Several barriers interfere with pain assessment and treatment in the elderly, with one of them being impaired cognitive functioning. Elders with dementia are sometimes unable to make their needs heard; therefore, it is the responsibility of the nurse to be observant of subtle clues. The elderly male patient in the clinical scenario is in pain.
Signs of pain
The patient is exhibiting several behavioral and physical signs which indicate that he is in pain. He strikes out when the nurse aids attempt to get him out of bed, and he screams when being washed in the lower extremities and when being dressed. The physical signs include his reddened right heel, and that he has ulcers; one on the medial aspect of his left foot and the other on the malleolus.
Assessing of pain in a cognitively impaired elder
Several systematic and validated pain assessment tools can be used to assess pain in a cognitively impaired elder. However, the tool best recommended to assess the intensity of pain among cognitively impaired elderlies in long-term care facilities is the behavioral pain scale. According to the American Geriatric Society, behaviors such as particular agitated body movements, negative interpersonal interactions, and mental status are potential indicators of pain (Lichtner et al., 2014). Moreover, there are tools created to identify these behavioral patterns associated with pain. The tools used will include the checklist of non-verbal pain indicators (CNPI); the Pain Assessment in Advanced Dementia (PAINAD) Scale; and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale (Lichtner et al., 2014).
These will include pharmacological and non-pharmacological approaches. In the pharmacological approach, the nurse will begin by administering simple analgesics and may, later on, upgrade to using weak opioids or strong opioids depending on the response of the patient to medication (Booker & Herr, 2016). Non-pharmacological approaches constitute massage and heat.
- Booker, S., & Herr, K. (2016). Assessment and measurement of pain in adults in later life. Clinical Geriatric Medicine, 32(4), 677-692.
- Lichtner, V., Dowding, D., Esterhuizen, P., Closs, S. J., Long, A. F., Corbett, A., & Briggs, M. (2014). Pain assessment for people with dementia: A systematic review of systematic reviews of pain assessment tools. BMC geriatrics, 14(138), 1-19.