Pain Experience and Expression in Patients with Dementia

Abstract

Up to 2025 1.2 billion people are going to be aged 60 and more (Fine, 2009). In USA individuals aged 85 and older are the fastest growing segment of population which is expected to double until 2030 (Evers et al., 2002; Mantyselka et al., 2004). Pain is an inseparable companion of the old age. The aim of the chapter is to describe the issues of pain presence in the population of the elderly with dementia from the theoretical and clinical point of view. We can characterize it as an unpleasant sensory and emotional sensation related to actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain, 2008). According to another definition pain is a compound, subjective phenomenon comprising nociceptive, perceptive, cognitive and emotional factors (Melzack and Wall, 1965; Cipher & Clifford, 2004). There are two main kinds of pain distinguished – acute and chronic one (Leone et al., 2009). The acute pain accounts for an essential defense mechanism which emerges in a situation of an organic or traumatic injury and its goal is to prevent the further damage increase. The chronic pain is more difficult to define because there are no clear time limits which would enable to assert when acute pain turns into chronic one. Generally it is assumed that pain, that remains longer than an expected healing time, is found to be the chronic one. Rouhgly speaking the minimum time span required for a diagnosis of chronic pain is estimated for 6 – 8 weeks (Mersky, 1986; Leone 2009) or 1 – 3 months (Sawyer et al., 2007). Torvik et al. (2010) claims that pain is the main problem in nursery homes and an estimated frequency of its prevalence is between 27% and 84%. Similar data are quoted by Manfredi et al. (2003) who claims pain and dementia are common in nursery homes with prevalence rates of 45%-84% and 40%-78% respectively. Fries et al. (2001) reports that 68% of nursery homes residents suffers from any kind of pain. Teno et al. (2001) speaks about a range of 40% 46% of residents experiencing pain and according to Snow's et al. (2004) estimates – 67,4%. Horgas et al. (2009) pertaining to elderly population in general states that pain is an experience shared by 50% 86% of them. Individuals with dementia also often suffer from pain – according to Horgas et al. (2009) this problem touches every day 32% to 53% of this group. Older research estimate prevalence of pain in the patients with dementia living in nursery homes at 60%-90% of the population (Krulewitch et al., 2000; Parmelee et al. 1993; Ferrell et al., 1990; Ferrell et al., 1995; Shega et al., 2004). There are data quoted in the literature suggesting pain prevalence in 33% to 80% 3