Pain is common in people with dementia but often goes undetected due to communication barriers. A team of researchers has found that the End-of-Life Dementia–Comfort Assessment in Dying (EOLD-CAD) tool can help skilled nursing facilities better assess and manage pain in residents with moderate to severe dementia.

Originally developed for post-mortem reviews of comfort during the final weeks of life, the EOLD-CAD has now been adapted for real-time use with living residents. According to lead researcher Kathleen T. Unroe, MD, this is a critical step forward for a population that frequently cannot verbalize pain or request help.

“The EOLD-CAD demonstrated generally valid and reliable psychometric properties in our population of long-stay nursing home residents with moderate to severe cognitive impairment,” Dr. Unroe noted.

In a multifacility study involving more than 600 residents, clinicians using the tool were able to categorize observed symptoms into four groups: physical distress, emotional distress, symptoms of dying, and overall well-being. Common indicators included restlessness, shortness of breath, gurgling, choking, swallowing difficulties, fear, and anxiety.

These findings suggest the EOLD-CAD could become a valuable tool for improving comfort and quality of care for individuals living with dementia in skilled nursing settings.

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