Pain and Dementia

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Pain and Dementia

• Ann M. Moore, DO, CMD

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Goals and Objectives

• Participants will be able to discuss the
  prevalence of pain in people with dementia.
• Participants will be able to identify non-verbal
  signs and symptoms of pain.
• Participants will be able to complete an
  assessment for pain in people with dementia.
• Participants will be able to discuss the impact
  of pain on people with dementia.
• Participants will be able to treat pain in people
  with dementia.

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Definitions

• Pain individuals unpleasant sensory of
  emotional experience.
• Acute pain abrupt onset of pain.
• Chronic pain persistent or recurrent pain.

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"If the purpose of lamentation be to excite pity,
it is surely superfluous for age and weakness to
tell their plaintive stories for pity
presupposes sympathy, and a little attention will
show them, that those who do not feel pain seldom
think that it is felt."Samuel Johnson Rambler
48 (September 1, 1750)
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Pain in Long-Term Care Residents

• Common in long-term care (45-80).
• Commonly associated with common diseases of aged.
• Not a normal part of aging.
• Commonly arthritis or musculoskeletal.

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Acute Versus Chronic Pain
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Barriers to Recognition of Pain

• Different response
• Cognitive or communication barriers
• Cultural or social barriers
• Co-existing illness with medications
• Staff training
• Access to appropriate tools
• Practitioner limitations
• System barriers

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Misconceptions About Pain by Elderly People

• Acknowledgement is sign of weakness
• Its normal
• Its punishment
• Death is near
• Always indicates a serious disease
• Mean tests

• Acknowledging pain leads to loss of independence
• Elderly have a high pain tolerance
• Elderly cannot be accurately assessed
• Attention seeking
• Drug addiction

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Common Conditions Associated with Pain in Elderly

• Degenerative joint
• Rheumatoid arthritis
• Fibromyalgia
• Low back disorders
• Osteoporosis
• Neuropathies
• Gastrointestinal
• Amputations

• Renal conditions
• Headaches
• Dental problems
• Vascular disease
• Post-stoke syndrome
• Immobility/contractures
• Pressure ulcers

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Complications of Pain

• Deconditioning
• Gait disturbance
• Falls
• Delayed rehab
• Medication
• Delirium
• Anxiety

• Malnutrition
• Sleep Disturbance
• Depression
• Decreased socialization
• Increased health care utilization costs

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Hunger, love, pain, fear are some of those inner
forces which rule the individual's instinct for
self preservation. Einstein
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Pain in the Cognitively Impaired Resident

• 80 can answer yes to pain even if they cannot
  describe it.
• Ask family for history.
• Review history for conditions associated with
  pain.

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Non-specific Signs and Symptoms of Pain

• Frowning/grimacing
• Fearful expression
• Teeth Grinding
• Bracing/guarding
• Rubbing
• Fidgeting
• Restlessness
• Behavior change
• Gait change

• Striking out/resisting care
• Agitation
• Sleep disturbance
• Poor appetite
• Sighing
• Groaning
• Crying
• Heavy breathing
• Decreased activity

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Possible Indicators of Pain on the MDS

• Pain symptoms (J2)
• Pain site (J3)
• Mouth pain (K1)
• Weight loss (K3)
• Oral status (L1)
• Skin lesions (M1)
• Other skin (M4)
• Foot problems (M6)
• ROM restorative (P3)
• Restlessness, repetition (B5)

• Sleep cycle (E1)
• Sad, apathetic, anxious (E1)
• Change in mood (E3)
• Resisting care (E4)
• Change in behavior (E5)
• Loss of initiative (F1)
• Functional limitation in ROM (G4)
• Change in ADL function (G9)
• Any disease associated with pain (I1)

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Pain Assessment

• Obtain history from resident, family, other staff
  and observation.
• Exam area for deformities, swelling,
  discoloration, pain with range of motions or
  palpation.

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Treatment

• Routine and PRN medications
• Reassuring words or touch
• Topical analgesics
• Massage
• Compresses
• Bath
• Chaplain
• Music

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Complementary Therapies

• Counseling
• Support groups
• Herbals
• Aromatherapy
• Music/art/drama
• Biofeedback
• Meditation

• Education
• Cognitive/behavioral
• Exercise
• PT/OT
• Positioning
• Chiropractic
• Acupuncture

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