Sometimes, the simplest cures are the best ones

JUST imagine being in pain, feeling confused and scared, and unable to tell anyone or summon help. All you can do is groan and cry out, while people come and go around you.

When the pain becomes too much and your cries more frequent, or if you start to writhe in agony, you are sedated with antipsychotic drugs and silenced.

It sounds like a living hell, doesn’t it? Yet this is precisely what many thousands of people with dementia have to endure, day in and day out.

As the Mail reported last week, a study by University College London estimates as many as a third of dementia patients in hospital experience physical pain, sometimes so intense they become delirious.

Yet, so often, their way of expressing discomfort is dismissed as a symptom of their dementia.

They might spend days, weeks, months or even years in acute pain without anyone realising.

I witnessed this many times when I provided medical cover to nursing homes.

Patients with dementia were sedated when, in fact, their disruptive behaviour was due to easily treated problems such as earache, toothache or joint pain.

While reading the new research, I was reminded of another study published several years ago.

It found, incredibly, that paracetamol was a very effective treatment for managing distress in dementia patients.

In fact, regular paracetamol was more effective in reducing agitation and distress than antipsychotics, suggesting the cause of the agitation and distress was rooted in the pain the patient was experiencing.

Give them a painkiller and the pain, stress and agitation disappears. I decided to put this into practice with patients referred to me by care homes, and I was astounded by the response of some of them.

After only a few days of regular paracetamol, I was able stop all the anti- psychotic drugs prescribed for one lady. Paracetamol became my first-line treatment for agitation in elderly patients.

But paracetamol isn’t the answer for everyone. Skilled nursing care is the missing factor in the tragic plight of so many dementia patients.

Just because someone is unable to articulate how they are feeling or what is wrong, doesn’t mean they are not communicating.

Non-verbal communication and subtle changes in demeanour can provide a wealth of information about the patient — but it takes experience and time spent with them to pick up on this.

I was once called to see an elderly man with dementia in a nursing home. ‘I don’t know what it is, but I’m sure there’s a problem,’ his nurse said. He knelt down and gently took the man’s hand. ‘You can tell from his face. See . . .?’

All I saw was an elderly man with his mouth wide open and expressionless eyes, utterly shut off from the world. Then his lip curled very slightly.

‘ There,’ the nurse said triumphantly. ‘He does that now and again when he’s hungry or thirsty, but he’s been doing it a lot for a few days now’.

I wasn’t convinced, but realised the nurse knew his patient so well that he recognised minute, idiosyncratic changes in facial expression indicating a problem. HOWEVER,

after examining the patient I could find nothing wrong. The nurse continued to insist the opposite was true, so I arranged for the man to be admitted to hospital for a full investigation.

He was subsequently diagnosed with a urinary tract infection that had spread to his kidneys — and which must have been causing him acute pain. But thanks to his relationship with an empathetic nurse he didn’t have to sit there and suffer for long.

Sadly, this type of patient/nurse relationship is all too rare in the modern NHS and even in many care homes because of staff shortages, high turnover and a pressured environment.

As a result society’s most vulnerable must suffer in silence.