Tuesday, April 26, 2016

Pain Often Untreated in Seniors With Dementia

Older adults are apt to suffer from a variety of painful health conditions, including arthritis, osteoporosis, urinary tract infections, diabetic neuropathy, tooth problems, constipation and many others. It’s important to address this discomfort and work with the person’s healthcare provider to arrive at the most effective treatment for pain. Treatments might include medication, exercise and managing conditions that cause the pain.
But when a person also has Alzheimer’s disease or other dementia, it can be very challenging to realize that the person is in pain, and what is causing the pain. As Alzheimer’s and other dementias progress, patients lose the ability to communicate what they are feeling. Consequently, they may express pain in ways that aren’t readily understood by family or even by medical personnel—and their pain may go untreated.
People with dementia may express pain in nonverbal ways, such as wincing, shouting, rocking, eating or sleep problems, or aggression. According to experts from the University of Alberta, family often assume that these behaviors are just a part of their loved one’s dementia. Said the researchers, “It is important for those who live or work with persons with dementia to know how to identify when an elderly person is experiencing pain.” The University of Alberta team offers an excellent online tutorial for families; it can be accessed here; a simple registration is required.
Dr. Alexia Torke of the Indiana University School of Medicine calls for increased access to hospice and palliative care for people with dementia. Said Torke, “Although the general public and many physicians do not associate palliative or hospice care with dementia, dementia is a terminal disease and should be respected as such. Palliative care is needed throughout the illness and can provide those who are unable to communicate their needs with a better quality of life as well as lowering the stress the illness places on caregivers and the entire family.”
A recent study by University of California, San Francisco School of Nursing researchers sought to better understand the issue of pain in people with dementia. The team found that while pain in nursing home residents had been studied, little was known about pain treatment for people with dementia who live at home. Said lead author Lauren Hunt, RN, MSN, “As a hospice nurse caring for people in their homes, I have seen many patients with dementia who suffer from distressing pain. I was motivated to conduct this research study to understand the issue from the broader national prospective. It turns out that pain is very common in this population and is frequently severe enough to limit activities.”
The researchers reported that people with dementia actually are at higher risk of pain, with 63 percent experiencing “bothersome pain” and 43 percent having “pain that limited activities.” The team reported that access to treatment was a big hurdle; many of the patients found it difficult or impossible to get to healthcare appointments, and had little access to care at home.
The study, which appeared in the Journal of the American Geriatrics Society, called for increased awareness of this important issue. Said UCSF professor Dr. Alexander Smith, “The extensive challenges associated with the assessment and treatment of pain in older adults with dementia will require creative solutions from researchers, clinicians and policymakers to ensure pain is being adequately managed in this vulnerable population.”
Source: IlluminAge AgeWise reporting on studies from University of California, San Francisco, University of Alberta and Indiana University School of Medicine.

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