People with moderate to severe dementia often cannot report pain reliably, and distress, agitation, resisting care or withdrawal may be the only signs. Use a validated observational scale such as PAINAD or the Abbey Pain Scale, ideally during movement or personal care, when pain is most likely to show. Involve carers who know the person's usual behaviour. Reassess after any treatment change so that analgesia is judged by its effect rather than continued by default.
- Use an observational pain scale such as PAINAD or the Abbey Pain Scale in people who cannot self-report.
- Assess during movement or personal care, not only at rest.
- Ask carers about changes from the person's usual behaviour.
- Consider pain as a cause of new agitation before prescribing an antipsychotic.
- Reassess pain after every analgesic change.
Why it matters
Unrecognised pain drives agitation and antipsychotic prescribing in care homes.
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