1. Pain Assessment and Dementia Amanda Floetke Elliott, PhD(c), ARNP Ann L. Horgas, RN, PhD, FAAN University of Florida College of Nursing

2. Objectives  To convey the importance of pain assessment in older adults with dementia  To describe the barriers to assessing pain in persons with dementia  To provide new strategies to assess pain in persons with dementia  To describe options for pain treatment in persons with dementia

3. Definition of Pain  “Whatever the experiencing person says it is, existing whenever the experiencing person says it does” (McCaffery & Beebe, 1968)  Self-report is considered the gold standard of pain assessment

4. Pain in Persons with Dementia  Do persons with dementia experience pain?

5. Persons with Dementia Experience Pain  Pain is a common problem for many older adults, including persons with dementia  There is no empirical evidence that persons with dementia experience less pain (American Geriatrics Society)  Evidence suggests that persons with dementia verbally report less pain and that pain is under-treated in this population

6. Pain in Persons with Dementia  What are appropriate strategies to assess pain in persons with dementia?

7. Barriers to Pain Assessment in Persons with Dementia Memory and learning problems + Deficits in communication ______________________________________________ Decreased ability to recognize, recall, and report the presence of pain

8. Pain Assessment Strategies  Self-report Scales like the numeric rating scale (NRS) or the verbal descriptor scale (VDS)  NRS I--I--I--I--I--I--I--I--I--I--I 0 1 2 3 4 5 6 7 8 9 10 No Worst pain possible  VDS Pain as bad as it could be (6) Extreme pain (5) Severe pain (4) Moderate pain (3) Mild pain (2) Slight pain (1) No pain (0)

9. Pain Assessment Strategies  Observed pain indicators Facial expressions Physical movements Change in activity patterns

10. Pain in Persons with Dementia  What are appropriate strategies for treating pain in persons with dementia?

11. Pain Treatment Strategies  Goal is to maximize function and quality of life  Individualized treatment plans  Non-pharmacologic treatment Examples: application of heat or cold, massage, mild exercise  Pharmacologic Should be discussed with your health care provider first. Mild pain can be effectively treated with over the counter pain relievers, such as Tylenol.

12. Resources Horgas, A. L. & Elliott, A. F. (2004) Pain assessment and mangagement in persons with dementia. Nursing Clinics of North America, 39(3), 593-606. Horgas, A. L., McLennon, S. M., Floetke, A. L. (2003). Pain management in persons with dementia. Alzheimer’s Care Quarterly, 4(4), 297- 311. Try This: Best Practices in Care for Older Adults series from the Hartford Institute for Geriatric Nursing http://www.hartfordign.org/resources/education/tryThis.html