Assessment Through Observation Of Behavior
Where self-report is not possible, observation and detection of pain-related behavior is a valuable approach to identification of pain in dementia. An expert panel convened by the American Geriatrics Society published guidance outlining the various behavioral expressions of pain in the elderly, including facial expressions, body movements and vocalizations, which are helpful when developing assessment tools for dementia . Facial expressions are particularly useful in detecting discomfort in AD., Interestingly, sensory and affective components of pain can be differentially expressed in the face, with sensory aspects shown by movements around the eyes, and affective aspects depicted by movements of the eyebrows and the upper lip. However, it should be noted that the accurate application of the method of reading facial expressions using the Facial Acting Coding System requires comprehensive training, which may make this approach unfeasible in clinical practice.
Good Advice For Handling Pain:
- Start by finding out why the person is in pain.
- You could try relieving the pressure.
- Use aids such as a heated cushion if, for example, the person has pain in the stomach.
- Massage and touch can alleviate pain. Find out more about touch therapy here.
- If necessary, use painkilling medication after taking advice from your doctor.
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Do Not Shy Away From Asking For Help
No one may have all the answers especially when it comes to taking care of a person with dementia. Try doing research on how their behavior changes and what needs to be done to help them live their lives without too many complications. Hire help when it becomes too much as it also ensures that you do not become too frustrated or drained. When you have multiple family members who can help, ask everyone to pitch in and look after the patient so that you can get some personal space to breathe and re-energize when it is your time to look after the patient. When you feel like you can no longer look after your loved one at your own home, it may be time to consider assisted living. In such case, look into dementia care homes that can provide specially trained professionals.
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Other Ways To Tackle Pain Without Medication
Gentle exercises to relieve stiff joints and massage to relive tight muscles can help, but seek advise from a physiotherapist on the best and safest techniques to use.
Some people benefit from using heat pads. However, be careful that they do not irritate, are too hot or used for too long.
Help position the person so that they are comfortable in bed or in a chair. Use an air mattress and air cushions to relieve pressure.
Help support the person with good mouthcare and oral hygiene, and ask a dentist for advise where there are problems.
Distraction, relieving boredom, a calm, comfortable environment, social contact, treating anxiety and/or depression can all help to alleviate pain.
Pain Assessment In Patients With Dementia
Competent pain assessment is a necessary prerequisite for good pain management and ideally considers several pain dimensions, namely intensity, location, affect, cognition, behavior, and social accompaniments. In case of patients with dementia, many cognitive and linguistic barriers prevent individuals from focusing on all these aspects. Those responsible for pain management must be adequately informed at the least about the presence and intensity of pain. Thus, limited and one-sided pain assessment is almost the rule in individuals with dementia, leading to deleterious consequences for their pain treatment or lack thereof. The best-possible forms of pain assessment will be briefly reviewed in the next paragraphs.
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What Medication Can Be Used To Relieve Pain In Advanced Dementia
One of the most common and effective medicines to relieve pain in advanced dementia is paracetamol. Ensure medication is given as prescribed. This can be when it is needed if pain is constant give it regularly. Paracetamol can be given one hour before someone is helped to move or before a dressing needs to be changed.
Other medications to relieve pain include antibiotics to treat infection, laxatives to relieve constipation, antacids to help indigestion, and peppermint water to relieve wind-type pain.
You can ask a range of professionals for advice on pain management: a tissue viability nurse, palliative care or district nurse, physiotherapist or massage therapist, or a GP or pain specialist team in your local area.
Just Because They Can’t Remember Your Name Doesn’t Mean You Aren’t Important To Them
Dont take it personally. In the early stages, it might be your name that they cant recall. In the middle stages, it may be entire events that are gone and even if you retell the story, it might not come back to them. This is not because they dont care, it wasnt meaningful to them, or theyre somehow choosing to forget it. Its the disease.
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What Causes A Dementia Patient To Stop Eating 4 Factors To Consider
The global statistics for dementia are mind-boggling. As of 2017, the total number of people with dementia was estimated to be 50 million.
This number is expected to rise to 75 million by 2030. Furthermore, in the US alone, one in three elderly people dies from Alzheimers or another form of dementia.
These increasing numbers of cases bring with them increasing challenges.
Feeding such patients is indeed one of the biggest challenges.
Poor nutrition increases the risk of dehydration, muscle loss, higher chances of infection, a decline in the overall well-being, and even death .
In the seven stages of Alzheimers a patient moves from their dementia being barely detectable to an extremely severe, steady, and visible decline .
Its not abnormal for Alzheimers patients to stop eating or drinking in the later stages of their diagnosis.
Approximately 50 percent of diagnosed Alzheimers patients wont eat enough food or drink sufficient fluids . The resulting weight loss develops into a larger problem as their disease progresses.
As per research, following are the four main reasons dementia patients stop eating and drinking as their disease progresses.
Memory Loss: Everything Became Fuzzier
Dementia symptoms result from damage to the brain caused by disease or injury. As brain cells die, it becomes difficult or impossible to store new memories or access old ones. Sometimes dementia comes on suddenly, after a stroke or head injury. Often it comes on more slowly as the result of conditions like Alzheimerâs disease or Parkinsonâs disease. Most causes of dementia cannot be reversed.
Mary Ann Becklenberg is in the early stages of Alzheimerâs disease, but her dementia symptoms have already had an enormous impact on her life. In 2006, she had to leave her position as a clinical social worker because she could no longer meet the responsibilities. âThe world became much less defined than it had been,â says Becklenberg. âEverything became fuzzier.â
The diagnosis didnât come until later. John Becklenberg says that he first knew that his wife had Alzheimerâs disease after she returned from a monthlong trip to California. âI was there with her for a week of her stay,â he says. âBut when she got back, she didnât remember that Iâd been there at all.â
âThat was so hard,â says Mary Ann Becklenberg, who now serves as an Alzheimerâs Association early stage adviser. âJohn listed all these things we did and places we went, and I didnât remember any of them. That was when we knew.â
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Alma And Silvias Story
Alma had been forgetful for years, but even after her family knew that Alzheimers disease was the cause of her forgetfulness, they never talked about what the future would bring. As time passed and the disease eroded Almas memory and ability to think and speak, she became less and less able to share her concerns and wishes with those close to her.
This made it hard for her daughter Silvia to know what Alma needed or wanted. When the doctors asked about feeding tubes or antibiotics to treat pneumonia, Silvia didnt know how to best reflect her mothers wishes. Her decisions had to be based on what she knew about her moms values, rather than on what Alma actually said she wanted.
Quality of life is an important issue when making healthcare decisions for people with dementia. For example, medicines are available that may delay or keep symptoms from becoming worse for a little while. Medicines also may help control some behavioral symptoms in people with mild-to-moderate Alzheimers disease.
However, some caregivers might not want drugs prescribed for people in the later stages of Alzheimers. They may believe that the persons quality of life is already so poor that the medicine is unlikely to make a difference. If the drug has serious side effects, they may be even more likely to decide against it.
Symptoms In The Later Stages
People in the later stages of dementia become increasingly frail and depend more on other people for support. As dementia progresses and causes changes to the person’s brain, they may struggle to do many of the things they used to. However, even in the later stages the person may experience moments of lucidity and some of their abilities may return temporarily.
The person’s reactions are likely to be influenced by their environment and how they feel. For example, they may react more positively if they are in a familiar environment or one where they feel comfortable.
People in the later stages of dementia often experience problems with the following:
- memory
- changes in behaviour.
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How To Recognize Signs Of Pain In Those With Dementia
I have been working in hospice care for more than 20 years, and when I hear the word pain, I cant help but think no one should have to hurt at the end of life. This is especially true when I think of people living with dementia. Dementia is disease type that causes impairments in language, memory, personality, behavior and judgment. It is a chronic disease that causes continuous decline in the ability to see, hear, move, taste, remember, reason and understand. Because of their disease, most dementia patients can no longer report pain because they do not recognize it. Who will advocate for their comfort?
Pain in individuals with dementia is often under assessed and under treated. Studies indicate that although dementia patients experience severe or chronic pain, they regularly receive fewer pain medications than healthy senior adults. The results of one study also showed Alzheimers disease, which is a category of dementia, did not alter the sensation of pain in individuals with Alzheimers it only altered their ability to report pain.
Signs or behaviorsnonverbal and verbalindicating pain can include:
- Anxiety or restlessness
- Constant pacing, moving or unwillingness to sit down
- Moaning, crying, sighing and even heavy breathing
- Frowning, grimacing or a furrowed brow
- Sleeping all day or not being able to sleep
- Very rigid, striking out or resistive
I hope this information will help caregivers continue to provide best care possible.
Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
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Signs That A Person With Dementia Might Be In Pain
Changes in the way the person is reacting might be possible signs of pain, for instance:
- behaviour, such as fidgeting, restlessness, or reacting with fear or distress during personal care such as washing or dressing
- speech, such as calling out, groaning or shouting
- sleep, such as sleeping more or less than usual
- body language, such as appearing panicked, bracing or guarding, or repetitive movements, such as rubbing or twitching
- facial expressions, such as grimacing, tensing or frowning
- mood, such as withdrawal or uncharacteristic quietness, low mood
- physical state, such as change in temperature, increased pulse, sweating, flushing or appearing pale
- appetite, such as refusing food
If you are looking after a person with dementia, then you might know the person best. If you can, think back to a time before their diagnosis or in their earlier life when you knew they were in pain. How did they react then? Does that help you consider their behaviour now?
Asking someone if they are in pain is the best way to find out, but as the persons dementia progresses, they may be less likely to tell you they are in pain. They may not be able to describe where the pain is coming from, and may say no if you ask even if this is not true.
Is Paranoia A Symptom Of Dementia
If you know somebody who started to display paranoia, you might be wondering if the paranoia is an early sign of dementia. Yes, paranoia can be one of dementias symptoms, but there is much more to dementia than just this. Here are some common symptoms found in people who have dementia. Remember, it is not necessarily true that a dementia patient would have every single one of these symptoms.
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Why Do Dementia Patients Fidget
If a dementia patient is anxious or stressed, you can usually see it in their hands. They are likely to pull at their clothes, wring their hands, rub their skin, or twist their fingers if they are afraid, upset, or agitated. Fidgeting and associated behaviors are how people with dementia deal with their discomfort.
Do Dementia Patients Feel Bored
Yes, just like everyone else, dementia patients may feel bored from time to time. Unfortunately, when they are no longer able to plan their own activities, the boredom may easily turn to frustration. The person may become agitated and start wandering the house, simply because his/her mind has been idle for too long. Activities that will keep dementia patients busy and engaged can help get rid of boredom.
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Where To Get Help
- Your local community health centre
- National Dementia Helpline Dementia Australia Tel. 1800 100 500
- Aged Care Assessment Services Tel. 1300 135 090
- My Aged Care 1800 200 422
- Cognitive Dementia and Memory Service clinics Tel. 1300 135 090
- Carers Victoria Tel. 1800 242 636
- Commonwealth Carelink and Respite Centres Australian Government Tel. 1800 052 222
- Dementia Behaviour Management Advisory Service Tel. 1800 699 799 for 24-hour telephone advice for carers and care workers
Tip : Deal With Anxiety And Depression
Depression and anxiety are common among early stage Alzheimers patients. Symptoms such as withdrawal, agitation, feelings of worthlessness, and changes in your sleeping patterns can make dementia symptoms worse, though, and limit your independence. Dont ignore symptoms. As well as counseling and medication, there are plenty of self-help steps that can help you overcome anxiety and depression.
- Learning how to challenge anxious thoughts and develop a more balanced way of looking at your new situation can help you come to terms with your diagnosis and ease anxiety.
- Opening up and talking about your fears and other emotions with someone who makes you feel safe and supported can help boost your mood.
- Exercising regularly, eating well, and improving your sleep are also proven ways to help improve depression and anxiety symptoms.
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An Overview Of Latestage Dementia
The patient reaching thisstage has probably suffered for a long time. Although they have family andloved ones who care for them from the beginning, the disease needs to betackled carefully now. At this stage, every day is a new trauma, and its like afresh goodbye to the brilliant, amazing and sparkling person that the suffereronce was. This stage can be incredibly straining for the carers, and they mayend up neglecting their own health needs.
Thereupon, experts recommendcaretakers to keep a keen eye at the changing actions of the patient. Behaviorssuch as rare talking and denial to recognize the nearest ones are the warningsigns that the patient is soon dying from dementia. To elaborate further, hereare four symptoms of late-stage dementia:
Do Not Ignore Physical Abuse
As much as one needs to be tolerant, kind, forgiving, and patient with older adults who have dementia, it does not mean that they have to excuse the patients when they become physically aggressive and allow the abuse to continue. It is not to be accepted, and if it happens, it is best to alert your doctor who will work on the solution to make sure it stops. It will keep both the patient and caregiver in safety.
From physical manifestations to angry outbursts, taking care of an individual with dementia may not be easy. However, working with the tips above can help caregivers and loved ones to get through it. Remember that there are plenty of treatments, interventions and special care providers who can help therefore, you should never be shy about getting help when you need it.
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Ahava Memory Care Residence For The Love Of Seniors
The Jewish Association on Agings new AHAVA Memory Care Residence is the only Memory Care Center of Excellence in Pennsylvania certified by The Hearthstone Institute. At AHAVA, we provide the proven approach of Hearthstones life-enriching Im Still Here® programming within a warm and comfortable atmosphere. With the Hearthstone approach, the expertise of our caregivers, the support of our community, and a purposeful design for those with memory loss, AHAVA Memory Care Residence is Pittsburghs premier resource for Alzheimers and dementia care.
The choice to partner with The Hearthstone Institute came from the desire to provide truly unique and specialized memory care programming to our residents. As a recognized leader in the field of Alzheimers care and founder of The Hearthstone Institute, Dr. John Zeisels philosophy and approach deeply aligns with ours to create nurturing environments where those living with Alzheimers disease and other forms of memory loss can flourish. We have created an atmosphere of hope for our residents and their families a place where everyone cares for, respects, and loves one another.
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