Untreated Pain and Dementia

At least half of all seniors suffer from chronic pain, according to the National Institutes of Health, and many of them are undertreated for it. That’s a problem for all pain sufferers, but it’s even worse for seniors with advanced Alzheimer’s or other cognitive and speech problems. The NIH says chronic pain rates among seniors living in long term care facilities can be as high as 85%. Dementia patients often can’t say when they’re in pain. Instead, they may react to pain by lashing out. If you suspect your loved one is suffering from untreated or undertreated pain, here are steps to take.

Is pain the cause of the aggressive behavior?

First, focus on safety. The physical safety of your loved one, yourself, and his or her other caregivers is paramount. Talk to your loved one’s doctor about nonmedical options, such as removing dangerous objects or weapons from the home, and medical options, such as time-limited use of sedatives when the patient is at risk of self-harm or hurting someone else.

Next, work with your loved one’s caregivers and doctors to see if undiagnosed or undertreated pain might be the cause of the acting out. Writing in the New York Times, author Paula Span related the story of a dementia patient who tore a door from its hinges before doctors realized he was in pain because of a urinary tract infection and treated him for it. Urinary tract infections are common in seniors, and they can cause confusion—another potential cause of aggression—as well as severe pain.

Joint pain is another common condition, especially among older adults with arthritis and those who have broken a hip or had joint surgery. Geriatrician Elizabeth Eckstrom, writing in The Gift of Caring, recommends making a list of your loved one’s pain history for to review with his or her doctor and caregivers.

She also advises looking out for new causes of pain—a sinus or ear infection, a cut or scrape, gum irritation, or another potential source of discomfort that needs treatment. If pain is the cause of your loved one’s agitation, discuss treatment options with your doctor. Eckstrom notes that in addition to over-the-counter and prescription pain medications, many patients experience less pain with regular massage therapy, hot water bottles for sore joints, help with proper posture, and regular exercise of some kind.

If your loved one can’t tell you what’s going on, watch for physical cues that he or she may be hurting.  Note his or her reaction to transitions like moving from chair to bed, eating, and walking around. You may notice expressions, movements or early signs of agitation that can help you home in on the source of pain.

When you’ve tried pain treatments and the behavior remains

Look for other causes of agitation. According to the Alzheimer’s Association, these may include clutter in the person’s living area, medication interactions or side effects, loud or irritating noises, and an irregular or confusing daily routine. Above all, keep communication open with your loved one’s doctor and caregivers so that you all have the information you need to keep pain and acting out to a minimum.

Casey Kelly-Barton

Casey Kelly-Barton is an Austin-based freelance writer whose childhood was made awesome by her grandmothers, great-grandmother, great-aunts and -uncles, and their friends.