Monday April 23, 2012
It has been recently noted after review of numerous medical
records a common trend has been identified. Residents with
impaired cognition are exhibiting behaviors i.e. screaming out,
resisting care, removing clothes etc. The residents are being
assessed for behavioral interventions and some resident are being
placed on psychoactive medications while pain is the cause of the
resident's behaviors. Residents were not consistently assessed for
pain during the behavioral assessment phase to rule out pain.
Facilities may want to review current systems and processes to
ensure there is an evaluation of the resident for pain with the
onset and/or increase in behaviors. This will also help
in the prevention of unnecessary drugs. See article
below.
Management of Pain In Persons With Dementia
Pain is a common medical condition in older persons; especially
residents in long term care (LTC) settings. Pain is defined as a
sensory and emotional experience associated with actual or
potential tissue damage. Chronic persistent pain occurs in 24% of
LTC residents while only 29% are free of all pain. Most, i.e., 74%,
demented nursing home residents have some pain and the majorities,
i.e., 70%, are untreated
or under-treated.
Pain can have multiple origins; however, discomfort produced by
musculoskeletal disease is the most common problem in the older
person, e.g., arthritis 42%, bone fracture 12%. Untreated or
under-treated pain can produce significant suffering as well
as agitation and
behavioral
problems in persons with dementia. Regular administration of
acetaminophen can reduce agitation in more than one-half of
agitated, demented patients with pain.
Assessment and management of pain is an important responsibility
of any clinical management team. Dementia patients are less likely
to receive analgesics despite the fact that they experience
suffering equal to cognitively intact individuals.
Source: Richard E. Powers, MD (2008) - Bureau
of Geriatric Psychiatryhttp://www.alzbrain.org/