Managing pain for residents with dementia requires a unique approach to pain assessments and interventions, especially if the resident can’t communicate verbally. “Every older adult deserves adequate pain management, and the treatment plan needs to involve what we know about the older adult’s goals,” said Kristen Swafford, RN, PhD, CNS, in a webinar hosted Tuesday by the Pioneer Network.
Being proactive about pain management is especially important for residents who have dementia, since pain can exacerbate or even initiate behavioral outbursts. Pain assessments should be done often and in a consistent way, Swafford told attendees. “Evaluate, evaluate, evaluate. Strive to use the least invasive means with the fewest side effects to achieve the goal.”
Caring for those with dementia also includes serving as an educator to families, she said. “Some families are very hesitant about pharmacologicals, especially opiods,” she said. “Educate along the way. Sometimes we only get one chance.” As the front-line interface between the resident and his or her doctors, the nursing staff also must keep communication lines open with physicians. “Be assertive in asking for what is needed,” she said. “Document everything.”
Thinking outside the (pill) box
Observation skills are extremely important when trying to determine the presence of pain in a resident who is non-communicative. Swafford suggested examining other environmental or external factors to assess their involvement in the residents’ pain levels. Can a hard, cold toilet seat be causing pain? Is there a reason why the resident doesn’t like his left shin touched? Would a resident benefit from more frequent gentle motion to alleviate cramping?
Pain management for those with dementia involves the traditional pain management attributes, including the “Start Low, Go Slow,” medication dosing strategy and a keen attention to pain assessment documentation. But pain management also means managing the side effects, Swafford added, stressing the importance of observing a resident closely for unintended effects of medications.
Different treatments work for different kinds of pain. Cold, heat, extra support, repositioning, warm lotion, or even pleasant distractions like music or videos can provide comfort. Try out different activities and document which ones seem to relax the resident and lessen pain responses, she added. While interacting with residents, ask them about your caregiving, she said. “Say, ‘How was that?’ even if they’re labeled non-verbal. It shows them that they matter to you.”
Pain management can be difficult for caregivers, too, especially if the caregiver has different values than the resident, Swafford said. “Sometimes we do for them what we would want done for ourselves. But we have to try hard to care for them under their wishes, rather than overlaying our values on them.”
For more tips on assessing and managing pain in older adults, see Geriatricpain.org