Question

A 90-year-old resident of a long-term care facility has a history of dementia, diabetes, mellitus, peripheral vascular disease, and osteoarthritis. He is totally dependent in activities of daily living (ADLs). Over the course of the past 2 weeks, he is noted to have a decreased appetite and a sudden change in behavior. He is being discussed at the team meeting due to this change in behavior.

The RN reports that when the nurse aids attempts to get him out of bed, he actively resists and strikes out. He also screams when being showered, especially when his lower extremities are washed, and when being dressed. He has been moved to a private room in the facility due to his behavioral changes disturbing his roommate. The RN reports that he has a large ulcer on the medial aspect of his left foot as well as a small ulcer on the malleolus. His right heel is reddened and soft to touch. The patient's daughter is present at the meeting and asks the RN whether she thinks her father is in pain. The RN responds that she attempted to administer the pain scale but that he was not able to respond.

1. Do you think this resident is in pain? What signs is he exhibiting that make you draw that conclusion?
2. What is the best way of assessing pain in a cognitively impaired elder?
3. What interventions can be instituted to improve his comfort?

Answer 1

The patient is in bed for a long period and 90yrs of age, he should definitely have pain,that is why patient exhibit his difficulty while staff nurse dress his wound. The methods used to assess pain in normal patients are not used in impaired elder patients.In those patients, behavioral observation is needed.The following are common pain behaviours.frowning, grimacing,distorted expression,rapid blinking etc.The measures which can improve comfort includes, provide water bed,keep the skin dry and clean,observe for signs of developing pressure ulcer,createvan incentive based programme for caregivers,change position periodically.