In 2002, a tool called The Assessment of Discomfort in Dementia (ADD) Protocol was created to improve comfort and decrease episodes of discomfort in people with advanced dementia. The authors observe that a person's discomfort can sometimes be resolved by simply meeting his or her basic needs. Therefore, a basic needs assessment should be done when you suspect discomfort in someone with dementia. An assessment of the following may reveal the source of discomfort:
- Does the person need his or her glasses or hearing aid?
- Is the hearing aid working properly?
- Is the person's discomfort due to toileting or incontinence problems? Hunger? Thirst?
- Is the person too hot or too cold?
- Has the person been sitting in one position too long?
- Does the person need more stimulation? Less stimulation?
If basic needs have been met and the person still seems distressed, look for nonverbal signs of discomfort or pain, including the following:
Facial Expressions: Grimacing, frowning, blinking, tightly closed or widely opened eyes, frightened, weepy, worried or sad.
Mood: Irritability, confusion, withdrawal, agitation, aggressiveness
Body Language: Tense, wringing hands, clenched fists, restless, rubbing/holding body part, guarding body part, noisy breathing
Voice: Moaning, mumbling, chanting, grunting, whining, calling out, screaming, crying, verbally aggressive
Behavior: Change in appetite, sleep, gait, function, participation, exiting, wandering, physical aggression, socially disruptive or inappropriate actions, resisting care
If potential pain behaviors are identified, the following protocol can be used to help your loved one:
Step One: Look for physical causes of discomfort such as an infection, inflammation or acute illness. Contact your health provider immediately if you suspect any of these conditions.
Step Two: Explore the person's history for possible sources of potentially painful conditions. For example, a history of headaches or arthritis may be the cause of the current pain. Treat accordingly.
Step Three: If you cannot find any acute or historical reason for the pain, implement non-pharmacological comfort interventions, including distraction, relaxation, massage, application of heat or cold, change of position or exercise.
Step Four: When non-pharmacological methods are ineffective, call your health provider and ask about possibly giving the person a non-narcotic analgesic (examples: Tylenol or Advil).
Step Five: If non of the above work, request an appointment with your health care provider for other possible drug interventions or physical therapy.
As a caregiver, you are a vital link to the pain management of the person with dementia. Keeping a journal of non-verbal indications of pain including what behaviors you observe, what time of day they take place and how you respond to those signs, is invaluable information for your health care provider.
For more information about Triple-R Adult Day Program go to: www.tripler.org