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Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. The systematic study of facial expressions through a computerised system has identified core features that are highly specific to the experience of pain, with potential future effects on assessment practices in people with dementia. Various observational–behavioural pain assessment instruments have been reported to be both reliable and valid in individuals with dementia. These techniques need to be interpreted in the context of observer bias, contextual variables, and the overall state of the individual's health and wellbeing.

The focus of this article is on the evolution of a programme of research on pain in dementia within the context of a changing research landscape. This landscape has shifted towards increased interdisciplinarity, partnerships with knowledge users, and emphasis on knowledge translation. Early laboratory-based investigations evolved into applied clinical research, approaches to knowledge mobilization, unique partnerships, novel costing analyses of clinical problems, technology development/evaluation, and policy studies. This article demonstrates that tackling complex clinical problems can lead traditionally trained clinical scientists to areas of scholarly inquiry that were previously foreign to them. Le présent article se penche sur l'évolution d'un programme de recherche sur la douleur chez les personnes atteintes de démence dans le contexte d'un paysage de recherche en mutation. Ce paysage est aujourd'hui caractérisé par une interdisciplinarité accrue, des partenariats avec les utilisateurs des connaissances et le transfert des connaissances. Les premières recherches en laboratoire ont évolué vers la recherche clinique appliquée, les approches de mobilisation des connaissances, les partenariats uniques, les nouvelles analyses de coûts des problèmes cliniques, le développement et l'évaluation des technologies et les études des politiques. Cet article démontre que le fait de s'attaquer à des problèmes cliniques complexes peut amener des scientifiques cliniciens ayant reçu une formation traditionnelle à s'intéresser à des domaines qui leur étaient auparavant étrangers. Public Significance Statement This article focuses on the evolution of a programme of research on pain in dementia within the context of a changing research landscape. The article shows that, within this changing research landscape, tackling complex clinical problems can lead traditionally trained clinical scientists to areas of scholarly inquiry (e.g., public policy research, partnerships with people with lived experience) that were previously foreign to them.

Adherence and participation can be improved in health programs for older people with concerns about falling. While health literacy empowers older people to have greater control over their health, little is known about the extent to which health literacy influences health behaviours associated with concerns about falling in older people. This study aimed to synthesise current findings on health literacy, concerns about falling and falls to propose a multicomponent theoretical model on health literacy and concerns about falling. The model was developed based on a review of the literature, existing frameworks and models on health literacy and concerns about falling. Existing evidence on the relationship between health literacy and concerns about falling in older people is limited. Evidence from other research areas, however, shows that health literacy is closely related to many of the determinants of concerns about falling. More research is needed to clarify the impact of health literacy on intervention adherence and decision-making processes of older people with concerns about falling. Our model offers a novel perspective on the role of health literacy in health behaviours associated with concerns about falling, suggesting new research directions and providing insights for clinicians to consider health literacy when managing older patients with concerns about falling.

Background We tested for differences in direct health care costs among long-term care (LTC) residents age 65 and older with clinically significant pain (CSP) and with no pain or non-daily mild pain (NP/NDMP). We are not aware of any other large scale investigation that examined the cost of pain in LTC environments. Methods Population-based administrative health data from Saskatchewan, Canada for 2004 to 2015 were used to compare direct health care costs for CSP and NP/NDMP groups up to one year after admission to LTC. Total accumulated costs for hospitalization, physician services, LTC, and prescription drugs were calculated in 2015 Canadian dollars. Group differences were tested using generalized linear models with generalized estimating equations. Results Amongst 24,870 LTC residents, 8289 (33.3%) were censored due to death or discharge in the 365-day study observation period. Of the 16,581 (66.7%) observed residents, 5683 (34.3%) had CSP at admission. Residents (66.3% female) had a mean age of 85 years (SD = 7.4). The mean annual total direct health care cost per resident was higher among the CSP group (CAD $8063) than the NP/NDMP group (CAD $6455). This difference was found even after including LTC costs, and for each cost component (i.e., CSP residents had higher hospitalization, physician, and prescription drug costs). Similar results were obtained after controlling for demographics, comorbidities, physical and cognitive impairment, prior health care costs, and facility characteristics. Conclusion The higher costs incurred by CSP residents compared to NP/NDMP residents are likely underestimated because pain problems are often missed in residents with dementia, who comprise a large portion of the LTC population. Improved pain care can reduce such costs and improve quality of life.

Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries. This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression. Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up. Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively). The provision of a translated iCBT program using a minimally monitored delivery model may improve patients' access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.

The types of ethical dilemmas that psychologists face do not remain static but evolve with the times and as a function of technological/scientific advances, political, world and national events (e.g., pandemics, international conflicts) as well as shifts in research paradigms and in sensitivity to individual aspects of identity. The focus of this article is on domains of ethical dilemmas that have been increasingly preoccupying psychologists in recent years (e.g., internet-delivered psychological interventions, applications of social media and computer vision technologies, use of advanced brain imaging procedures in research, genetic testing in clinical settings, refugee integration, work with patient partners in research, open access publishing, and open sharing of research data). Consideration is also given to increased sensitivity to cross-cultural and individual differences that has led to changes in the way that psychologists use language and work with diverse groups. The goal of this article is to raise awareness of the manner in which ethical dilemmas and views about ethicality shift over time. It is recommended that ethics courses and related training initiatives encourage psychologists to remain mindful of emerging ethical issues and foster an understanding of the manner in which accumulating knowledge and changes in society can impact our approach to ethical decision-making. Les types de dilemmes éthiques auxquels les psychologues sont confrontés ne restent pas statiques, mais évoluent avec le temps et en fonction des avancées technologiques/scientifiques, des événements politiques, mondiaux et nationaux (par exemple, les pandémies, les conflits internationaux) ainsi que des changements dans les paradigmes de recherche et dans la sensibilité aux aspects individuels de l'identité. Cet article se penche sur les domaines de dilemmes éthiques qui préoccupent de plus en plus les psychologues ces dernières années (par exemple, les interventions psychologiques délivrées par Internet, les applications des médias sociaux et des technologies de vision par ordinateur, l'utilisation de procédures avancées d'imagerie cérébrale dans la recherche, les tests génétiques en milieu clinique, l'intégration des réfugiés, le travail avec des patients partenaires dans la recherche, la publication en libre accès et le partage ouvert des données de recherche). L'on tient également compte de la sensibilité accrue aux différences interculturelles et individuelles qui a conduit à des changements dans la façon dont les psychologues utilisent le langage et travaillent avec des groupes divers. Le but de cet article est de sensibiliser par rapport à la manière dont les dilemmes éthiques et les points de vue sur l'éthique évoluent. Il est recommandé que les cours d'éthique et les initiatives de formation connexes encouragent les psychologues à rester attentifs aux questions éthiques émergentes et à favoriser la compréhension de la manière dont l'accumulation des connaissances et les changements dans la société peuvent avoir un impact sur notre approche de la prise de décision éthique. Public Significance Statement The types of ethical dilemmas that psychologists face evolve with the times as a function of a variety of factors such as technological advances and increases in knowledge. Psychologists must remain mindful of emerging ethical issues and the way in which changes in society can impact our approach to ethical decision-making.

Background Pain among long-term care (LTC) residents, and especially residents with dementia, is often underassessed and this underassessment has been attributed, in part, to gaps in front-line staff education. Furthermore, although evidence-based clinical guidelines for pain assessment in LTC are available, pain assessment protocols are often inconsistently implemented and, when they are implemented, it is usually within urban LTC facilities located in large metropolitan centers. Implementation science methodologies are needed so that changes in pain assessment practices can be integrated in rural facilities. Thus, our purpose was to evaluate an online pain assessment training program and implement a standardized pain assessment protocol in rural LTC environments. Methods During the baseline and implementation periods, we obtained facility-wide pain-related quality indicators from seven rural LTC homes. Prior to implementing the protocol, front-line staff completed the online training program. Front-line staff also completed a set of self-report questionnaires and semi-structured interviews prior to and following completion of the online training program. Results Results indicated that knowledge about pain assessment significantly increased following completion of the online training program. Implementation of the standardized protocol resulted in more frequent pain assessments on admission and on a weekly basis, although improvements in the timeliness of follow-up assessments for those identified as having moderate to severe pain were not as consistent. Directed content analysis of semi-structured interviews revealed that the online training program and standardized protocol were well-received despite a few barriers to effective implementation. Conclusions In conclusion, we demonstrated the feasibility of the remote delivery of an online training program and implementation of a standardized protocol to address the underassessment of pain in rural LTC facilities.

Background Cannabinoids such as cannabidiol (CBD) exhibit anti-inflammatory properties and have the potential to act as a therapeutic following mild traumatic brain injury. There is limited evidence available on the pharmacological, physiological and psychological effects of escalating CBD dosages in a healthy, male, university athlete population. Furthermore, no dosing regimen for CBD is available with implications of improving physiological function. This study will develop an optimal CBD dose based on the pharmacokinetic data in contact-sport athletes. The physiological and psychological data will be correlated to the pharmacokinetic data to understand the mechanism(s) associated with an escalating CBD dose. Methods/design Forty participants will receive escalating doses of CBD ranging from 5 mg CBD/kg/day to 30 mg CBD/kg/day. The CBD dose is escalated every two weeks in increments of 5 mg CBD/kg/day. Participants will provide blood for pharmacological assessments at each of the 10 visits. Participants will complete a physiological assessment at each of the visits, including assessments of cerebral hemodynamics, blood pressure, electrocardiogram, seismocardiogram, transcranial magnetic stimulation, and salivary analysis for genomic sequencing. Finally, participants will complete a psychological assessment consisting of sleep, anxiety, and pain-related questionnaires. Discussion This study will develop of an optimal CBD dose based on pharmacological, physiological, and psychological properties for future use during contact sport seasons to understand if CBD can help to reduce the frequency of mild traumatic injuries and enhance recovery. Trial registration Clinicaltrials.gov: NCT06204003.

Regular use of standardized observational tools to assess nonverbal pain behaviors results in improved pain care for older adults with severe dementia. While frequent monitoring of pain behaviors in long-term care (LTC) is constrained by resource limitations, computer vision technology has the potential to mitigate these challenges. A computerized algorithm designed to assess pain behavior in older adults with and without dementia was recently developed and validated using video recordings. This study was the first live, real-time evaluation of the algorithm incorporated in an automated system with community-dwelling older adults in a laboratory. Three safely-administered thermal pain tasks were completed while the system automatically processed facial activity. Receiver Operating Characteristic curves were used to determine the sensitivity and specificity of the system in identifying facial pain expressions using gold standard manual coding. The relationship between scoring methods was analyzed and gender differences were explored. Results supported the potential viability of the system for use with older adults. System performance improved when more intense facial pain expressiveness was considered. While average pain scores remained homogenous between genders, system performance was better for women. Findings will be used to further refine the system prior to future field testing in LTC.