How to Help Someone With Dementia Avoid Unnecessary Pain in the Hospital

Five important ways caregivers can improve pain management
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Many hospitalized people experience pain. After all, pain can be caused by chronic problems (like arthritis), an injury (such as a broken hip), or an acute illness (like diverticulitis, a common inflammation of the colon). For some, pain is present all the time. For others, it's associated only with certain movements, like getting out of bed.

Studies show that older adults are often undertreated for pain, especially if they have dementia.

The trouble is that people with dementia often have difficulty communicating pain. They may not remember the pain when hospital staffers come to ask about it. Or they may consistently deny being in pain ("Oh, I'm all right"), even though careful observation of their activity and facial expressions tells another story. What's more, studies show that hospital staff often fail to assess pain correctly or follow up on evidence of pain, partly because of poor training in pain management.

There's absolutely no need, however, for anyone to soldier through intense pain while being hospitalized (or after!). Proper treatment of pain is essential because untreated pain can cause delirium. It can also mask underlying health problems or affect a patient's ability to participate in the physical therapy that's needed for recovery.

How to ensure your loved one gets properly treated for pain

1. Don't take "I'm fine" for an answer.

If your loved one denies being in pain, watch for other telltale signs:

  • Grimacing, wincing, frowning

  • Moaning during sleep

  • Favoring a body part

  • Avoiding moving a certain way

  • Being more confused than usual

  • Loss of appetite

2. Promptly inform hospital staff if you suspect your loved one is in pain.

You know your loved one better than they do. You know which behaviors are unusual. You see him or her more continuously than any hospital staffer while you're at bedside. Trust your instincts and your observations.

Don't wait until the next time the doctor rolls around; your loved one shouldn't have to suffer needlessly. Tell a nurse right away.

More ways to help someone with dementia avoid unnecessary pain in the hospital

3. Follow up on as-needed painkillers when they seem to be needed.

Often pain relievers are prescribed on an as-needed basis. This means your loved one will get them when the staff observes a need or the patient complains -- but staff may not notice right away, and the patient with dementia may not express the need. That's why you shouldn't hesitate to remind hospital staff to give medications to your loved one, especially if you see any signs of pain. If you don't speak up, it may not happen -- and your loved one will suffer unnecessarily.

If pain seems present most of the time, ask the doctor if the dosage can be switched to a scheduled delivery rather than an as-needed basis.

4. Don't let constipation be a reason to avoid using pain medication.

Many people in the hospital need stronger opiate-type medications for pain, especially if surgery or a fracture is involved. These medications almost always cause constipation.

Fortunately, painkiller-associated constipation can be treated, although it usually takes more than the measures that are commonly prescribed. If your loved one needs pain medication that leads to constipation, be sure to raise the issue with the doctors. They may need to prescribe, or increase, a dosage of a laxative, rather than reducing the painkiller.

More ways to help someone with dementia avoid unnecessary pain in the hospital

5. Ask for help if you're concerned that pain isn't being properly addressed.

Hospital staff may avoid pain medication out of concern that pain meds will worsen a dementia patient's mental state or balance. While there's some reason for this concern, studies have shown that undertreated pain can also cause delirium and poor recovery.

Balancing the benefits and risks of pain medications can be tricky, and unfortunately, many doctors and nurses haven't been trained to manage pain in older adults with dementia. So ''if you feel your loved one's pain isn't being adequately treated, ask to have a specialist in aging (such as a geriatrician) or pain management (a palliative care doctor) do a consult -- that is, assess your loved one and provide recommendations to the primary hospital doctors.

Don't give up.

The choice of pain medicine can make a difference (depending on what medications are being taken and what conditions your loved one has). So can the dosage; the best approach typically is to start at lower doses, carefully watch for effects, and increase the dose as necessary. If your loved one seems to be developing side effects from his or her pain medicine, ask that a different type of medication be tried. Even regular dosing of simple acetaminophen (brand name Tylenol) might help, depending on your loved one's case.