Pain Assessment in People With Dementia: Remaining Controversies

Abstract

BACKGROUND: Pain in people with dementia is under recognized, underestimated, and under-treated due to the complexity of pain assessment in this population.SUMMARY: Self-report tools are the gold standard of pain assessment. However, people with dementia are not always able to clearly and meaningfully self-report their pain. Self-report tools capture the affective experience of pain, which is impaired in people with dementia. Observational pain tools are more useful to assess pain especially in people with advanced dementia who are unable to self-report. Observational pain tools capture the physical component of pain experience, which is unchanged in people with dementia. However, nurses often misunderstand the behavioral changes associated with pain in people with dementia. Also, there is a huge inconsistency in presentation of these behavioral changes associated with pain among people with dementia as behaviors can be due to multiple different unmet needs, pain being one.