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People in need of care or with severe disability have a worse oral health status compared to people without these needs. The increasing number of older people who are able to keep their own teeth requires specific steps to support oral health. Whereas in 1997 1 in 4 people between 65 and 74 years of age was toothless, in 2016 this figure had risen to 1 in 8. Special challenges in oral care arise for older people and people with dementia. The management requires an interprofessional approach.Interprofessional development of an expert standard for the promotion of oral health by nurses and a focus on older people.The expert standard is based on a systematic literature analysis. Based on this, members of an interprofessional expert working group consisting of nurses, dentists and a representative of those affected formulated recommendations to promote oral health of people in need of care.The interprofessional approach defines the selection of the guiding questions for the literature search, the evaluation of the literature and the formulation of the recommendations. Interventions to maintain and promote oral health were identified for the guiding questions of the expert standard, for example, in cases of oral fungal diseases, mucositis, gingivitis or accompanying symptoms, such as dry mouth and pain.Interventions to promote oral health of people in need of care or with severe disability could be focused more deeply within the nursing profession and formulated by an interprofessional group to guide their actions.HINTERGRUND: Menschen mit Pflege- oder Unterstützungsbedarf oder einer Behinderung haben einen schlechteren Mundgesundheitsstatus als Menschen ohne diesen Bedarf. Die zunehmende Anzahl älterer Menschen, die über eigene Zähne verfügen, erfordert spezifische Maßnahmen zur Förderung der Mundgesundheit. Während 1997 jeder 4. Mensch zwischen 65 und 74 Jahren zahnlos war, galt dies 2016 nur noch für jeden 8. Besondere Herausforderungen in der Mundpflege stellen sich bei älteren Menschen und Personen mit Demenz. Zur Bewältigung braucht es eine interprofessionelle Herangehensweise und Zusammenarbeit während der gesamten Versorgung.Interprofessionelle Entwicklung eines Expertenstandards zur Förderung der Mundgesundheit durch Pflegefachpersonen mit Fokus auf ältere Menschen.Grundlage des Expertenstandards bildet eine systematische Literaturanalyse. Aufbauend auf den Ergebnissen formulierte eine interprofessionelle Expertinnen- und Expertenarbeitsgruppe unter Beteiligung von Pflege, Zahnmedizin und einem Vertreter aus der Selbsthilfe Empfehlungen zur Förderung der Mundgesundheit von Menschen mit pflegerischem Unterstützungsbedarf.Die interprofessionelle Herangehensweise prägte die Auswahl der leitenden Fragen der Literaturrecherche, die Literaturauswertung und die Formulierung der Empfehlungen. Zu den leitenden Fragen des Expertenstandards konnten Maßnahmen zu Erhalt und Förderung der Mundgesundheit ausgewiesen werden, beispielsweise bei oralen Pilzerkrankungen, Mukositis oder Gingivitis sowie bei Begleiterscheinungen wie Mundtrockenheit und Schmerzen.Maßnahmen zur Förderung der Mundgesundheit bei Menschen mit Pflege- oder Unterstützungsbedarf oder einer Behinderung konnten im pflegerischen Kontext vertieft fokussiert und durch eine interprofessionelle Gruppe formuliert werden.

Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.

BackgroundNursing home residents are often affected by pain. Pain assessment aims to determine pain intensity and quality. An evidence-based guideline on pain assessment in nursing homes was developed to support residents and informal caregivers in archiving an adequate pain assessment prerequisite to pain treatment.AimThe residents' guideline presents key recommendations that is comprehensible and accessible to residents and informal carers.DesignWe conducted a content analysis.Setting/subjectsTherefore, all recommendations of an evidence-based guideline for pain assessment in nursing home were evaluated on relevance for supporting residents' decision-making process.MethodsTwo researchers conducted the content analysis independently and as a result, 29 recommendations could be included. In addition, representatives of a support-group organization for patients with pain validated the derived recommendations.ResultsThe present residents' guideline of pain assessment consists of nine thematic categories, written in laymen's terms to enable older persons to make informed choices and optimizing their own pain management process.ConclusionsThe Guideline is available in print format and ready for implementation to enhance the effects on maintaining the physical and psychological well-being and optimal care of older adults in Nursing Homes.

Zusammenfassung Rolle der Pflegenden Mundgesundheit ist ein zentrales Thema in der Versorgung alter Menschen, sie hat direkte Auswirkungen auf die Lebensqualität. Pflegende haben direkten Einfluss auf die Mundgesundheit. Umfangreiches Wissen ist nötig, um die Mundpflege durchzuführen, Risiken und Beeinträchtigungen zu erkennen und ggf. eine zahnärztliche Behandlung zu veranlassen. Pflegende haben somit eine zentrale Position in der Versorgung alter Menschen, um einer bisher mitunter vernachlässigten Mundgesundheit den erforderlichen Stellenwert zu verschaffen.

Zusammenfassung Hintergrund Eine grose Zahl an Menschen mit kognitiven Einschrankungen leidet an chronischen Schmerzen, die auch als Ausloser fur herausforderndes Verhalten diskutiert werden. Fur die Durchfuhrung einer systematischen Schmerzeinschatzung wird bei Menschen mit fortgeschrittenen kognitiven Beeintrachtigungen empfohlen, ein Fremdeinschatzungsinstrument (FES) zu nutzen; fur Menschen ohne oder mit geringen kognitiven Einschrankungen gilt die Selbsteinschatzung (SES) als Goldstandard. Bislang ist unbekannt, ob in der stationaren Altenhilfe die systematische Schmerzeinschatzung bei Bewohnern mit schweren kognitiven Einschrankungen, wie empfohlen, mithilfe von FES erfolgt und welche Instrumente zum Einsatz kommen. Es wird angenommen, dass aufgrund ihrer Bewohnerstruktur in Demenzwohnbereichen haufiger eine FES vorgenommen wird als in integrativen Wohnbereichen. Die Untersuchung hat das Ziel, die Vorgehensweise und die eingesetzten Instrumente in beiden Wohnbereichstypen zu untersuchen. Methode Bei der Untersuchung handelt es sich um eine deskriptive Querschnittsstudie, die auf einer standardisierten Datenerhebung basiert. Mittels Fragebogen wurde in Demenz- und in integrativen Wohnbereichen erhoben, ob und mit welchem Instrument die letzte Schmerzeinschatzung erfolgt war. Zusatzlich wurde der kognitive Status erfasst. Mit dieser Angabe wurde fur jeden Bewohner unter Berucksichtigung seines kognitiven Status ermittelt, ob zur Einschatzung ein FES oder ein SES eingesetzt worden war. Die Bewohnerdaten wurden anschliesend auf Wohnbereichsebene aggregiert. Die Berechnung der Nutzung einzelner Instrumente fur jeden Wohnbereich erfolgte prozentual. Die Identifikation von Unterschieden zwischen den Wohnbereichen erfolgte mittels deskriptiver Statistik und einem unabhangigen t-test. Um den Einfluss von Clustereffekten auszuschliesen, wurde ein gemischtes binares Regressionsmodell errechnet. Ergebnisse Die Analysestichprobe beinhaltete n=1397 teilnehmende Bewohner in n=75 Wohnbereichen (n=30 Demenzwohnbereiche, n=45 integrative Wohnbereiche). In Demenzwohnbereichen wurden im Mittel 82% der kognitiv schwer eingeschrankten Bewohner mit einem FES erfasst; in den integrativen Wohnbereichen 42%. In Demenzwohnbereichen lag der mittlere Anteil der kognitiv schwer eingeschrankten Bewohner, bei denen die Schmerzeinschatzung mit einem SES erfolgte, bei unter 10%; in integrativen Wohnbereichen lag dieser bei 51%. Alle Unterschiede waren statistisch signifikant. Im gemischten Regressionsmodell bestatigte sich dieses Ergebnis. In der Mehrzahl der Demenzwohnbereiche wurde ein einziges Instrument zur Schmerzeinschatzung fur alle Bewohner eingesetzt; in 18 von 30 Demenzwohnbereichen fand jeweils ein FES Anwendung. Diskussion Die Ergebnisse weisen darauf hin, dass das Schmerzassessment bei Menschen mit kognitiven Einschrankungen in vielen integrativen Wohnbereichen nicht optimal verlauft, da unpassende Instrumente genutzt werden. Ferner stutzen die Ergebnisse die Erkenntnisse vorangegangener Studien, indem sie darauf hin weisen, dass in der Praxis Instrumente genutzt werden, die nicht empfohlen werden, da sie in der deutschen Sprache noch nicht wissenschaftlich getestet sind. Da ein valides Schmerzassessment eine wichtige Voraussetzung fur eine adaquate Schmerzbehandlung darstellt, kann vermutet werden, dass diese bei einem Grosteil der Bewohner nicht wie empfohlen erfolgt. Praktische Implikationen Insbesondere in den integrativen Wohnbereichen ist ein definiertes und von allen Mitarbeitern eingehaltenes Vorgehen zur Erfassung eines Schmerzerlebens aufgrund sehr unterschiedlicher kognitiver und verbaler Fahigkeiten der Bewohner wichtig. Entsprechende Bildungsmasnahmen konnten diesen Prozess unterstutzen.

Up to 80% of nursing home residents are affected by pain. Pain assessment aims to determine pain intensity, quality, and course of pain to underpin diagnostic decision making. In the nursing home population, pain assessment is frequently compromised by cognitive impairment. Characteristics of the nursing home setting, such as resident's age, staff skill mix, and overall aims of the care provided, also need to be taken into account. Therefore, an interdisciplinary evidence-based clinical practice guideline for pain assessment in the nursing home setting was developed. A systematic literature search was carried out covering publications between 2003 and 2015. Thirty-nine studies were included in the preparation of this guideline, supplemented by 12 international reference guidelines. Recommendations were subjected to a structured consensus-finding process with representatives from 37 scientific and professional organizations and patient representatives. The guideline underwent independent peer review before finalization. It comprises 62 recommendations that are grouped into 4 chapters: (1) context of pain assessment in nursing home care; (2) screening; (3) focused assessment; and (4) reassessment/monitoring of pain. Main recommendations stipulate that clinicians should assess the patient's ability to provide self-report of pain when screening for pain and that each resident should be screened for the presence of pain. A focused assessment of pain, performed during rest and activities, should include pain intensity, changed behaviors, general mobility, pain history, comorbidities, and pain medication. Pain should be re-assessed at regular intervals using the same instruments that were used for the focused assessment. Guideline development demonstrated that many aspects of pain assessment in older persons have not received adequate research attention so far. Available studies predominantly possess only low levels of evidence. Therefore, research into this area needs to be systematically developed to address questions of clinical relevance to support patient care.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of algorithm‐based pain management interventions to reduce pain and challenging behaviour in people with dementia living in nursing homes. To describe the components of the interventions and the content of the algorithms.

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.

Um Schmerzen zu erfassen können Pflegende strukturierte Einschätzungsinstrumente nutzen, die zielgruppenspezifisch angewendet werden müssen. Besondere Anforderungen werden an ein strukturiertes pflegerisches Schmerzassessment bei Menschen mit Demenz im Krankenhaus gestellt.

A large number of nursing home residents with cognitive impairments (CI) suffer from chronic pain, which is also discussed as a reason for challenging behavior. To assess pain in people with severe CI, the use of an observational pain instrument is recommended; for people without or with mild CI the gold standard is a self-rating instrument. It is unknown whether in German nursing homes pain assessment in residents with severe CI is actually conducted using observational instruments and which instruments are used. Because of different resident structure we assume that in dementia care units observational pain instruments are more often used than in integrated care units. The aim of this study was to investigate the conduction of pain assessments and the instruments used in both types of care units.We conducted an observational study based on standardized data collection. A questionnaire was used to elicit whether pain assessment had been performed and what kind of instrument had been used last time. The cognitive status was also assessed. Based on these data, we determined for each resident whether a self- or proxy-rating instrument had been applied, considering his or her cognitive status. Afterwards, the resident data were aggregated on a care unit level. The use of single instruments was calculated in percentages. Differences between dementia care units and integrated care units were investigated with descriptive statistics and an independent t-test. A mixed-effects binary regression model was used to adjust for cluster effects.The analysis sample consisted of n = 1,397 participating residents living in n = 75 care units (n = 30 dementia care units; n = 45 integrated care units). In the dementia care units, a mean of 82 % of residents with severe cognitive impairments was assessed using an observational proxy-rating assessment instrument; in the traditional integrated care units a percentage of 42 % was calculated. In the dementia care units, the median percentage of residents with severe cognitive impairments who were assessed with a self-rating instrument was below 10 %; in integrated care units it was 51 %. The differences were statistically significant. A mixed regression model confirmed the results. In the majority of dementia care units a single pain assessment tool was used for all residents; in 18 of 30 dementia care units this was a proxy-rated observational instrument.The results indicate that pain assessment in cognitively impaired patients is suboptimal in many integrated care units because the nurses use inappropriate instruments. Also, they confirm the results of previous studies by demonstrating that instruments are used in clinical practice that are not recommended because their German-language versions are not validated. Since valid pain assessment is a prerequisite to appropriate pain treatment, we may assume that in many residents this is also not carried out as recommended.Especially in integrated units, a defined and consented method of pain assessment is important because of the differences in their residents' cognitive and verbal abilities. Appropriate education may help to improve this process.

Background Studies 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/design The 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. Results Eight 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. Conclusion People 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 registration This systematic review was registered at Prospero (CRD42016037309); on 11 April 2016, and the systematic review protocol was published (Syst Rev. 5(1):1, 2016).

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 fur 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. V."), the German Agency for Quality in Medicine ("Arztliche Zentrum fur Qualitat in der Medizin"), and that described in the DELBI ("Deutschen Leitlinien-Bewertungsinstrument"). Delegates of the 38 scientific 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.

Die Mundgesundheitssituation von AltenheimbewohnerInnen in Deutschland ist verbesserungswürdig. Daher war das Ziel dieser Interventionsstudie zu evaluieren, ob Schulungsmaßnahmen für Pflegende in Altenpflegeheimen die Fähigkeit zur Einschätzung der Mundgesundheit der BewohnerInnen verbessern und ob dies zu einer verbesserten Mundgesundheit führt. 53 Bewohner und die Pflegenden aus drei Einrichtungen nahmen an dieser Studie teil. Die Pflegenden wurden zahnmedizinisch geschult. Zu Beginn sowie vier Monate nach der Schulung wurde als primäres Outcome die Vollständigkeit der Erhebung der Brief Oral Health Examination (BOHSE) erfasst. Weitere Outcomes waren die Zahn- und Prothesenhygiene der Bewohner, der funktionelle Status von Zahnersatz sowie der zahnärztliche Behandlungsbedarf. Im Ergebnis haben die Schulungsmaßnahmen zu einer Verbesserung der vollständigen Erhebung der Brief Oral Health Examination durch die Pflegenden geführt. Weiterhin ist es zu einer signifikanten Verbesserung in der Mundhygiene der BewohnerInnen gekommen. Es zeigten sich allerdings keine relevanten Auswirkungen auf Pflege und Funktion von Zahnersatz. Der zahnärztliche Behandlungsbedarf stellte sich zu beiden Zeitpunkten als hoch heraus. Eine Modifizierung des Untersuchungsinstruments mit Ausweisung eines Behandlungsbedarfs erscheint diskussionswürdig, um die pflegerische Zusammenarbeit mit Zahnärzten in Altenpflegeheimen zukünftig weiter zu verbessern.

Background Little is known about the phenomenon of pain in German nursing homes. In particular, it is unknown to what extent and severity pain occurs among residents and how their pain can be described. Material and methods A total of 13 nursing homes located in the city of Munster, Germany, were included as part of the health services research project "Action Alliance Pain-free City Munster." Data were collected from 436 residents over 65 years old via self-report or the observational pain tool pain assessment in advanced dementia, german version (PAINAD-G), according to the cognitive status of the residents. Results At the time of the interview, the majority of the residents questioned reported suffering from pain at rest and/or during movement. Approximately one quarter of residents complained about moderate to intolerable pain at rest and nearly 45% during movement. Residents encountered pain most often when standing up, sitting, resting in bed and walking and three quarters of residents had suffered from pain for more than 1 year. Many residents experienced pain in several body regions. Among residents assessed solely by the observational pain scale PAINAD-G, signs indicating pain existed in 21% (≥ 6) or 69% (≥ 2), respectively, depending on the cut-off value chosen on the PAINAD-G scale. Conclusion Pain in nursing homes is a challenge that needs more attention as it has considerable negative consequences for the persons concerned. The extent of pain in the studied facilities indicates an urgent need for action on the part of all professionals caring for residents in nursing homes.

Der erste Sektionstag der Deutschen Gesellschaft fur Pflegewissenschaft bot die Moglichkeit, die Arbeitsergebnisse der einzelnen Sektionen einem erweiterten Publikum sichtbar zu machen.