As stated previously, those who have dementia often cannot tell us they hurt verbally. That does not mean there are not other signs and symptoms. The Pain Assessment in Advanced Dementia (PAINAD) Scale was developed with these people in mind. Though it was designed for professionals, I think you will find it useful too.
The areas assessed are breathing, negative vocalization, facial expression, body language and consolablitiy. The scale is a simple 0-2 scale making it easy to use for anyone.
Breathing is rated as 0=normal. 1=Occasional labored breathing. Short period of hyperventilation. 2=Noisy labored breathing. Long period of hyperventilation. *Cheyne-Stokes respirations.
Negative Vocalization is rated as 0=none. 1=Occasional moan or groan. Low-level speech with a negative or disapproving quality. 2=Repeated troubled calling out. Loud moaning or groaning. Crying.
Facial Expression is rated as 0=Smiling or inexpressive. 1=Sad. Frightened. Frown. 2=Facial Grimacing
Body Language is rated as 0=Relaxed. 2=Tense. Distressed pacing. Fidgeting. 3=Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.
Consolability is rated as 0=No need to console 1=Distracted or reassured by voice or touch. 2=Unable to console, distract or reassure.
Add the scores up for interpretation. Total scores range from 0 to 10 (based on a scale of 0 to 2 for five items), with a higher score indicating more severe pain (0=”no pain” to 10=”severe pain”).
More information is available at the AMDA website.
If you would like to see this assessment in action there is a case study posted at the Nursing Center
There are videos of nursing students learning to use this assessment scale.
Make note of these assessment areas so that you can discuss this with your healthcare provider. Everyone deserves good pain control and you may find that negative behaviors decrease when pain is managed appropriately.
Other signs of severe pain include profuse sweating, hands and/or feet may be cold to touch. They may guard an area that is hurting by placing a hand over it in a protective manner. You may notice them reluctant to use a hand or move their arm beyond a certain point. They may limp or have an altered gain, especially if they have low back pain.
You may notice your parent has given up an activity they previously enjoyed, their grooming habits and/or housekeeping habits have declined. They may move slower or with more caution. They may spend more time lying around.
Poor pain management lowers the quality of life for the sufferer, shortens their lifespan and often leads to depression and even suicide. If your elderly parent is suffering with pain, please be an advocate for them if they can not do so themselves. This is one area of their lives you can really help them.
*Cheyne-Stokes respirations refers to an abnormal breathing pattern characterized by respirations becoming progressively deeper and faster, followed by a progressively shallower and slower breathing that stops temporarily. The pattern repeats in cycles lasting from 30 seconds to two minutes and is often seen near death.