Pitfalls and recommendations regarding the management of acute pain among hospitalized patients with dementia

Objective. Older adults with dementia are frequently hospitalized, and a substantial minority present with (or develop) pain during hospitalization. Although general pain management guidelines are available, care can prove challenging in the setting of dementia. The purposes of this study were to review cases of older demented adults with pain admitted to an inpatient geriatric medicine service, and to identify difficulties in their management, which arise as a consequence of patients' dementia. Design. Case series. Setting. An urban tertiary care hospital located inNew York City. Patients. Adults aged 70 years and older with dementia and pain. Results. Patients with dementia and pain may be 1) unable to describe the qualitative characteristics and associated features of their pain; 2) less able than cognitively intact older adults to alert their care providers to the presence of side effects from pain medicines; and 3) unable to discern variations in the level of pain or compare their current pain to their experience of the day or hours before. These deficits can lead to a delayed or incorrect diagnosis, suffering due to side effects, and overtreatment, which can lead to complications like delirium, bowel problems, and prolong length of stay. Conclusions. The cases presented herein highlight the need to conduct a thorough cognitive assessment of all older hospitalized patients with pain prior to implementing pain medicines. Research is needed to develop effective strategies for managing pain among demented elders in the acute-care setting.