Identifying pain in dementia

A new study, conducted by researchers at the University of New South Wales, investigates why pain is often undetected or misinterpreted in people with the later stages of dementia in residential aged care facilities.

The results, published in the Journal Clinical Interventions in Aging, reveals while pain is proactively assessed and pain tools are routinely used by staff and carers in aged care facilities, it is often driven more by regulatory requirements than a person centred approach to care.

Identification of pain and need for pain relief was reportedly “ill defined and poorly understood”. Both pharmacological and non pharmacological regimes were used, but in an ad hoc, variable and unsystematic manner, with patient, staff, and attitudinal obstacles between the experience of pain and its relief.

Staff from 15 different Australian aged care facilities were interviewed.

As a result of the findings, researchers recommend a systemic, individualised approach to pain assessment and management that relies on a comprehensive history and examination to identify individualised pain patterns, possible behaviours displayed when the person is in pain and strategies to relieve the pain which everyone involved can agree upon, including carers, staff and doctors.

People with severe dementia can have multiple potential sources of pain, such as genitourinary infection, fall related injuries, pressure ulcers, contractures, and gastrointestinal and cardiac pain.

People with dementia may experience physical pain for the same reasons as everyone else. However, because of their declining brain function, they may be less able to communicate to their carers that they are in pain. By looking out for non verbal signs of pain, adequate treatment can be provided.