Assessing Pain and Unmet Need in Patients with Advanced Dementia: The Role of the Serial Trial Intervention (STI)

  • Christine R. KovachEmail author
  • Crystal-Rae Evans


People with dementia experience painful conditions such as osteoarthritis and neuropathic disorders at rates commonly seen in the older adult population. There is ample evidence that those with dementia are less likely to be assessed or treated for these conditions. Because of impaired verbal skills, people with moderate to severe dementia commonly communicate pain and other problems through behaviors. Needs are often left unmet because of misinterpretations of these behavioral symptoms. This chapter describes the Serial Trial Intervention, a clinical decision support tool for recognizing and treating pain and other unmet needs in people with advanced dementia. The intervention was found to be highly effective as a treatment for discomfort in a randomized controlled trial conducted in 14 nursing homes (effect size 0.89). Both the five-step version, focused on identifying and meeting immediate needs, and a nine-step STI focused on long-term resolution of the problem are described. Research regarding lack of physical assessment, delayed identification of changes in physical condition, and analgesic use is also presented with recommendations for the future.


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Authors and Affiliations

  1. 1.University of Wisconsin-MilwaukeeMilwaukeeUSA

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