How can I get my grandmother with Alzheimer's to receive better pain management?
I am very frustrated with pain management for my loved one who suffers from moderate Alzheimers'. My frail 87 year old grandmother had a recent fall at her skilled care nursing home that resulted in 4 separate fractures of her pelvis. She had a badly broken hip a year ago plus other falls as well, and so I do realize pain from such an injury cannot be entirely erased and she will have to live with some discomfort as she slowly heals over the next few months. However, doctors have not yet gotten on top of her pain enough to allow even the most basic daily activities even somewhat tolerable for her now. She sobs and sobs for hours daily, begging staff not to touch her because she hurts so much. In the last 2 weeks she's become combative and angry and tries to hit at staff. She can't even sleep. I don't think this constitutes proper pain management at all. The pain is making her demantia-related behavioral problems and confusion/agitation IMMENSELY worse and NEEDS to be addressed more aggressively. But all of my discussions with staff and her doctors have gone seemingly ignored and no adjustments are ever made.
On top of all this, I was told today by one of her doctors that use of pain meds in patients with dementia can/does increase their confusion and lead to higher levels of anxiety and agitation. Is there any truth to this? Doesn't her pain level warrant some pharmacological help? What help can be done to help her?
Expert Answer
Pain management with Alzheimer’s disease-There is no reason why her pain should be left untreated. The symptoms she is beginning to show is typical for a person with poorly treated pain. Her doctors are correct and pain meds can affect her dementia/anxiety, but from a quality of life standpoint, there should be proactive attempts to control her pain. Make sure she is having a pain specialist provide consults; these physicians are focused on pain management and have great comfort prescribing meds for pain in the senior population. I would need more information on her medications to provide a general assessment of whether it is the typical pain management regimen for a patient in pain. There is a basic strategy we follow---one medication for sustained coverage around the clock and another for break through pain.