People with advanced dementia often cannot describe pain, and it shows instead as agitation, resisting care, guarding, grimacing, moaning or withdrawal. Behaviour change in a care-home resident should prompt a pain assessment before any sedative or antipsychotic. Use a validated observational tool such as PAINAD, scored during movement or care, not only at rest. Look for a cause: constipation, urinary retention, dental problems, pressure areas and fractures are common and treatable.
- Assess for pain whenever a resident with dementia shows new agitation or resists care.
- Use an observational pain scale such as PAINAD during movement and personal care.
- Check for constipation, retention, dental pain, pressure areas and occult fracture.
- Reassess after any treatment to see whether behaviour improves.
Why it matters
Untreated pain is a common, reversible cause of distress that is often managed with antipsychotics instead.
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