The health care community has made great strides in pain assessment, often described as the “fifth vital sign”. It is estimated that approximately 80% of elders living in long term care facilities experience pain that impairs functioning, activities of daily living, mood and quality of life. (AgingWell, 2011).
Whether living within the home, or long term care facility my focus is on the advancing demented client who cannot report pain as a result of decline in cognitive and verbal skills; instead these clients express pain through behavioral symptoms. Behavioral symptoms to be assessed include, increased motor activity, sleep disturbance, fidgeting, grimacing, moaning and yelling. Requiring the clinician to demonstrate strong assessment skills, with a firm foundation regarding behavioral observations of the client.
As reported by the “Management of Pain in the Person with Dementia: Dementia Education & Training Program (2011), the assessment of pain in the demented client requires:
1. Review of medical records.
2. Timing and sequencing of pain.
3. Mental Status Examination, to determine the client’s ability to interpret pain.
4. History of depression and anxiety.
5. Ability to assess behavioral symptoms, i.e. body language, pacing, agitation, verbal outbursts.
An important first step for the clinician in assessing pain in clients with dementia is to have an understanding of indicators. Such as:
Mr Grant, 82 year old male patient admitted to long term care facility with diagnosis of Alzheimer type dementia, diabetes, history of lower back pain and depression. Patient presented as restless, with intrusive wandering, sleep disturbance and difficult to redirect. Facility treatment course consisted of Zyprexia and Trazadone dosing, with subsequent increased dosing. Within one month of admission, patient transferred for Geri-Psychiatric Hospital admission resulting in diagnosis of Acute Delirium.
Unfortunately, appropriate nursing indicators such as the PAINAD Scale, and other recommended pain assessments were not indicated, including the history of pain and depression; this hospitalization most likely would of been prevented. This patient responded quite well to a scheduled Tylenol and Celexa dosing. Concluding, that it is essiential for the clinician to recognize a patient’s pain profile, and timely treatment of underlying conditions.(http://www.nursingcenter.com)
At Caring Resources, the Alzheimer’s Coach provides a personalized at-home assessment with family members of individuals diagnosed with Alzheimer’s disease and related dementias. Our program assesses for additional resources, including assessment by Certified Dementia Practitioner, Geriatric Psychiatrist, Licensed Independent Social Worker to meet the clinical, social and environmental needs of the dementia client. Our program encompasses individual caregiver education, support, guidance, care planning and appropriate referral sources to best meet the needs of the dementia client. For more information contact a representative today.