Over half of people with dementia in hospital experience pain

From Care and Cure magazine spring 2015, find out why pain in people with dementia is underreported in hospitals.

new study has shown that pain in people with dementia when admitted to hospital is underreported, which leads to symptoms worsening.

Pain is commonly under-detected and under-treated in people with dementia, as they may not easily be able to indicate that they are in pain. To investigate this in a hospital setting, the researchers followed 230 people with dementia during their stays in hospital

The study, which was jointly funded by Alzheimer's Society and the BUPA Foundation, found that only 39 per cent of the participants reported pain at least once during their hospital admission. Meanwhile 57 per cent were observed by the researchers to be in pain at some stage. 

The presence of pain was strongly associated with behavioural and psychiatric symptoms of dementia (BPSD), such as aggression and apathy. This matches with what has been previously observed in care homes, but this is the first study to demonstrate the same in a hospital setting.

The researchers, led by Dr Elizabeth Sampson, reported:

'Some BPSD in the acute hospital may be due to under-detected and under-managed pain. This then leads to a cycle whereby behavioural problems and rejection of care by the person with dementia can lead to dysfunctional coping in staff, increasing care burden and further alienating staff from the person with dementia.'

About half of the participants in the study could use the standard pain scale to describe their level of pain although this varied strongly, from 80 per cent of people with early-stage dementia to just 3 per cent of those with advanced dementia.

'This illustrates how self-report may lead to underestimation of pain in people with dementia, and the importance of careful observation for pain at rest and during movement.'

The study is due to be published in a journal titled 'Pain' later this month.


Further reading