Recognising and management of pain in dementia

Pain in someone with Dementia, especially in the moderate to the advanced stages can be a challenging issue. The elderly may be unable to express that they are uncomfortable or feeling ill. This can be because they have forgotten they had a fall or hurt themselves as well as the fact they are unable to communicate since language skills deteriorate eventually.

A very common issue faced by caregivers are : why do people with Dementia get agitated or aggressive? One of the most common causes can be pain- It may be physical or emotional pain. It can also manifest as anxiety, confusion, or increase in wandering.

Some other indications of pain in Dementia;Italic

• In depth knowledge regarding the resident is very important. How did they react to pain in the past? Did they experience withdrawal, anger or agitation, or simply expressed it by rubbing their palms or knees?
• Have they stopped taking proper meals? Assess, do they have any toothache, mouth ulcers or issues with their dentures. Do they look depressed or more withdrawn?
• Does the person react while touching any particular part of their body? Caregivers can observe minutely all their reactions while helping with their daily activities
• Do they seem more confused or disoriented than usual?

Managing pain in dementiaItalic

As a registered nurse, once we get to know the cause of pain, the first thing to do is to administer them analgesics like Paracetamol, Spasmoles, Ultracet etc so that they are comfortable. Additionally hot or cold fermentation can be administered. One of the important aspects which needs to be kept in mind is to analyze and address any suspected medical issues like dental pain, haemorrhoids, any infections or any ongoing condition like Arthritis. The root cause must be identified and dealt with.

For this, we can consult with our medical practitioner to suggest appropriate assessments.Once the treatment plan has been identified, we should make sure of that the changes are implemented and medicines are being given regularly to the elderly, because we can't rely on them for doing this themselves.

Caregivers who are in direct contact with the elderly like family members, nurses, care attendants should make sure that any procedure like giving a shower, giving positioning, transferring them from wheelchair to bed, should be done very carefully and cause minimal discomfort and pain to them. If there is a hospital visit or any other requirement which needs long distance journey or transferring many times, the resident must be given an analgesic prior to decrease the level of pain, which can later cause agitation in dementia resident.

Other aspects to keep in mind are:

• Make sure the person is comfortable with the bed, chair, wheelchair, commode and it is well cushioned and has no sharp edges,
• Always use air cushions or air mattress to relieve pressure
• Diverting mind away from pain: This can be difficult but every person has a special way to be engaged.
• Passive involvement in activities (sensory & motor), Music therapy, aroma therapy all done in small intervals can be helpful.
• Make sure they are well hydrated and nourished since medications can change taste buds and they may refuse food
• Make a note of how they reacted to pain this time and what can be the early signs
• Be around them. Since pain can lead to more confusion, it will always help to see a friendly cheerful face next to them

Medicines can relive their physical pain to an extent but emotional pain and loneliness is bit different. No medicines can get them comfort from this, only love and care can relieve it.