Introduction

Being free from pain is a basic human need. This refers to both physical and psychological pain. When we feel well, we function better and are more likely to have an overall sense of well-being. Sometimes, in the face of cognitive decline, as in dementia, a person may neglect their physical health or not recognize the source of their pain. Health professionals who focus just on behaviors and cognitive decline may also forget to pay attention to the person's physical and psychological health. In this lesson, you'll review why it is critical to pay attention to general physical health.

Physical Health

Providing for good general health includes making sure the person has the following conditions:

• Is free from pain or managing pain well
• Is free from infection
• Has opportunities for physical activity
• Has sufficient access to nutritional food and beverages that taste good and are easy to enjoy
• Has access to regular oral care
• Is living in a room that is comfortable (warm/cool enough)

Why Is Paying Attention to General Health Important?

• It enhances a person’s sense of well-being.
• It strengthens resilience. Resilience is the capacity to bounce back from difficulties.
• It helps reduce the risk of delirium, a serious brain disturbance. Delirium is a medical emergency which can result in death if the underlying cause is not treated. It worsens dementia and prolongs hospitalizations.

The key features of delirium are the following:

• Acute onset and fluctuating course: symptoms tend to come on abruptly and wax/wane over the course of a day
• Inattention (inability to maintain attention on something)
• Disorganized thinking
• Change in consciousness

Dementia and Pain

Unrecognized or poorly managed pain is a common source of distress in persons with dementia. Behavioral expressions of pain include calling out, screaming, not wanting to be touched or assisted with grooming and pushing care partners away or striking out. These behavioral expressions are often misunderstood, leading to the inappropriate prescribing of an antipsychotic medication.

Always ask the person in your care about pain, but do not expect the person to always be able to tell you. Be alert to behavioral clues such as body language (grimacing and flinching), changes in demeanor, and withdrawal. Ask family members or care partners how the person acts when in pain, and what has helped in the past.

Treatment for pain will vary but may include medications and non-pharmacologic interventions such as massage or physical therapy.