• Pain vs. Behaviors

    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/

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