Pain in people suffering moderate or severe dementia: Narrative review

Abstract

The prevalence of pain in people over 65 years of age oscillates between 30 and 50% within the community, and reaches 70% in institutionalized patients. Pain must be considered a geriatric syndrome. In order to appropriately evaluate pain, validated must be used. Dementia in itself is not painful; it is estimated that 30-50% of older people with dementia have chronic pain. This pain may contribute to an increase in the behavioral and psychological symptoms of dementia. The aims of this revision were to examine the observational scales in pain, validated in Spanish, and identify the non-pharmacological interventions to treat pain in people with moderate to severe dementia. Evaluating pain in people with moderate to severe has to be multidimensional. It is always advised to question pain directly regarding the experience of pain. The four recommended tools in this revision are: DOLOPLUS2, PACSLAC, PAINAD and Abbey Pain Scale; the last two being simpler and quicker. The implementation of non-pharmacological measures during treatment is positive, because of pain reduction and the avoidance of unnecessary medication. However, prejudices from health professionals and organizational problems in applying these, must be overcome. The proposal of concrete non-pharmacological interventions in the treatment of pain is the most important contribution of this review, as they may be prescribed and implemented by nursing staff.