Gestão da dor em pessoas com demência que não a conseguem verbalizar: estudo de efetividade-implementação em estruturas residenciais para pessoas idosas

Dementia prevalence is set to triple by 2050 due to ageing, according to WHO estimates (2023). Dementia ranks as the 7th leading cause of death worldwide and is associated with a significant economic burden. To illustrate, in Portugal there are over 193,000 persons diagnosed with dementia, incurring an estimated cost of €2 billion for Alzheimer's disease care and management (Alzheimer Europe, 2019; Costa, 2021). PAIN is one of the MOST COMMON SYMPTOMS experienced by people living with dementia (PLWD). A systematic review of 25 studies in nursing homes revealed that 10% to 80% PLWD experience significant acute or chronic pain, with those with moderate or severe dementia showing a higher prevalence (Helvik, 2023). About 70% of people with behavioural and psychological symptoms of dementia (BPSD) experience pain, unrecognised by professionals (Atee, 2021). In Portugal, a study in 135 hospitalised patients with advanced dementia indicated that half experienced pain (Louro, 2018). PAIN in PLWD is UNDER RECOGNISED and UNDERTREATED (Achterberg, 2021), leading to AVOIDABLE SUFFERING. In American nursing homes, a study involving 50,673 residents found that those with dementia were provided with fewer pain assessments and less pharmacological and non-pharmacological treatment compared to those without dementia (Nakashima, 2019). A systematic review of 32 studies indicated that community-dwelling PLWD are prescribed less pain medication compared to their matched controls (Bullock, 2019). MULTIFACETED FACTORS compound the challenge of pain management in PLWD, specially for those in more advanced stages who cannot verbalise it. Barriers highlighted by meta-research include BPSD, professionals' knowledge and training gaps, concerns about analgesia, complexity of pain assessment tools, lack of accessibility to pain management guidelines and time constraints (Liao, 2023; Smith, 2023; Jonsdottirs, 2021; Pringle, 2021). The AIM of e-cuidaDOR 2 is to evaluate the effectiveness and real-word implementation of a multicomponent intervention for pain management in noncommunicative PLWD in residential care facilities, including economic evaluation. We will address knowledge gaps relevant nationally and internationally and will advance the state-of-the-art by developing and testing a comprehensive intervention for pain management in this vulnerable population, combining theory, evidence and the cutting-edge technology PainChek. This app uses AI-driven facial recognition to detect facial micro-expressions indicative of pain, which are then combined with automated computation of non-facial pain cues, yielding a numerical pain score and intensity level (Atee, Hoti, & Hughes, 2018). The app is supplemented by a cloud-based portal, streamlining information sharing and communication. The PainCheck app is a regulatory-cleared CE marked medical device with over 3 million pain assessments on a global scale. Its expansion into continental Europe begins with Portugal, thanks to a research collaboration between PainChek Ltd and Egas Moniz. In summary, we tackle a significant challenge in dementia care, with an ambitious aim that subsumes novel technology in a comprehensive intervention and real-world evaluation. We focus on a vulnerable population, innovative use of AI for pain assessment, and consideration of the practical and economic aspects of integrating the multicomponent intervention in residential care facilities.