“My mom has moderate dementia and has had increased issues expressing herself verbally. She has a long history of osteoarthritis and diabetes – however, is currently on nothing for pain. Could she be in pain? How would we know now that she might not be able to tell us?” Megan from Decatur

Thank you so much for your question!  I am glad that our newsletter this month has increased your awareness and concern for your mom’s potential experience of pain.

First, with those that are cognitively impaired, we should not assume that mom cannot disclose her pain verbally. It’s important if cues are seen that we continue to ask specific questions about her pain or discomfort. It is often also helpful to ask questions using multiple words to describe pain – such as being “achy”, sore, or uncomfortable.

It is best to combine any type of self-report of pain with what we are seeing regarding non-verbal cues, behaviors, verbal (non-word) cues, and facial expressions. These might include grimacing, crying, groaning, restlessness, guarding, resisting care, decreased social interactions, combativeness, increased wandering, decreased appetite, or difficulty sleeping. It is important to note changes in these behaviors – as things outside of their customary ways of acting – could signal she is in pain. It may also signal a variety of other concerns – such as a potential UTI with delirium – so proper assessment is a must!

It is also appropriate to assume that she does have pain if she has conditions or procedures that are typically associated with pain – such as a recent fall, diabetic neuropathy, or osteoarthritis. It can be important, as with those without cognitive impairment, that we be proactive regarding the assessment and management of her pain.

If pain is suspected, sometimes a time-limited trial use of pain medication – ranging from over the counter to Rx as appropriate to her perceived intensity – can be attempted. This will require frequent reassessment and monitoring of its benefit as well as potentially negative side effects – such as increased fall risk, constipation, and lethargy. This, in combination with non-medication based measures, can assist in assuring that mom is at her greatest overall comfort level. These comfort measures may include playing her enjoyed music, massage, and even “thinking-outside-of-the-box” measures like allowing her to fold warm towels out of the dryer to assist as an activity, a potential distraction from her pain, and a bonus warm sensation felt to her muscles or joints.

Wishing the best to you and yours!   Lisa

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