Many hospital patients who are living dementia experience pain, but they are unable to let others know about it, according to new research.

A study investigating the link between pain and delirium, found that pain could be a contributing factor to delirium, and that those with delirium often weren’t able to communicate whether or not they were experiencing pain.

When those with dementia can’t express to others that they are in pain, it can be understandably distressing, and there can be serious consequences for their health, said Dr Liz Sampson, Reader, Marie Curie Palliative Care Research Department, University College London.

“We know that people living with dementia can find it difficult to communicate, and when this concerns inability to communicate pain to hospital staff, it’s clearly extremely concerning, as it’s not only upsetting and frustrating but can have serious consequences on a person’s health,” said Dr Sampson.

People living with dementia are experiencing pain but they are unable to let others know about it, she said.

“It’s deeply troubling to think that this vulnerable group of patients are suffering in silence, unable to tell healthcare professionals that they are in pain,” said Dr Sampson.

The study highlights the importance of regular pain and delirium assessments for those who are living with dementia.

The Study

The study was conducted by the Marie Curie Palliative Care Research Department of the University College London. It followed 230 patients who were all over 70 years old and admitted to hospital.

The study found that of those with dementia, 15 per cent developed delirium during their admission, and the chance of being delirious was more than three times higher for those experiencing pain at rest.

One third of patients with delirium were unable to self-report their pain.

What is delirium?

Delirium is a state of acute confusion that impacts a person’s mental ability. It is more common among those with a cognitive impairment, such as dementia. It can develop quickly, sometimes in a matter of hours, and its symptoms can vary over time.

When someone experiences delirium, it can be extremely distressing for the person themselves, as well as friends and family, and health professionals.

What are the symptoms of delirium?

People experiencing delirium may:

  • Have trouble remembering recent events
  • Appear disoriented
  • Their speech may be unclear and difficult understand
  • Become restless or agitated, or even combative
  • Hallucinate

Why do people with dementia have difficulties communicating?

Over time, as those living with dementia experience a decline in their cognitive ability, they often experience a decline in their ability to communicate.

The loss of the ability to communicate can be one of the most distressing effects of dementia, both for the person with dementia, but also for their loved ones, and can lead to feelings of apathy, anger, and frustration.

The research now shows that the loss of the ability to communicate can also have significant health implications.

Diagnosing pain for those who are living with dementia?

“Studies like this may help hospital staff provide better care now and in the future as dementia diagnosis rates continue to rise,” said Dr Sampson.

“Regular pain and delirium assessments are required to manage pain and delirium,” an article on the research in Age and Ageing notes.

In the study, researchers assessed pain using the ‘Gold Standard’ assessment – they asked patients if they were in pain. If the patient wasn’t able to communicate, they used the ‘Pain Assessment in Advanced Dementia Scale’ (PAINAD), which involves observing and rating patients’:

  • breathing,
  • negative vocalisation,
  • facial expression,
  • body language and
  • consolability.
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