Dementia, delirium, and stoicism hinder pain management in elderly, studies show

By: Devon Andre | Pain Management | Monday, April 18, 2016 - 11:30 AM

Pain management in elderly with dementiaDementia, delirium, and stoicism hinder pain management in elderly. These factors make it difficult for patients to express how they are feeling, which can create a barrier for providing proper pain management.

The findings come from a study of nurses working in long-term healthcare facilities in Ireland. The researchers found that the participants with dementia, delirium, stoicism, and even sensory issues, like hearing impairment or vision problems, were more likely to receive sub-par treatment for pain.

The researchers said, “It is therefore essential that patients are encouraged to verbalize their pain to family and care staff.”

Other barriers to pain management were organizational and caregiver-related. For example, caregivers may attribute the changes in a patient’s behavior to the effects of dementia rather than identify them as indications of pain. Failure to properly detect the experienced pain without the patient’s complaint may result in erroneous prescription of antipsychotics instead of pain management treatments.

The researchers stress that caregivers and doctors should receive a continued pain management education to be able to provide the best in pain management treatment.

Pain management in elderly with dementia

Treating pain in dementia can be more complex than treating pain in a healthy individual because dementia patients have greater difficulty communicating their pain effectively. Because of this, it has been found time and time again that dementia patients receive less pain treatment.

Some reasons why pain may be overlooked in dementia patients include:

  • Perception of pain as a natural part of aging
  • Fear of addiction to pain medications
  • Resource considerations
  • Difficulties in assessing and detecting pain in impaired individuals

Detecting pain may be very challenging because it is largely based on self-reporting, which dementia patients have difficulty doing. Unfortunately, there is no clear-cut diagnostic guide to be used across all dementia patients, so doctors may use many tools and mechanisms in order to detect and assess pain.

If patients are unable to self-report their pain, then doctors often opt for observational diagnosis. Below is a chart that outlines the indications that a doctor would look for in order to assess pain in a dementia patient.

Facial expressions Verbalizations/vocalizations Body movements
  • Pained expression
  • Frowning
  • Narrowing/closing eyes
  • Raising upper lip
  • Opening mouth
  • Tightened lips
  • Clenched teeth
  • Empty gaze
  • Seeming disinterested
  • Pale face
  • Teary eyes
  • Looking tense
  • Looking sad
  • Looking frightened
  • Offensive words
  • Pain-related words
  • Repeated words
  • Complaining
  • Shouting
  • Mumbling
  • Screaming
  • Groaning
  • Crying
  • Gasping
  • Sighing
  • Freezing
  • Curling up
  • Clenched hands
  • Resisting care
  • Pushing
  • Guarding
  • Rubbing
  • Limping
  • Restlessness
  • Pacing
  • Once a doctor can uncover pain in dementia patients, then they can begin prescribing the appropriate treatments, whether that be medication or physical therapy as a means to improve pain.

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