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  • Determining If a Person With Dementia Is in Pain

    IMAGE If you are caring for a loved one with dementia, you try to keep him as comfortable and pain-free as possible. This can be difficult if your loved one's dementia impairs his ability to communicate with you. In addition, many older people—whether they have dementia or not—think that pain is a natural part of aging. However this is not true, and there are many things that can be done to help relieve pain. The first step, though, is recognizing it.

    Be a Careful Observer

    Look for these clues that your loved one may be experiencing pain:
    • Distorted expressions, such as frowning, grimacing, wrinkling of the brow, or a frightened look
    • Eyes tightly closed or blinking rapidly
    • Moaning, groaning, grunting, sighing, or breathing noticeably loud
    • Chanting, calling out for help, or being verbally abusive
    • Physical or verbal aggression
    • Excessively rigid or tense posture
    • Fidgeting, pacing, or rocking back and forth
    • Restricted movement or limping
    • Distinct change in appetite: refusing food or eating significantly more than normal
    • Changes in sleep and resting habits
    • Straying from well-established routines
    • Wandering
    • Crying, confusion, or irritability
    • Changes in level of consciousness
    Also notice when pain occurs. For example, is it while the person is walking, going from sitting to standing, or doing tasks that require fine motor skills? Or does pain seem to occur during rest? Does your loved one grimace while sleeping?

    Talk With the Doctor

    If you have observed these signs, accompany your loved one to the doctor. Before the doctor visit, sit down with your loved one and write down the signs you have observed. If possible, ask your loved one to describe any discomfort he feels. Also write down all of the medications, including dosages, that your loved one is taking. And note if anything seems to relieve the pain.
    The doctor will evaluate the pain based on pain tools and scales. The visit may also include a physical exam and laboratory testing.

    Treatments for Pain

    Many medications are helpful for relieving pain in older people. Some common options include:
    • Around-the-clock doses of acetaminophen (eg, Tylenol) help with mild to moderate muscle and bone pain, such as that which occurs with arthritis.
    • Nonsteroidal anti-inflammatory drugs (NSAIDS; eg, aspirin and ibuprofen) are also effective, but often cause side effects in older people, such as bleeding ulcers.
    • Opioid drugs (eg, Vicodin, Roxicet) are for moderate to severe pain, these drugs can be very effective in some cases.
    • Some classes of medications can be given to help prevent the pain from starting and may be prescribed when a person has chronic pain or frequently occurring pain.
    There are many other drugs that can be prescribed for pain. The doctor will consider several factors such as the cause of the pain and other health conditions the person is managing.
    Once you've seen the doctor and your loved one has received treatment, monitoring is essential. Continue to watch for signs that could signal pain and talk with your loved one about how he feels and the effects of the medication, and communicate these findings to your doctor.

    RESOURCES

    The AGS Foundation for Health in Aging http://www.healthinaging.org

    The American Geriatrics Society http://www.americangeriatrics.org

    American Pain Society http://www.ampainsoc.org

    CANADIAN RESOURCES

    Alzheimer Association of Canada http://www.alzheimer.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    References

    The AGS Foundation for Health in Aging website. Available at: http://www.healthinaging.org .

    The American Geriatrics Society website. Available at: http://www.americangeriatrics.org .

    Kennard C. Assessing pain in dementia. Available at: http://alzheimers.about.com/od/treatmentoptions/a/pain.htm . Accessed July 18, 2008.

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