Assessing Pain in Loved Ones with Dementia

Persistent pain is common among older persons, who are more likely to suffer from problems such as arthritis and other chronic conditions. The person with dementia often has trouble communicating his or her feelings or thoughts—and this can mean the inability to tell you if a physical problem, such as pain, exists.
If your loved one has dementia, determining if he or she is experiencing pain may be up to you. Careful observation can reveal important clues to let you know that he or she is experiencing pain.

These clues can include:

• Facial expressions: frowning, looking frightened, grimacing, wrinkling his or her brow, keeping eyes closed tightly, blinking rapidly, or exhibiting any distorted expression.
• Verbalizations/vocalizations: moaning, groaning, sighing, grunting/chanting/calling out, breathing noisily, asking for help or becoming verbally abusive.
• Body movements: rigid or tense posture, fidgeting, pacing or rocking back and forth; restricted movement, gait or mobility changes.
• Behavioral changes: refusing food or showing any appetite change; change in sleep/rest periods; wandering; stopping common routines.
• Mental status changes: crying, showing increased confusion or irritability, acting distressed.

When does the pain occur?

• During movement: Signs could be grimacing or groaning during personal care (such as bathing), walking, or transferring (from bed to chair, for example).
• Without movement: Does your loved one appear agitated or have other behavioral changes, such as trouble sleeping, loss of appetite, or reclusiveness?

If you see any of these signs, talk to your healthcare provider as soon as possible, telling him or her what you have noticed and giving examples. Focus on when the pain occurs, and how it seems to be experienced (burning? aching? stabbing?) and whether it occurs with or without movement. Tell your healthcare provider what, if anything, relieves the pain. It is important to provide your healthcare professional with a history of all prescription and over-the-counter medicines your loved one now takes and has taken in the past, writing down all medications and dosages.