‘Dementia link to sudden low blood pressure and dizziness’
October 13, 2024
In an excellent article recently in the Guardian, Jo James, dementia lead at the Imperial College Healthcare Trust and stalwart champion of Johns Campaign from the start, told the story about her own mothers unidentified pain in hospital.
Her mother had advanced dementia when she sustained facial injuries after a fall.
She had 60 stitches to her face, a broken cheekbone and nose and the loss of most of her front teeth.
She had been given nothing for pain. The nurse said: Dont worry. She wont be in any pain.
The clinicians looking after Jo’s mother simply had not thought about pain and she could not tell them.
Research shows that people with dementia receive significantly less pain relief than others when they are in hospital.
The thought of someone being in terrible pain with no hope of respite from it is hard to imagine, and combined with all the other challenges facing a person with dementia, it also seems tremendously unfair.
However, the solution is simple and requires no specialist knowledge or training.
Simply being aware of the possibility of pain and flagging it up so that the person can be given some relief is all that is required and is something that we can all do.
Nurses and doctors need to become much more sensitive to the fact that the person with dementia may be in pain.
If they had any kind of past physical issue or condition such as arthritis, back pain, shoulder pain, or any aches and pains, they will most likely continue to experience that issue as they develop dementia.
Their physical issues don’t disappear.
They may not be able to communicate the fact they are in pain.
Our approach is to carry out an assessment which incorporates all potential physical signs and the past history of any painful condition.
This has been really successful.
Recently a lovely gentleman was admitted to our Care Home. He was admitted from a psychiatric assessment ward.
On admission he was prescribed numerous, medications including antipsychotic drugs, sedatives and tranquilisers.
His behaviour was extremely agitated and anxious most of the time.
He appeared to be very frustrated, and could not communicate verbally, and it was not clear at all that he was in pain.
He was prescribed an analgesic as required in the hospital but he did not receive it regularly.
We asked the doctor if we could try giving the pain relief regularly for a two week period to see if this helped him, as the gentleman was unable to communicate he was in pain. He agreed.
The difference was amazing. His wife could not believe the transformation in her husband. He is now calm, content, and at peace with himself and others.
He enjoys his food more, he participates in most activities, and he smiles and engages with the staff and his family more than he has done since his disease was diagnosed.
He also is speaking and communicating much more than he did, previously.
His quality of life has improved tremendously.
It makes complete sense especially if the person with dementia is elderly.
Their joints, bones tendons and muscles suffer wear and tear, and arthritis can set in.
To try analgesics in the assessment period is a sensible approach.
Too often when residents appear agitated, anxious or aggressive the only remedy appears to be sedation or antipsychotics.
This should not always be the case.