Friday, March 29, 2024 | Ramadan 18, 1445 H
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EDITOR IN CHIEF- ABDULLAH BIN SALIM AL SHUEILI

When dementia patients suffer pain in silence

Yousuf
Yousuf
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A young man was talking to me about his grandmother who had been admitted to hospital with bouts of pain. Suddenly the grandmother stopped complaining, asking her grandson over and over, “what did I do and what happened?” The grandson told me with sadness the story of his grandmother, who was 80 years old and in the late stages of Alzheimer’s disease. Sadly, this meant that she was no longer able to form new memories. It all happened in the middle of last year when she fell down and broke her vertebra, and soon after she forgot what had happened. However, the grandson at this point said, here it became clear to us that pain became the only remaining evidence of her fall. It took weeks and two visits to the hospital to understand why she stopped eating or getting out of bed and unfortunately she could not remember!


We all know that dealing with pain is sometimes a thorny issue. When one feels pain he or she complains about it. But, as we learned from the story, when a patient’s cognitive state prevents reliable self-evaluation, as it does for grandmother, our ability to see a person’s pain and process what we see is even more limited. For healthcare providers and their treatment of people with dementia, resolving their suffering sometimes becomes almost impossible. For instance, the patient’s complaint of frequent headaches may only be an analogy from a dementia patient that he is already unable to remember!


Most importantly, Alzheimer’s disease, the most common cause of dementia, can undermine the entire process of pain transmission, from perception to communication. Therefore, you may notice how a person with Alzheimer’s disease expresses in several ways, such as uncomfortable wandering or a situation that brings him up, grumbling and he may refuse to eat or sleep. On the other hand, dementia does not prevent any of the other common sources of pain for the elderly such as cancer, arthritis, osteoporosis and injuries from falls for instance. However, it makes this pain more difficult to identify and less likely to be taken care of!


When a person with dementia feels pain and does not understand it, he can end up suffering in silence! Therefore, researchers have developed a technique whereby the patient describes their pain using words that fall into three categories: sensory, emotional, and evaluative. As the disease progresses the person loses the ability to form new memories, use language, control emotions and critically perceive or analyse the world around him. The young man, mentioned above, explained from his own experience about his grandmother. He said his grandmother used to groan all night even when she was given prescribed pain relievers. She stopped groaning when someone was in the room with her. It took a while for us to understand that she was not groaning in pain, but she seemed to be crying out of fear! It is clear here that the lack of awareness among caregivers of these signs led to the administering of anti-psychiatric drugs to dementia patients, forgetting that such cases do not result in their behavioural changes from mental illness but from emotional distress caused by untreated pain. Remarkably, what I would like to stress here is that the therapist should look for other signs of the patient indicating that they are uncomfortable, as it requires a lot of questions and a close examination.


We notice how a number of families deal with such cases of Alzheimer’s disease and dementia on their own, which is wrong. Rather, it is ideal that the family cooperates with an elderly care professional, for example. In some ways, basic care such as touch, interaction, and having another person nearby can help relieve pain in dementia patients. And perhaps when you care more about your grandmother, grandfather, or mother, those moments of connection between you may keep her physical suffering less. The least you can do for her is to lie in the bed beside her while she groans, holding her hand. Perhaps she might quietly be saying to you: I love you... I’m not afraid now!


Dr Yousuf Ali al Mulla, MD, Ministry of Health, is a medical innovator and educator. For any queries regarding the content of the column, he can be contacted at dryusufalmulla@gmail.com


 


Dr Yousuf Ali al Mulla


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