Pain assessment and management in persons with dementia

Pain is a significant problem for older adults, and it has the potential to negatively impact their independence, functioning, and quality of life. In order for pain to be managed effectively, it first must be assessed carefully and systematically. Pain assessment in patients with dementia should start with self-report of pain, but must incorporate assessment of nonverbal pain behaviors. Pain treatment in older adults should be tailored to the individual. Pain medications can be used safely in elders, and they may be more effective when combined with nonpharmacological treatment. Despite the preponderance of research on pain, relatively few investigations have focused on pain in older adults in general, and on persons with dementia specifically. Better strategies for assessing pain, using observational methods, are the cornerstone of effective pain management in persons with dementia. Practitioners must be knowledgeable about pain treatment, and use both pharmacological and nonpharmacological strategies to relieve pain. Moreover, clinicians must be aware of the barriers to effective pain management and work to overcome them. In so doing, they may make significant contributions to managing pain in patients with dementia, and in improving the quality of life of this vulnerable population of elders.