Understanding Pain and Dementia in Aging
Pain
The ideas of old age and pain are often considered an inseparable concept. There are no conclusive studies; some authors admit that there is diminished pain perception, although the multiple disorders, chronicity, and atypicality of syndromes make the study of pain in aging difficult. Conversely, some authors maintain that chronic pain is more severe in the elderly due to the psychological, social, and cultural rights of older people, where decreased adaptability to changes increases vulnerability.
Pain is defined as an unpleasant emotional and sensory experience caused by actual or potential tissue injury, described in terms of such injury.
Pain Manifestations
- Verbal or nonverbal manifestations
- Sleep disorder
- Narrowing the focus of attention
- Conduct oversight
- Changes in muscle tone
- Autonomic response
- Changes in appetite
Pain Outcome Criteria
Decrease pain to a tolerable level and encourage patient and family participation in care.
Nursing Care for Pain
- Assess the patient’s willingness and ability to participate in the development of care.
- Allow the patient to express their feelings.
- Assess verbal and nonverbal signs to determine the degree and intensity of pain.
- Encourage the patient to use relaxation or recreational activities.
- Provide opportunities for rest.
- Determine the need to refer the patient for physical therapy or support devices.
- Use non-invasive techniques such as massage or friction. Cutaneous stimulation can accelerate endorphin production and strengthen patient confidence in nursing professionals.
- Teach the patient and the caregiver how to administer analgesics.
Integrating Pain Care into Family Support
Caregivers should be informed about the etiology of pain, the prescribed analgesia, and its expected effects.
Dementia
Dementia is an organic syndrome characterized by acquired, persistent deterioration in various higher mental functions without alteration in the level of consciousness, leading to functional impairment in social and occupational areas. It must be differentiated from other psychiatric problems; dementias are not synonymous with mental illness and are therefore not an obligatory part of aging. Dementia is a multi-factorial syndrome and is not always synonymous with irreversibility.
Dementia Classification
- Cortical:
- Alzheimer’s disease
- Pick’s disease
- Frontal lobe dementia
- Subcortical:
- Extrapyramidal syndromes: Huntington’s disease, Progressive Supranuclear Palsy
- Vascular dementia: Binswanger’s disease, Lacunar state
- Normal Pressure Hydrocephalus
- Cortico-Subcortical:
- Vascular dementia
- Post-traumatic dementia
- Toxic dementia
- Dementias associated with other diseases
- Metabolic dementias
Dementia Frequency
- Alzheimer’s: 50%-60%
- Vascular dementia: 15%-20%
- Mixed: 5%
- Other: 5%
Dementia Symptoms
- Memory loss
- Disorientation
- Language impairment (Aphasia)
- Apraxia
- Agnosia
- Behavioral and personality changes
Dementia Diagnosis
- Neurological tests:
- Mini-Mental State Examination (MMSE)
- Blessed Dementia Scale
- Hachinski Ischemic Scale
- Functional assessment scales:
- Katz Index of Independence in Activities of Daily Living
- Lawton and Brody Instrumental Activities of Daily Living Scale
Dementia Treatment
Treatment of known causes (pharmacological or surgical). Vascular dementia: Cardiovascular treatments and rehabilitation. Alzheimer’s disease: Therapies based on restoring cholinergic function. Acetylcholinesterase inhibitors have proven effective in improving symptoms in short-term studies. Marketed drugs include tacrine, donepezil, rivastigmine, and galantamine.