9 JULY 2025ELDERCARE REVIEW5. Changes in appetite or sleep: Pain can lead to notable changes in eating and sleeping patterns.These expressions are often more acute and related to specific stimuli or range of motion through ADL care (showers, brief changes, etc.), differentiating them from the chronic behaviors seen in cognitive decline. For example, I had a dementia patient who was yelling; this was out of the norm for him. He was going to be sent to a behavioral health hospital, but right before we called 911, the nurses did a head-to-toe assessment, literally, and found that he had an ingrown toenail that was causing discomfort. Another example was a female patient who hit others and was agitated, and the nurse thought her cognitive decline was to blame; again, a head-to-toe assessment and range of motion exercise revealed pain in her back when the nurse put pressure on her. The resident was physically jolted from the pressure, but when she was verbally asked if she was in pain, she said NO! However, we know her answer expressed at that time was due to her cognitive decline and not the reality of the situation, she was diagnosed that night with a kidney infection. By recognizing the subtle distinctions and employing precise assessment methods, the quality of life for individuals with cognitive decline and those experiencing pain can be significantly enhancedThe Critical Overlap and MisinterpretationBoth sets of symptoms can present with behaviors like restlessness and verbal outbursts, leading to misinterpretation. For example:· Agitation in a person with cognitive decline might be mistaken for discomfort from an untreated physical condition.· Vocal Outbursts could be seen as cognitive-related confusion rather than a response to underlying pain.· Wandering might be due to searching for relief from discomfort rather than disorientation alone.· Misinterpretations can lead to improper handling and inadequate treatment. A patient showing signs of restlessness might be administered sedation, assuming cognitive-related agitation, while the real issue could be an untreated physical illness causing discomfort.Differentiating the CausesTo avoid these misinterpretations, caregivers and medical professionals need to employ:1. Comprehensive assessments: Regular and thorough physical examinations to identify underlying pain sources.2. Behavioral tracking: Maintaining logs of behaviors, their frequency, and context to discern patterns.3. Improved communication: Utilizing tools and strategies to better understand and interpret the expressions of those unable to communicate effectively.4. Multidisciplinary approaches: Collaborating with neurologists, pain specialists, and geriatricians to develop a holistic understanding of the patient's condition.By recognizing the subtle distinctions and employing precise assessment methods, the quality of life for individuals with cognitive decline and those experiencing pain can be significantly enhanced. This nuanced approach ensures that pain is not overlooked as mere symptomatic behavior of cognitive issues, thereby providing targeted and effective care, a quality of life we all deserve.
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