In moderate to severe dementia, pain shows as behaviour: grimacing, guarding, groaning, restlessness, resisting care or new aggression. Use a validated observational scale, such as PAINAD or MOBID-2, during movement and care rather than at rest, because pain often appears only when a joint is moved. Ask family and care staff what is usual for the person. Look for a cause, such as constipation, urinary retention, pressure areas, dental pain or an unrecognised fracture, before adding an analgesic. Reassess after any change to see whether it helped.
- Use an observational pain scale such as PAINAD or MOBID-2 during care and movement
- Ask family and carers what is normal behaviour for the person
- Look for treatable causes such as constipation, retention, pressure areas and dental pain
- Reassess after every analgesic change and stop what does not help
Why it matters
Unrecognised pain in dementia is often treated as agitation.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for geriatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free