Suffering in silence

Dementia patients left in agony as they can’t explain their pain to nurses

MORE than a third of dementia patients in hospital endure the agony of injury and illness without pain relief because they cannot explain their suffering, according to a study.

Experts last night urged doctors to do more to identify those ‘suffering in silence’ on their wards.

The research, led by University College London, found that when dementia patients suffer intense pain it often triggers an episode of ‘delirium’, a state of acute confusion in which they usually lose the ability to communicate.

This is particularly concerning because 40 per cent of all patients in acute hospital wards suffer from dementia.

The researchers, whose work is published in the journal Age and Ageing, assessed 230 elderly dementia patients in two NHS hospitals in north London. They found 35 per cent of those they saw were delirious and unable to report their pain.

Of those, a third had previously reported experiencing pain at rest and 56 per cent had experienced pain while moving.

The odds of being delirious was three times higher among those in pain, the study found.

The researchers, funded by the Alzheimer’s Society, the terminal illness support charity Marie Curie and the Bupa Foundation, concluded pain triggered the delirium.

The team urged hospital staff to do regular assessments so pain and delirium are managed effectively.

Researcher Dr Liz Sampson, of the Marie Curie palliative care research department at UCL, said: ‘In the UK, almost half of people admitted to hospital over the age of 70 will have dementia. We know that they are a high-risk group for delirium and yet delirium is often under-treated.

‘Our latest work suggests that pain could be a cause of delirium.’

She added: ‘It’s deeply troubling to think that this vulnerable group of patients are suffering in silence, unable to tell healthcare professionals that they are in pain.

‘Studies like this may help hospital staff provide better care now and in the future as dementia diagnosis rates continue to rise.’

For those unable to communicate, the researchers looked for signs of pain in their facial expression and body language, using a measure called the ‘ pain assessment in advanced dementia scale’.

They said that this should be used regularly by hospital staff to look for problems.

‘Regular gold standard self-report and observational assessments are needed to detect and thus manage pain and delirium effectively,’ the researchers wrote.

‘It is important for hospital staff to identify patients at risk of delirium – it may be preventable and effective pain management may contribute to this.’

Dr Doug Brown, chief policy and research officer at the Alzheimer’s Society, said last night: ‘We know that people living with dementia can find it difficult to communicate and when this concerns inability to communicate pain to hospital staff, it’s clearly extremely concerning.

‘It’s not only upsetting and frustrating but can have serious consequences on a person’s health.

‘The link this research shows between delirium and pain shows that the problem may be worse than previously realised.’

There are 850,000 people with dementia in the UK, and numbers are set to rise to more than a million by 2025 and two million by 2051.

Lose ability to communicate