Pain awareness for the person with dementia

[peterg04]

The physical needs of people with dementia often get missed, not noticed or even mistaken for behaviours that are inappropriate, behaviours that often will be classed as challenging. But who is it challenging to, the staff, the family, and the visitor. No the person themselves. Often unable to understand what the pain is or unable to communicate that they are in pain. The service user in the corner banging their head against the wall because they have a headache is often seen as self harming, disruptive, challenging instead of the recognition and understanding from staff as to why it is happening.

NICE Guidelines (2006) states “If a person with dementia has unexplained changes in behaviour and/or shows signs of distress, health and social care professionals should assess whether the person is in pain, using an observational pain assessment tool if helpful.” However, the possibility of other causes should be considered. Often confused the service user loses respect and dignity from staff by the way the staff deal with the situation, assuming because of the service users condition or confusion they cannot or will not complain.

We often misdiagnose pain when it is considered that the service user is exhibiting behaviours that challenge, which if the reason is pain will not help the service user. Ways in which staff can recognise pain in someone with Dementia is.
Talk to the person direct and ask questions, some service users no matter at what stage their memory is at, having short term memory will only tell the service user the pain exists at that moment, but never the less it is still reality to them. Getting to know the service user from the first moment they arrive into the home can only establish an understanding of their daily routine, which will show any differences in their behaviour. Behaviour such as
vocalisations (or making sounds): whimpering, groaning, crying
facial expressions: looking tense, frowning, grimacing, looking frightened
changes in body language: fidgeting, rocking, guarding part of body, withdrawn
behavioural changes: increased confusion, refusing to eat, alteration in usual patterns
bodily changes: raised temperature, pulse rate or blood pressure, perspiring, flushing or looking very pale

Make note of changes in the person and explore their behaviours to determine if pain is their concern, the use of pain assessment tools will also help determine the cause of the pain, its severity, when it occurs and what helps to make the pain better or worse.

This leads to a lot of distress and behaviour.

 

[cragmaid]

Peter, what you say is all very well written down, but the majority of " service users" " patients" "sufferers of Dementia"( there must be a kinder expression) will deny pain when asked or alternatively claim violent pain but we can never be totally sure that the description of pain is valid.

My own Mother would wince, cry ouch or demand pain relief. I'd then go and ask the carers for pain relief and when the carers came in she'd say that she was OK. I'd say "well it hurt before Mum, so take the pills anyway". My belief being, better two pills taken than a pain continues.

 

[Tin]

Every week or so my mum complains of a headache, always from the same area, just above her right eye. I always offer her a pain killer but sometimes she says no or the pain has gone. All a mystery to me!

 

[lin1]

My mum use to Sundown quite badly .mum was unable to tell us her needs . Several time various Drs had seen her like this. It took an Admiral Nurse to recognise that the cause was pain.
Mum was already on painkillers as she was riddled with Arthritis.

As soon as mum's pain killers were changed their was a big difference in her Sundowning, it was much less severe

 

[peterg04]

Body Language

55% of good communication is through body language. When someone is in pain or hurt we do the one thing that we were taught as a child. "we rub it better, because thats what our mothers did" Staff and carers need to recognise the importance of body language, if someone is rubbing their head it is possible to conceive that they have a headache but can not verbally communicate this. Body language for someone who has dementia and limited verbal communication normally shows a level of distress, this is what is being communicated to us, pain, security, as well as other distress reactions which often gets seen as challenging behaviour, a new approach needs to happen for staff and carers to be able to recognise these distresses that the person has. The reasons as to why, causes, triggers but importantly how to react and manage distress not focus on challenging,

 

[henfenywfach]

55% of good communication is through body language. When someone is in pain or hurt we do the one thing that we were taught as a child. "we rub it better, because thats what our mothers did" Staff and carers need to recognise the importance of body language, if someone is rubbing their head it is possible to conceive that they have a headache but can not verbally communicate this. Body language for someone who has dementia and limited verbal communication normally shows a level of distress, this is what is being communicated to us, pain, security, as well as other distress reactions which often gets seen as challenging behaviour, a new approach needs to happen for staff and carers to be able to recognise these distresses that the person has. The reasons as to why, causes, triggers but importantly how to react and manage distress not focus on challenging,

Hi!
Absolutely.

I care for my dad and over the last few years weve moved on from word association to gestures and now we clearly are using body language to communicate. He is verbal mobile yet says one thing to those that dont really understand him, not to worry them and his body language is saying something else .

I am fed up of lack of training being used as an exscuse...basic instincts use your eyes ears and lots of common sense..

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