menschen mit Schmerzen unterscheidet sich von der jüngerer Menschen. So sind alte Menschen insgesamt häufig und v.xa0a. von chronischen Schmerzen betroffen. Sie weisen oft mehrere Schmerzereignisse gleichzeitig auf und ihre Situation ist insgesamt durch Multimorbidität geprägt. Vor diesem Hintergrund geht der Beitrag der Frage nach, welche Anforderungen an die Diagnostik von Schmerzen im Alter sich von der Schmerzdiagnostik in anderen Lebensphasen unterscheiden und wie diesen Anforderungen derzeit begegnet wird. Grundlegend ist die Orientierung an einem biopsychosozialen Modell des Schmerzes, das die Mehrdimensionalität von Schmerz berücksichtigt. Auch die Berücksichtigung der Schmerzkommunikation und der alterspezifischen Einflussfaktoren auf sie ist bedeutsam. Die systematisierte Einschätzung von Schmerz im Alter soll die motivational-affektive, die sensorisch-diskriminative sowie die kognitiv-evaluative Schmerzdimension berücksichtigen. Eine Verengung nur auf die Schmerzstärke oder eine reine Verhaltensbeobachtung liefern unzureichende Informationen, die den biografischen, gesundheitlichen, lebensweltlichen und versorgungsspezifischen Einflussfaktoren nicht gerecht werden. Die verschiedenen Schmerzdimensionen sind in der Diagnostik nicht austauschbar, sondern müssen sich vielmehr ergänzen. Insbesondere bei alterstypischen Erkrankungen, wie Demenz, ist dies jedoch derzeit nicht immer machbar. Derzeit steht als altersspezifisches mehrdimensionales Instrument lediglich das geriatrische Schmerzinterview zur Verfügung. Es besteht Forschungs- und Entwicklungsbedarf im Hinblick auf die mehrdimensionale, altersspezifische Diagnostik. Old people’s experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.Old peoples experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.

The Assessment of Pain in Older People

Pain assessment is a crucial step toward adequate management of pain in older adults. This chapter addresses the assessment of pain as part of a multidimensional stepwise approach. Although pain assessment uses standardized screening, assessment, and monitoring tools, it needs to be tailored to the individual patient. In the case of pain assessment in older adults, one size does not fit all is a fundamental principle. Pain is a personal and subjective experience because of numerous factors. A broad, inclusive approach to assessment is required. In this chapter several case studies highlight the differences and factors that need to be taken into account in the assessment of pain in older people.

Assessment of patient-reported outcomes after polytrauma: protocol for a systematic review

Introduction Survivors of polytrauma experience long-term and short-term burden that influences their lives. The patients’ view of relevant short-term and long-term outcomes should be captured in instruments that measure quality of life and other patient-reported outcomes (PROs) after a polytrauma. The aim of this systematic review is to (1) collect instruments that assess PROs (quality of life, social participation and activities of daily living) during follow-up after polytrauma, (2) describe the instruments’ application (eg, duration of period of follow-up) and (3) investigate other relevant PROs that are also assessed in the included studies (pain, depression, anxiety and cognitive function). Methods and analysis The systematic review protocol is developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials and the trials registers ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be searched. Keywords, for example, ‘polytrauma’, ‘multiple trauma’, ‘quality of life’, ‘activities of daily living’ or ‘pain’ will be used. Publications published between January 2005 and the most recent date (currently: August 2016) will be included. In order to present the latest possible results, an update of the search is conducted before publication. The data extraction and a content analysis will be carried out systematically. A critical appraisal will be performed. Ethics and dissemination Formal ethical approval is not required as primary data will not be collected. The results will be published in a peer-reviewed publication. PROSPERO registration number CRD42017060825.

Diagnostik von Schmerzen im Alter@@@Diagnostics of pain in old age: Perspektiven auf ein multidimensionales Phänomen@@@Perspectives on a multidimensional phenomenon

Die Situation alter Menschen mit Schmerzen unterscheidet sich von der jüngerer Menschen. So sind alte Menschen insgesamt häufig und v.xa0a. von chronischen Schmerzen betroffen. Sie weisen oft mehrere Schmerzereignisse gleichzeitig auf und ihre Situation ist insgesamt durch Multimorbidität geprägt. Vor diesem Hintergrund geht der Beitrag der Frage nach, welche Anforderungen an die Diagnostik von Schmerzen im Alter sich von der Schmerzdiagnostik in anderen Lebensphasen unterscheiden und wie diesen Anforderungen derzeit begegnet wird. Grundlegend ist die Orientierung an einem biopsychosozialen Modell des Schmerzes, das die Mehrdimensionalität von Schmerz berücksichtigt. Auch die Berücksichtigung der Schmerzkommunikation und der alterspezifischen Einflussfaktoren auf sie ist bedeutsam. Die systematisierte Einschätzung von Schmerz im Alter soll die motivational-affektive, die sensorisch-diskriminative sowie die kognitiv-evaluative Schmerzdimension berücksichtigen. Eine Verengung nur auf die Schmerzstärke oder eine reine Verhaltensbeobachtung liefern unzureichende Informationen, die den biografischen, gesundheitlichen, lebensweltlichen und versorgungsspezifischen Einflussfaktoren nicht gerecht werden. Die verschiedenen Schmerzdimensionen sind in der Diagnostik nicht austauschbar, sondern müssen sich vielmehr ergänzen. Insbesondere bei alterstypischen Erkrankungen, wie Demenz, ist dies jedoch derzeit nicht immer machbar. Derzeit steht als altersspezifisches mehrdimensionales Instrument lediglich das geriatrische Schmerzinterview zur Verfügung. Es besteht Forschungs- und Entwicklungsbedarf im Hinblick auf die mehrdimensionale, altersspezifische Diagnostik. Old people’s experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.Old peoples experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.

Diagnostics of pain in old age. Perspectives on a multidimensional phenomenon

Die Situation alter Menschen mit Schmerzen unterscheidet sich von der jüngerer Menschen. So sind alte Menschen insgesamt häufig und v.xa0a. von chronischen Schmerzen betroffen. Sie weisen oft mehrere Schmerzereignisse gleichzeitig auf und ihre Situation ist insgesamt durch Multimorbidität geprägt. Vor diesem Hintergrund geht der Beitrag der Frage nach, welche Anforderungen an die Diagnostik von Schmerzen im Alter sich von der Schmerzdiagnostik in anderen Lebensphasen unterscheiden und wie diesen Anforderungen derzeit begegnet wird. Grundlegend ist die Orientierung an einem biopsychosozialen Modell des Schmerzes, das die Mehrdimensionalität von Schmerz berücksichtigt. Auch die Berücksichtigung der Schmerzkommunikation und der alterspezifischen Einflussfaktoren auf sie ist bedeutsam. Die systematisierte Einschätzung von Schmerz im Alter soll die motivational-affektive, die sensorisch-diskriminative sowie die kognitiv-evaluative Schmerzdimension berücksichtigen. Eine Verengung nur auf die Schmerzstärke oder eine reine Verhaltensbeobachtung liefern unzureichende Informationen, die den biografischen, gesundheitlichen, lebensweltlichen und versorgungsspezifischen Einflussfaktoren nicht gerecht werden. Die verschiedenen Schmerzdimensionen sind in der Diagnostik nicht austauschbar, sondern müssen sich vielmehr ergänzen. Insbesondere bei alterstypischen Erkrankungen, wie Demenz, ist dies jedoch derzeit nicht immer machbar. Derzeit steht als altersspezifisches mehrdimensionales Instrument lediglich das geriatrische Schmerzinterview zur Verfügung. Es besteht Forschungs- und Entwicklungsbedarf im Hinblick auf die mehrdimensionale, altersspezifische Diagnostik. Old people’s experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.Old peoples experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.

Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe@@@Pain assessment in elderly nursing home residents: Methodenpapier zur S3-Leitlinie@@@Methods paper for the S3-guideline development

ZusammenfassungDerzeit liegen für den deutschsprachigen Raum keine Leitlinien zum Schmerzassessment speziell bei älteren Menschen vor. Dabei wird ein systematisches Schmerzmanagement in Einrichtungen der Altenhilfe durch den Gesetzgeber gefordert. Für diese spezielle Gruppe, insbesondere für Menschen mit Demenz, fehlt es allerdings in Deutschland an geeigneten interdisziplinären Orientierungen für die Versorgungspraxis. Der Arbeitskreis „Schmerz und Alter“ der Deutschen Schmerzgesellschaft hat daher gemeinsam mit dem Deutschen Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, die Entwicklung einer interdisziplinären S3-Leitline zum „Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe“ initiiert. Das durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V. (AWMF) und das Ärztliche Zentrum für Qualität in der Medizin (ÄZQ) sowie im Deutschen Leitlinien-Bewertungsinstrument (DELBI) beschriebene Prozedere liegt dieser Arbeit zugrunde. Auf 3xa0unterschiedlichen Ebenen können sich die Delegierten der derzeit 38xa0beteiligten wissenschaftlichen Fachgesellschaften und Interessengruppen an der inhaltlichen Arbeit beteiligen. Dieser Artikel beschreibt das methodische Vorgehen der Leitlinienentwicklung.AbstractIn Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group “Pain and Age” of the German Pain Society (“Deutschen Schmerzgesellschaft”) in conjunction with the German Centre for Neurodegenerative Diseases (“Deutschen Zentrum für Neurodegenerative Erkrankungen”), Witten, has embarked on the development of interdisciplinary S3-Guideline for “Pain Assessment in Elderly People in Nursing Homes”, based on the methodology suggested by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V.”), the German Agency for Quality in Medicine (“Ärztliche Zentrum für Qualität in der Medizin”), and that described in the DELBI (“Deutschen Leitlinien-Bewertungsinstrument”). Delegates of the 38xa0scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany. The working group Pain and Age of the German Pain Society (Deutschen Schmerzgesellschaft) in conjunction with the German Centre for Neurodegenerative Diseases (Deutschen Zentrum für Neurodegenerative Erkrankungen), Witten, has embarked on the development of interdisciplinary S3-Guideline for Pain Assessment in Elderly People in Nursing Homes, based on the methodology suggested by the Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.xa0V.), the German Agency for Quality in Medicine (Ärztliche Zentrum für Qualität in der Medizin), and that described in the DELBI (Deutschen Leitlinien-Bewertungsinstrument). Delegates of the 38xa0scientific societies and interest groups currently participating can contribute to the contents on three different levels. The present article outlines the methods for developing the guideline.