Pain Management in People with Dementia

Nearly 135 million people worldwide will be impacted by dementia by 2050 (Robinson, Tang, Taylor,. 2015). Dementia is not a disease, it is an overall term that describes a wide range of symptoms associated with the decline in memory and thinking skills. Dementia is a progressive illness that results in the loss of one’s sense of self (Burns, Byrne, Ballard, Holmes, 2002). The two most common forms of dementia are Alzheimer’s disease and Vascular dementia. Dementia is progressive and people with dementia experience complications with short-term memory, keeping track of personal items, paying bills, taking care of themselves and daily tasks (Haigh, Mytton, 2016). Due to the rising number of individuals developing dementia, it is causing major challenges in the healthcare systems and society (Angermeter, Luck, Then, Riedel-Heller, 2016). Utilizing psychotropic medications are often ineffective or harmful to the individual, therefore, many patients decide to utilize sensory therapy as a form of treatment instead (Livingston, Kelly olmes, et al., 2014). Caregivers of individuals with dementia can also experience health consequences related to caregiving at the end of life. Spousal caregivers are 40.5% higher odds of experiencing frailty as a result of caregiving (Carr, Dassel, 2017). Dementia does not only affect the individual, it affects those around them, society, and the healthcare system.

Psychological factors are known to contribute to how people experience and cope with pain. However, as people age, they experience normative age-related changes in psychological functioning. Thus, much of what is known about psychology and pain may not necessarily apply to older adults, unless it has specifically been tested in older populations. This is a particularly important point, because pain remains a major problem for millions of older adults. Furthermore, it is expected that the populations of older adults in America will increase significantly in the coming years, as people are living longer now that at any other point in history. Given that psychology changes across the lifespan, and that pain is a problem in older populations, this

5. Zwakhalen, S., Hof, C., & Hamers, J. (2012). Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. Journal Of Clinical Nursing, 21(21/22), 3009-3017. doi:10.1111/j.1365-2702.2012.04313.x

As with all older adults, clients with dementia present with chronic conditions such as arthritis and acute pain experienced in the aging and the end of life process. Moss (2002) gives evidence that most elderly clients who move into long-term care will die in an institution either a nursing home or a hospital many of whom will have dementia. She states that 91% have a strong co morbid condition likely to cause pain.

As the dementia progresses the individual could be unable to communicate, but they may be able to express pain through noise I.e. screams, but these could be easily misinterpreted by care providers as a “normal” behaviour if these are regular occurrences.

Providing care for a person with dementia is like being on a roller coaster ride that never ends and the ride can make the caregiver sick. In order to discuss dementia caregiving, a definition of dementia and the impacts of dementia are needed. Dementia is the generic term used by health care professionals to describe a person’s symptoms of memory and judgment issues (Alzheimer’s Association, 2015b) and furthermore is a growing problem in the United States of America (USA) and around the world. Currently 5.3 million people in the USA have been diagnosed with Alzheimer’s or other dementias, and dementia numbers are expected to increase by 40% in the next decade (Alzheimer’s Association, 2015a). Dementia care is

More than 5 million Americans currently have dementia in the United States and this number is projected to rise to between 8 and 13 million by 2050 (Alzheimer’s Association, 2015). Dementia is known to become more prevalent with age, increasing from 5 to 10 percent in people over 65 years of age to almost one half of people over the age of 85 (Alzheimer’s Association, 2015). Although family members provide the majority of care for people with dementia, increasing needs over time often lead to placement in a long-term care setting. Dementia is the most common reason for entry into long-term care facilities (Zimmerman, 2013) and nearly 90% of persons with dementia will have at least one stay at a nursing home in their lifetime (Grunier, 2007).

JCAHO (2011) also stated that patients and their families needed to be educated about pain and how the patients’ pain is going to be managed. Every patient perceives and exhibits pain in a different manner and if nurses do not assess the patient thoroughly they can miss it. For instance, Engebretson et al. (2006) acknowledged that, patients manifest pain in different ways and this resulted in nurses performing an inadequate assessment of their patients’ pain. Also, Engebretson et al. recognized that patients often conceal their pain because they do not want to be viewed by staff as complainers or addicts, and if patients decide to speak up the nurses frequently view their patients’ statements from their own cultural, moral and ethical belief system and not their patients which leaves the patients’ pain untreated.

As baby boomers age and the demographic of the nation changes, it is with increasing frequency that the terms dementia, Alzheimer’s, and chronic cognitive decline are included in common vocabulary. Television viewers are inundated with advertisements for Alzheimer’s medications. Popular sitcoms include episodes about dealing with the stresses that can occur in a family dealing with cognitive decline issues. Entire movies, such as Still Alice, speak to these issues from the perspective of the patient. Chronic cognitive decline has been brought to the forefront of the American culture not only in homes across the country but in the healthcare system where the challenges of recognizing, treating, and managing these conditions while providing quality of care can be challenging.

In a geriatric population, they are more likely to accept their symptoms and feel that they don’t want to bother their healthcare providers (Norton,

Dementia is an extremely common disease among the elderly, with 4 million Americans currently suffering from the Alzheimer’s type alone. Figures show that 3% of people between the ages of 65-74 suffer from the disease, rapidly increasing to 19% for the 75-84 age bracket, and as high as 47% for the over 85s. Therefore, it is easy to see why Dementia is such a large part of many people’s lives, whether they are suffering from the condition themselves, or have an elderly relative who requires full time care just to undertake simple day to day tasks. The disease can be extremely traumatic for the patient and their families, as the person, who may have been extremely lively and bright throughout their

Pain is a complex and multidimensional phenomenon that is subjective and unique to each individual. Pain is difficult to describe and often hard to measure; however, most healthcare professionals agree that pain is whatever the patient describes it to be. Pain is one of the most frequently used nursing diagnosis and is the most common problem for which patients in the clinical setting seek help (Cheng, Foster, & Huang, 2003). Unrelieved pain can have a profound impact on the lives of both the patient and his or her family members. The subjective nature of pain makes pain difficult to assess; therefore, many patients do not receive adequate relief. The Joint Commission on Accreditation of Healthcare Organizations

This assignment critically discusses about dementia, a widespread disability among older adults today. It provides an introduction to dementia and analyses its prevalence in society. The various forms of dementias are elaborated with description about dysfunctions and symptoms. Nursing Assessment and Interventions are provided in the further sections which discusses about actions nurses should take on while evaluating patients and treating them. Finally, communication, an important Activity of Daily Living (ADL) is explored and patient/carer advice is presented so as to maintain good health conditions in the patient.

‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ (International association for the study of pain 2014). Pain can be made up of complex and subjective experiences. The experience of pain is highly personal and private, and can not be directly observed or measured from one person to the next (Mac Lellan 2006). According to the agency for health care policy and research 1992, an individuals self-report of pain is the most reliable indicator of its presence. This is also supported by Mc Caffery’s definition in 1972, when he said ‘Pain is whatever the experiencing patient says it is, existing whenever he says it does’.

The most common reason that people seek medical care is pain, and pain is the leading cause of disability (Peterson & Bredow, 2013, p. 51; National Institute of Health, 2010). Pain is such an important topic in healthcare that the United States congress “identified 2000 to 2010 as the Decade of Pain Control and Research” (Brunner L. S., et al., 2010, p. 231). Unfortunatelly, patients are reporting a small increase in satisfaction with the pain management while in the hospital (Bernhofer, 2011). Pain assessment and treatment can be complex since nurses do not have a tool to quantify it. Pain is considered the fifth vital sign, however, we do not have numbers to guide our interventions. Pain is a subjective expirience that cannot be shared easily. Since nurses spend more time with patients in pain than any other healthcare provider, nurses must have a clear understanding of the concept of pain (Brunner, et al., 2010). Concept analysis’ main objective is to clarify ideas, to enhance critical thinking, and to promote communication (Rodgers & Knafl, 2000). This paper will examine the concept of pain using Wilson’s Steps of Concept Analysis (Rodgers & Knafl, 2000).