Table 1.

Components to Consider in a Pain Management Advance Care Plan

1. Goals for care: guided by patient preferences, develop an overall goal and a specific comfort-function-mood goal; this is critical in determining pathway to pain treatment.

2. Procedures: specify procedures that should be avoided or minimized (e.g., intravenous therapy if at risk for venous complications). It is important to minimize procedures that may cause additional pain and risk for suffering (e.g., cardiopulmonary resuscitation, intubation), even if the pain is temporary.

3. Risk/benefit: determine appropriateness of and when to use basic and/or advanced therapies and time-limited analgesic trials. Treatments should be based on patient health status, any health or cultural contraindications, and risks and benefits of each treatment.

4. Type of treatment: nonpharmacological (i.e., environmental, complementary, alternative, and integrative therapies) and/or pharmacological treatments, or no treatments.

5. Frequency of treatments: around-the-clock and/or as needed.

6. Route/mode of treatment: determine best treatment method based on patient’s current health status and preference (e.g., oral, intravenous, etc.).

7. Medication titration: establish procedure for de-/escalation of pain medication dose

8. Social support: determine the individual(s) who will assist the older adult with dementia implement and adhere to a pain (self)management regimen or will ensure pain management plan is honored in acute or long-term care settings.

9. Research: identify if participation in pain research at any point is acceptable and feasible.