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Pain and Dementia

Unfortunately, behavior problems are all too common in persons with dementia.  But what many people don’t realize is that probably 95% of all behaviors are a form of communication.  And, at least half of the time, what the person is trying to communicate is that he is in pain.

Think about it.  Let’s say you have pain from arthritis, or poorly-fitting dentures, or a headache, or any of a myriad of other causes.  But your words aren’t coming out so good any more, and you can’t make anyone understand you.  Or maybe your brain is having trouble processing the signals sent to it from your pain receptors.  You know something is wrong, but you can’t begin to figure out what.  Or you try to wave down a passing nurse, and she just pats you on the head and turns on the television before breezing on down the hallway.

What would you do?  Would you yell for the nurse, or pound on the table to get someone’s attention?  Would you sit in the corner and cry quietly?  Would you stop eating?  Or would you follow the nurse around as she passes out medications, hoping she will notice you?  Maybe your sleep pattern will be disrupted, or you might suddenly forget to tell someone you have to go to the bathroom.

Too often, in long-term care, we don’t look at pain as being a possible source for a resident’s changes in behavior.  We try to re-direct the person, telling him that he needs to stay in his room.  Or we might change his diet, or give him a nutritional supplement.  Maybe we give him an anti-anxiety medication, when what he really needs is a pain pill.  Or, sadly, we just assume that his behavior is just a sign that his dementia is getting worse.

Here are some behaviors that we can look for, to indicate that a person may be in pain:

  1.  Facial expression:  Does he grimace, or wrinkle his brow, or look frightened?
  2. Verbalizations/vocalizations:  The person may use words, albeit not necessarily the most appropriate ones, to indicate distress.  He might be more irritable than usual, or call for help without being able to say what he needs.  He might groan, cry, breathe noisily, or just stop talking altogether.
  3. Body movements:  Look at posture, increased wandering, refusal to get out of bed, having more trouble than usual walking, wringing of hands, and so on.
  4. Other behavioral changes:  The person may refuse food, show a change in sleeping habits, wander incessantly, or suddenly become incontinent.
  5. Mental status changes:  Is the person suddenly more confused than normal, or does he cry or become more nervous?

If you see any of these signs, talk to the person’s doctor about finding the cause of his pain.  Or, if the doctor has previously indicated that he may have pain medication, consider using it.  Some long-term care facilities give certain residents a low dosage of Tylenol at regular times through the day, if they are plagued by arthritis or some other source of chronic pain.  Or, perhaps it’s just as simple as smoothing out the wrinkles in the sheets under him.

Another common source of pain in this population is oral.  (Some say up to 50% of all pain – or even more – is due to mouth pain.)  Consider that many of these people have few teeth left, if any, and these teeth may be in a very decayed state.  Their dentures may no longer fit comfortably, due to weight loss, or just the age of the dentures themselves.  There may actually be sores on the gums, or there may be food stuck in the teeth.

Pain is not something that should be ignored.  And we should make ourselves more aware of the sometimes subtle signs that a person may be in pain and need some relief.  A big part of the answer is just being sure to be as observant as possible.

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