Review articlePain assessment and management in persons with dementia☆
Section snippets
Pain in older adults
Physical pain is a common and significant problem for many older adults. Studies report prevalence rates ranging from 45% to 80%, depending on the residential status of the study sample. Among community-dwelling adults, estimates of the prevalence of pain generally converge around 50% [5], [6]. In nursing home residents, the prevalence of pain is considerably higher. Studies have reported that as many as 70% to 80% of these residents have pain, and that approximately 45% have persistent pain [7]
Pain in persons with dementia
Among older Americans today, the most common cause of disability is dementia [34]. AD accounts for 65% to 75% of dementia cases [17]. Approximately 4.5 million Americans have AD, and AD is expected to affect 14 million people by 2050 [34], [35], [36]. Prevalence rates of dementia double in every 5-year age interval, such that approximately 2% of those age 65 are affected, but almost 50% of those age 85 and older are affected [17]. The costs of caring for persons with dementia are estimated to
Pain management in persons with dementia
Pain assessment is the most critical part of pain management [14]. This is particularly crucial when working with persons with dementia because of their impaired cognitive and verbal abilities. Thus, there are three fundamental issues that must be understood to maximize pain management in this vulnerable population.
Summary
Pain is a significant problem for older adults, and it has the potential to negatively impact their independence, functioning, and quality of life. In order for pain to be managed effectively, it first must be assessed carefully and systematically. Pain assessment in patients with dementia should start with self-report of pain, but must incorporate assessment of nonverbal pain behaviors. Pain treatment in older adults should be tailored to the individual. Pain medications can be used safely in
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This work was supported by Grant No. NR05069-02 from the National Institute for Nursing Research awarded to the first author and John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Predoctoral Scholarship awarded to second author.