Pain assessment and management in care homes: understanding the internal and external context through a scoping review

Jan Pringle, Ana Sofia Alvarado Vázquez Mellado, Erna Haraldsdottir, Fiona Kelly, Jo Hockley

Research output: Contribution to journalArticlepeer-review


Background: Internationally, 2-5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the internal and external contexts that might influence its management.
Methods: Scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were screened, and website searches carried out of key organisations, to ensure relevant evidence was retrieved, including grey literature. As per the methodological framework, stakeholder evidence from 16 local care home managers was included to gain an understanding of their perspective.
Results: Inclusion criteria were met by 109 studies. Three overarching themes were identified: staff variables and beliefs, pain assessment, and interventions. Evidence from the review indicated a lack of training and staff confidence in relation to pain assessment and management in care homes. This was particularly the case for residents with dementia, who cannot always verbalize their pain, and may resort to behavioral manifestations to try and communicate their distress.
Conclusions: This review has highlighted that training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way. Internal and external contexts need further examination in order to integrate recognition and assessment of pain, and its management, to the benefit of residents.
Original languageEnglish
Article number(2021) 21:431
Number of pages13
JournalBMC Geriatrics
Early online date18 Jul 2021
Publication statusE-pub ahead of print - 18 Jul 2021


  • Pain assessment, Pain management, Care homes, Scoping review


Dive into the research topics of 'Pain assessment and management in care homes: understanding the internal and external context through a scoping review'. Together they form a unique fingerprint.

Cite this