As adults grow older a substantial number of people experience pain and cognitive impairment. Assessment’s of their pain become more complex as patient’s cognitive abilities decline, patient’s losing their ability to express themselves, and not understanding their pain (Chatterjee, 2012). Dementia is one the many cognitive impairments elders might go through. It is a progressive brain disease and can be classified as mild, moderate, or severe according to the level of cognitive impairment. Cognitive impairment can affect a person’s ability to describe their pain, understand the assessment questions that are asked, recall painful events, and rate their pain on a numeric scale 0-10 (Wilsons et al, 2006). Observation assessments like the Abbey …show more content…
The provider will ask the patient to assign a number for the severity of their pain. This is useful for patients with mild or moderate dementia. Zero indicates no pain and ten indicates worst imaginable pain. They will often give patients a chart to look at if they don’t fully understand. The ranges are one to three being mild pain; four to six is moderate pain and seven to ten is severe pain (Chatterjee, 2012). Observation scales, such as the Abbey Pain scale, or PAINAD, is useful for scoring pain when patients are unable to (Chatterjee, 2012). While observing, the patients score questions one to six, for example, vocalization (e.g. groaning), facial expression (e.g. Frowning), and changes in body movements (e.g. resistance to care) (Sherder Ej, …show more content…
According to (Ro, 2013), pain can manifest as agitation or aggression in people with dementia, which can lead to behaviors that are from unaffected pain treatment. (Achterberg, 2013), stated there are an estimated 35 million people with dementia across the world and 50% experience pain and assessment relies on a large part on observational methods. Pain perception is often a forgotten issue with the neuropathological changes in dementia. Several self-report scales, including Visual Analog Scale, Numerical Rating Scale and Face Pain Scale, but when self-reports are not possible, then observation and detection pain-related behavior is a valuable approach (Achterberg, 2013). Studies have shown in several situations where pain might arise. Pain might arise at rest, during day-to-day activities, and during guided movements (Achterberg, 2013). Orofacial pain has been overlooked, but elevated level of facial response to pain stimuli in people with dementia is the key omission in the existing tools (Achterberg, 2013). Neuropathic pain from having diabetes, stroke or amputation is a form of pain in dementia that is challenging to assess. Studies have shown that central neuropathic pain is the most under-treated type of pain in people with dementia. The assessment and treatment is of high
Smith , M., Gerdner, L., Hall, G. & Buckwalter, K., 2004. History, Development, and Future of the Progressively Lowered Stress Threshold: A Conceptual Model for Dementia Care, pp. 1755-1760, viewed 2 Febuary 2014, < http://onlinelibrary.wiley.com.ezproxy.utas.edu.au/doi/10.1111/j.1532-5415.2004.52473.x/pdf>
care to the residents suffering from dementia. Banner et al (2009 as cited in Lee J.et al.2012)
The purpose of this paper is to present a discussion of the application and evaluation of Post-Operative pain management in elderly patients with dementia in a rehabilitation setting.
“The Pain Tree” written by Olive Senior tells the story of a woman who comes back home after many years and begins to think about her childhood in a new light, which changes much of what she thought she knew of her family and childhood. The story shows the main character, Lorraine, revisiting the memories of her family and the woman who had taken care of her as a child, Larissa. Children mainly focus on the happy memories which may be tied to more important topics that they do not understand until they are older. Most children do not pick up on many of the complicated things happening around them. Lorraine can now see the bigger picture of her relationship with Larissa and how large the divides were between Lorraine’s family and Larissa’s
Dementia is common among a large population of elderly people. The disease affects not only the individual diagnosed, but also the caregivers that work towards making their life comfortable in the end. Understanding and learning about the disease is crucial in helping those that experience or live with someone who has dementia. The services and support that are currently in affect for elderly people with dementia and the caregivers is poor, and ineffective because of the lack of research and information on the topic.
Nerney, C. (2014, April). Dementia. Lecture conducted from Massachusetts’s College of Liberal Arts, North Adams, MA.
...amount of pain) is a great teaching tool for the patient who is able to self-report (Nevius & D’Arcy, 2008). This will put the patient and nurse on the same level of understanding regarding the patient’s pain. The patient should also be aware of the added information included with the pain scale: quality, duration, and location of the pain. During patient teaching, it should be noted that obtaining a zero out of ten on the pain scale is not always attainable after a painful procedure. A realistic pain management goal can be set by the patient for his pain level each day.
Under-treatment is common because of the misguided perceptions many healthcare providers have for older adult patients. In Dr. Erdman Palmore’s Ageism Survey (2001) of community-dwelling older adults ages 60 to 93, 43% of respondents reported that “a doctor or nurse assumed my ailments were caused by my age,” and 9% said they were “denied medical treatment because of age.”(cite) Situations like these are detrimental because if the symptoms are because of a legitimate problem that is overlooked due to old age, a patient’s health can worsen and a small problem can grow into something fatal. Furthermore, a patient who is told that a symptom is because of their old age can internalize those negative feelings that the physician expresses, and can then become depressed due to believing that they are helpless. Negative attitudes affect people’s physical and mental health. A few opinions that healthcare providers have about older patients that cause under-treatment are evident in a current cross-sectional survey, the Expectations Regarding Aging Scale, which assessed perceptions of aging. The majority of providers surveyed were primary care providers (PCP). PCP’s include nurse practitioners, physician assistants, and physicians. Over 60% of PCPs agreed with the statements “Having more aches and pains is an accepted part of aging” and “The human body is like a car: when it gets old, it gets worn out” (61%). Another 52% agreed that one should expect to become more forgetful with age, and 17% agreed “mental slowness” is “impossible to escape,” (cite). An example of under-treatment of a symptom in an older adult is back pain. Pain is commonly under-treated among older adults. While patients may already have ageist expectations about the
It is evident from the literature that, the adverse effects of dementia make changes in patients quality of life by changing their behavioural and functional abilities including expression of feelings or communicational skills. As a result, it becomes a challenge for the health care provider to assess or identify pain or symptoms of pain in dementia patients when they are unable to articulate their needs. Using a pain measurement tool helps the health care provider to meet this challenge, thus improve the pain management in persons with severe cognitive impairment. Throughout the research, in order to find out the suitable diagnostic tool for pain assessment in patients with advanced dementia, author reviewed studies on different pain assessment
DEFINING AND DIAGNOSING DEMENTIA. (2005). In The Cambridge Handbook of Age and Ageing. Retrieved from https://hodges.idm.oclc.org/login?url=http://www.credoreference.com.hodges.
Findings. Pain has many different meanings to many people. What is important to know as a nurse or health care provider is that pain is what the patient says it is. It is not the nurse or provider’s place to determine what the patient’s pain is but rather take an in-depth history and assessment. Using this assessment and history can therefore help treat your patient’s pain accordingly. Also pain theories have been proposed and used the implications of nursing practice in regard to pain.
Snyder, M., Egan, E., & Burns, K. R. (1995). Efficacy of Hand Massage in Decreasing Agitation Behaviors. Associated with Care Activities in Persons with Dementia. Geriatric Nursing, 16, 60-63. Taylor, A. (1995)
Pain is neither objective nor seen or felt by anybody other than the person that is experiencing it. Pain is subjective, therefore there is no way to distinguish whether or not someone is hurting and the only and best measurement of pain is that what the patient says it is. In settings such as end of life care, patients present with many different disease processes and ultimately are there because they have an average of six months to live. Along with this stage in their lives, palliative care patients can encounter a myriad of symptoms, which can result in these patients experiencing tremendous physical and psychological suffering (Creedon & O’Regan, 2010, p. [ 257]). For patients requiring palliative care, pain is the most incapacitating of symptoms and in return unrelieved pain is the primary symptom that is feared most by these patients. So why has pain management not become the top priority when it comes to end of life care, considering this area is growing at an extraordinary rate as a result of an increasingly ageing population?
Introduction This assignment critically discusses dementia, a widespread disability among older adults today. It provides an introduction to dementia and analyses its prevalence in society. The various forms of dementia are elaborated with descriptions of dysfunctions and symptoms. Nursing Assessment and Interventions are provided in the further sections which discuss actions nurses should take while evaluating patients and treating them.
Dementia is defined by the World Health Organization as a syndrome due to damage of the brain cells that most often chronic and progressive in nature. Some of the cortical functions that become impaired include memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment. Other manifestations that may accompany this disease are deterioration in emotional control, social behavior or motivation (Ouldred & Bryant, 2009) Dementia is not a normal part of aging, however it occurs most frequently in the older population. Fifteen percent of Americans over the age of sixty-five have dementia, and as the average life span continues to increase, so will the number of those affected by dementia (Fredman, James, Johnson, Scholz, & Weuve, 2012). The purpose of this paper is to discuss the pathophysiology, risk factors, symptoms, and treatment options for different types of dementia.