Assessment and treatment of discomfort for people with late-stage dementia

People with dementia have often been excluded from pain studies. However there is evidence supporting that people with dementia experience frequent pain, often poorly assessed and undertreated, and that the etiology for pain descriptions is poorly documented. The Assessment of Discomfort in Dementia (ADD) Protocol is designed to: a) more accurately assess discomfort in people with dementia who can no longer verbally desribe physical pain or affective discomfort; b) more accurately and thoroughly treat physical pain and affective discomfort; and c) elect-ease inappropriate use of psychotropic medication. The use of the ADD Protocol was studies with a convenience sample of 104 residents of long-term care with end-stage dementia. Use of the ADD Protocol was associated with a significant decrease in discomfort (t = 6.56, p = 0.000). The most frequently seen behavior symptoms associated with discomfort were tense body language, sad facial expression, fidgeting perseverant verbalizations, and verbal outburts. The ADD Protocol was also associated with a significant increase in the use of scheduled analgesics and non-pharmacological comfort interventions. The protocol was not associated with an increase in the use of prn analgesics or with km or scheduled psychotropics. This study has provided some support for the notion that the needs of people with significant dementia can be discerned and treated. (C) U.S. Cancer Pain Relief Committee, 1999.