Common Pain Behaviours in Cognitively-Impaired Elderly Persons
As care providers, we must ensure that our assessment skills are top notch, especially for those adults unable to speak their pain. For persons suffering with dementia, aphasia, or other conditions preventing an oral report, pain expression sometimes takes on less obvious forms, such as confusion, social withdrawal, aggression or subtle changes in behaviors ….which are not always typical manifestations of pain.
| Facial Expressions | Verbalizations Vocalization | Body Movements | Changes in Interpersonal Interactions | Changes in Interpersonal Activity Patterns or Routines | Mental Status Changes |
| Slight frown
Sad face Frightened face Grimacing Wrinkled forehead Closed or tightened eyes Any distorted expression Rapid blinking |
Sighing
Moaning Groaning Grunting Chanting Calling out Noisy breathing Asking for help Verbally abusive |
Rigid posture
Tense body posture Guarding Fidgeting Increased pacing Increased rocking Restricted movement Gait or mobility changes |
Aggressiveness
Combativeness Resisting care Decreased social interactions Socially inappropriate behaviours Disruptive behaviours Acting withdrawn |
Refusing food
Appetite changes Increase in rest periods Changes in sleep & rest patterns Sudden cessation of common routines Increased wandering |
Crying or tears
Increased confusion Irritability or distress |
Consider utilizing a tool to assist with assessment!
The PAINAD Scale or The Abbey Pain Scale
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PDF – Common Pain Behaviours in Cognitively-Impaired Elderly Persons
Sources:
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4:9-15.
Herr, K., Coyne, P., McCaffrey, M., Manwarren, R. & Merkel, S. (2011). Pain Assessment in the Patient Unable to Self-Report. American Society for Pain Management Nursing
