[quote_right]Irrespective of degree of cognitive impairment, the impact of untreated pain in older people can be devastating.[/quote_right]Pain in people with dementia is a critical public health problem. As the population of older adults’ increases, hospital nurses are more likely to encounter patients with dementia admitted for acute and often painful conditions. Indeed, nearly 50% of older people admitted to the hospital report pain with approximately 20% reporting severe pain. Despite years of initiatives, inadequate pain care in people with dementia continues to be a problem. One major barrier to the delivery of adequate pain management is the inability of caregivers to determine the existence of pain in those with advanced dementia, given patients’ inability to report pain.

People with mild to moderate cognitive impairment can report their pain. Pain in those with severe cognitive impairment is difficult to determine. For many years the medical community has been taught that pain is “whatever the person experiencing it says that it is, existing wherever he or she says that it does”. When verbal reports are no longer possible, behavioral indicators of pain, such as a grimace, are the recommended pain assessment method. However, as dementia progresses the behavioral indicators of pain may become less reliable. Studies have shown that those with advanced dementia and known acute painful conditions demonstrate increased responses (such as rocking, grimacing, or groaning), but also chronic pain can present with a diminished behavioral response as seen in the case study.

Irrespective of degree of cognitive impairment, the impact of untreated pain in older people can be devastating, causing depression, anxiety, worsening cognitive impairment, slower healing, and functional loss. Because people with advanced dementia may have chronic and/or acute untreated pain, they are more likely to suffer with these conditions as compared to those who are able to express their pain.

What can you do?
1. Help caregivers to assess pain by providing a good history of ‘normal behaviors’ and any behaviors that may indicate pain.
2. Report possible pain to staff or caregivers.
3. Educate yourself on types of pain medication and side effects – very few people ever become addicted to pain medication and fear of addiction should not prevent appropriate treatment.

For more information about study opportunities in pain research in older adults with and without dementia, please contact Dr. Todd Monroe at todd.b.monroe@vanderbilt.edu or 615-875-7690.

Blog Contributed by:
Todd Monroe PhD, RN-BC, FNAP
Assistant Professor, Vanderbilt University School of Nursing
Vanderbilt University Institute of Imaging Science
Vanderbilt Psychiatric Neuroimaging Program