Friday, May 2, 2014

Many studies indicate that although dementia patients experience severe or chronic pain, they regularly receive fewer analgesics than healthy senior adults. This can primarily be attributed to the fact that while a healthy senior can verbalize pain and discomfort, dementia patients, especially those in the late stages, cannot. Pain reporting is dependent on memory and verbal capacity; dementia patients generally have difficulty with both and cannot report when they are experiencing pain. Moreover, if they can report their pain and discomfort, they may not be able to fully understand pain scales presented by doctors so the self-report may be inaccurate.

An additional factor making pain difficult to identify in the elderly in general is that the symptoms may not be the same as in a younger person. For seniors with dementia, it is also not uncommon for the effects of pain to be erroneously identified as symptoms of dementia. Pain may increase aggression and depression and cause cognitive problems like lack of focus. Unfortunately, if left untreated, pain can cause mental and functional decline and reduce mobility. Unidentified pain can also be an indication of a condition or infection that needs immediate treatment, so there is a risk the dementia sufferer can experience complications from untreated illnesses.

Pain indicators

Dementia patients can experience all types of pain ranging from musculoskeletal (joints and bones) and visceral (headaches, intestinal obstructions, peritonitis, appendicitis, ulcers)  genito-urinary (urinary tract infections) and dental. No matter what the source of the pain is, however, there are some general cues the person may give that can help family and caregivers identify that the person is experiencing pain.

Our caregivers, those special people we refer to as Comfort Keepers^®, can help families of seniors with dementia by notifying them when some of these pain indicators are present. Our Comfort Keepers are specially trained to interact with dementia patients and report physical or behavioral changes. Some of the changes our Comfort Keepers look for as indicators of pain include the following: 

Facial expressions: Dementia patients in pain may squint or close their eyes and furrow their brows when they feel pain.

Vocalizations: Increased moaning, calling out, or groaning may mean the person is feeling pain.

Labored breathing: The person may have more difficulty breathing when dealing with pain.

Body language: The dementia patient may crouch, fidget, stay very still, limp, or be very restless when feeling pain.

Demeanor: The dementia patient may be more aggressive or verbally abusive. These can be defense mechanisms when the person is feeling pain. The person may also be very upset and inconsolable.

Our Comfort Keepers are trained to look for these and other changes in the seniors under their care and to report these changes to their supervisor and the family as soon as they are identified. As with other pain sufferers, dementia patients may benefit from a healthy diet and exercise. Our Comfort Keepers can help seniors to manage their pain by assisting with daily tasks, helping with meal preparation, reminding them to take medications their doctor has prescribed, and keeping them physically active by taking them on walks or helping with range of motion exercises. Interacting with the senior with dementia and addressing his or her daily needs can not only provide relief for the senior but also peace of mind and reduced stress for the family.

References

Alzheimer’s Disease International. (n.d.) Dementia statistics.

Horgas, A.L. (2012). Assessing pain in older adults with dementia. In Greenberg, S. (Ed.). Try this: Best practices in nursing care to older adults with dementia, D2.

Husebo,  B. S., Kunz, M., Achterberg, W. P., Lobbezoo, F., Kappesser, J., Tudose, C., et al. (2012). Pain assessment and treatment challenges in patients with dementia. Zeitschrift fr Neuropsychologie, 23 (4), 237–246. DOI 10.1024/1016-264X/a000078

Zwakhalen, S., Hamers, J., Abu-Saad H.H., and Berger, M. (January 27, 2006). Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools. BMC Geriatrics 2006, 6(3).