PAIN AND ALZHEIMER'S IN THE HOME CONTEXT: NARRATIVE REVIEW ON NURSE SKILLS

F. Gallone¹, A. Budaca², G. Cotichelli³, A. Giambartolomei⁴, P. Palumbo⁴, D. Gaggia⁵ | ¹Adjunct Professor and Teaching Tutor, Polytechnic University of Marche, Faculty of Medicine and Surgery - Degree Course in Nursing, Ancona; ²Nurse, Ancona; ³Director of ADP and Adjunct Professor, Polytechnic University of Marche, Faculty of Medicine and Surgery - Degree Course in Nursing, Ancona; ⁴Teaching Tutor, Polytechnic University of Marche, Faculty of Medicine and Surgery - Degree Course in Nursing, Ancona; ⁵Coordinator of C.O.T. 118, AST Ancona

INTRODUCTION
Chronic pain often occurs in older adults, especially in patients with neurodegenerative diseases such as Alzheimer's disease. According to Brodaty & Donkin (2009), the majority (80%) of people with Alzheimer's and related dementias receive home care. The pain of patients with Alzheimer's disease remains underreported compared to their cognitively intact functions.
METHODS
Literature narrative review on PubMed, Cochrane, CINAHL and EMBASE. The review was based on the steps and processes reported in the PRISMA standards for systematic reviews. The authors followed these steps: selection of the guiding question; definition of eligibility criteria; definition of relevant information deriving from studies; evaluation of results; interpretation; summary of the information found. Limitations: review, last ten years, human > 18 y/o. After this, due to the lack of results in finding, studies of lesser reliability were also included (such as clinical trial and case report), articles older than 10 years worthy of interest were selected. 46 articles were found, of which 17 were eligible for the study. Keywords: pain, Alzheimer, nursing, assessment, scale.RESULTS The stigma of Alzheimer's disease is a real phenomenon and tends to be mainly aroused by the symptoms of the acute phase of the disease. People with dementia are less likely to receive appropriate care for their pain. A 2016 review lists the most frequently used scales in pain assessment, but there are no scales for home nursing use. Validated pain assessment tools are available but have not been implemented for use by home care staff, and have not been fully tested for response to treatment: several tools, developed and tested for nursing home patients with dementia, were reviewed in a 2016 review, and the MOBID-2 pain scale is the only tool tested for responsiveness in patients with dementia. Observational pain assessment tools using nonverbal assessment have been developed to aid in the assessment of pain in speech-impaired populations; these require additional training and further research to determine their reliability and validity. The role of the caregiver is very important in the home setting: the nurse is responsible for educating family members and recognizing verbal and nonverbal signs of pain; a 2018 review demonstrates the primary need for adequate pain assessment and interprofessional treatment of pain.
CONCLUSIONS
Despite the increased use of analgesics, pain is still a prevalent problem in people with dementia, especially at home. It is essential that nurses working with patients with dementia understand how to recognize, assess, and manage pain in this population. The initial step to improve pain treatment is proper pain assessment, monitoring the change in pain intensity during treatment. Studies on nonverbal reactive pain assessment tools in the end-of-life context are needed.