{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:55:43Z","timestamp":1791579343275,"version":"4.3.4"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pain is common among patients presenting to the emergency department (ED) but is frequently underdetected and undertreated in older people living with dementia (PLWD). This systematic review examined whether dementia\u2010specific pain assessment tools improve pain management compared with usual care in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and have reported the methods and results following PRISMA (PROSPERO: CRD420251044828). Eligible studies included randomized, quasi\u2010experimental, and observational designs enrolling ED patients aged \u2265\u200965\u2009years with dementia or cognitive impairment. Interventions were pain assessment tools developed for PLWD, and comparisons were with standard pain scales. Primary outcomes were patient\u2010reported outcome measures and analgesia administration; secondary outcomes included repeated pain scores, ED revisits, functional decline, mortality, and adverse events. Five databases (Ovid MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo) and two clinical trial registries were searched without language or date restrictions on April 22, 2025, and December 16, 2025, respectively. Two reviewers independently screened, extracted data, and assessed risk of bias using Cochrane RoB\u20102.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 987 records identified, 18 underwent full\u2010text review, and one study met eligibility criteria. Fry et\u00a0al. (2017) conducted a multicenter, cluster\u2010randomized controlled trial of 602 older adults with suspected long bone fractures, comparing the Pain Assessment in Advanced Dementia (PAINAD) tool with standard pain scales. No significant differences were observed in median time to first analgesia (83 vs. 82\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.42) or proportion receiving analgesia within 60\u2009min (28% vs. 32%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.19). Evidence certainty was rated very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Evidence on dementia\u2010specific pain assessment tools in the ED is extremely limited. Available data suggest PAINAD does not improve timeliness of analgesia, underscoring the urgent need for rigorous studies to guide pain management for PLWD in the ED.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70230","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T13:55:55Z","timestamp":1770904555000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Systematic Review Evaluating Pain Assessment Strategies for Patients With Dementia in the Emergency Department: The Geriatric\n                    <scp>ED<\/scp>\n                    Guidelines 2.0"],"prefix":"10.1111","volume":"33","author":[{"given":"Sangil","family":"Lee","sequence":"first","affiliation":[{"name":"University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander X.","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Center for Health Services and Outcomes Research Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresita M.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Section of Emergency Medicine Section of Geriatrics &amp; Palliative Care University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2570-7112","authenticated-orcid":false,"given":"James D.","family":"van Oppen","sequence":"additional","affiliation":[{"name":"Centre for Urgent and Emergency Care Research University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6249-1023","authenticated-orcid":false,"given":"Cameron J.","family":"Gettel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Lapointe\u2010Shaw","sequence":"additional","affiliation":[{"name":"Department of Medicine University Health Network and University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6912-7315","authenticated-orcid":false,"given":"Justine","family":"Seidenfeld","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4251-639X","authenticated-orcid":false,"given":"Kaiho","family":"Hirata","sequence":"additional","affiliation":[{"name":"International University of Health and Welfare Narita Hospital  Narita City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rlon Juliano Romero","family":"Aliberti","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigacao Medica Em Envelhecimento (LIM\u201066), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"},{"name":"Research Institute, Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6370-2251","authenticated-orcid":false,"given":"Heather S.","family":"Healy","sequence":"additional","affiliation":[{"name":"Hardin Library for the Health Sciences University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-3717","authenticated-orcid":false,"given":"Shan W.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Geriatric ED Guidelines Writing 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