They found that few participants were concerned with reducing risk and lengthening life, with 28% even favouring a shorter life. The most significant concerns were remaining at home and minimising burden on family, two priorities that are an example of the difficult trade-offs that are often required. The authors highlight the value placed on remaining at home by many older people, even in challenging circumstances where there is greater risk of harm and it seems inadvisable.

High numbers of residents were prescribed analgesics “when required” but no guidelines were in place for assessment of pain before administering and many staff were unfamiliar with observational pain assessment tools. There were also high levels of anti-psychotic prescription despite recent policy recommendations on their reduction. The authors acknowledge the limitation of a small sample size but conclude the study demonstrates a need for care providers to really focus on assessment and management of pain among their residents with dementia.