Pain in people with dementia is under-assessed and undertreated.
Antipsychotic drugs, sedatives, antidepressants and many other drugs are often prescribed to people with dementia. Anxious, distressed and aggressive behaviour may be the result of pain, which in some cases the person with dementia cannot express or communicate.
If it is difficult or impossible to assess if a person with dementia has pain, would it not be a great step forward to try painkillers for a short period and assess the effect, before commencing all the sedatives?
Click here for Pain Assessment for Residents with Communication Issues
Analgesia Awakens Alzheimer’s Patient From Dementia
My friend’s mother has very advanced dementia and was extremely unsettled, agitated and could be extremely angry and aggressive at times.
She had never complained of pain nor showed signs of being in pain when she was being cared for.
She fractured her femur just over a month ago and was commenced on strong analgesics post operatively.
Her behaviour and quality of life changed almost immediately. She has continued on analgesics regularly and continues to have a much improved quality of life.
She is now settled, calm and and enjoys spending time with her husband and family.
Her family are so upset that for years no one realised she was in pain.
A review in the Nursing Times discusses the main barriers to effective assessment and management of pain in people with dementia
5 key points
An estimated 115 million people could be affected by dementia by 2050
The prevalence of pain in older people is estimated to be 25-50%
People with dementia receive fewer analgesics than their counterparts who are cognitively intact
One study found three quarters of care homes did not use standardised pain assessment tools
Attitudes and beliefs among patients and nurses can be substantial barriers to effective pain management
People With Communication Issues Can Not Complain Of Pain Or Express Pain
Doctors often are not able to determine if a person with dementia has pain.
Nurses likewise may consider that people with dementia cannot reliably report pain or any change in the level of pain.
Correctly Assessing and Meeting Peoples Needs Improves Quality of Life
A simple tool, based on the ‘PAINAD’ (Pain Assessment in Advanced Dementia scale) could help:
P – Pick up on mood (are they withdrawn or irritable?)
A – Assess verbal cues (are they muttering under their breath, moaning or crying out?)
I – Inspect facial expressions (are they grimacing or looking frightened?)
N – Notice body language (are they pacing, clenching their fists, fidgeting or curled up as if trying to hide?)
Use of assessment tools and guidelines
Increasing the use of assessment tools would assist Nurses and carers in recognising pain.
Education for staff
All staff need training and guidance to be able to care well for a person with dementia. They need training to understand the complex issues of the condition, and how important empathy and understanding are.
Assessment of Pain
Consistency of care with residents with dementia is extremely important in assessing pain and delivering excellent person centred care.