The influence of Alzheimer’s disease stigma on pain assessment in older persons

Résumé En

Introduction Pain of nursing homes residents with Alzheimer’s disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored. Research question The objective of this research was to analyze whether a diagnosis label of Alzheimer’s disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes. Methods Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer’s disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer’s disease (mild stage vs severe stage). Results Alzheimer’s disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions. Conclusion These results confirm that the Alzheimer’s disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer’s disease and to enhance the pain management of this frail population.