Managing Special Challenges in Dementia Care
Certain situations present particular challenges in dementia care and require specialized approaches.
Pain Assessment and Management
Pain is often underdetected and undertreated in people with dementia due to communication difficulties:
Evidence-Based Approaches
- Behavioral Pain Assessment: Using validated tools such as the Pain Assessment in Advanced Dementia (PAINAD) scale
- Regular Screening: Implementing systematic pain assessment, especially during care activities
- Trial Treatments: Conducting analgesic trials when pain is suspected
- Non-pharmacological Pain Management: Implementing positioning, physical therapy, heat/cold therapy
- Preventive Approaches: Addressing potential sources of discomfort proactively
- Scheduled Rather Than PRN Analgesics: Providing regular pain medication when ongoing pain is identified
Research indicates that improved pain management can reduce agitation by 30-60% in people with dementia who have untreated pain (Livingston et al. 167).
Delirium Prevention and Management
People with dementia are at high risk for delirium, which can worsen cognitive function and outcomes:
Evidence-Based Approaches
- Regular Screening: Using tools validated for detecting delirium superimposed on dementia
- Preventive Strategies: Ensuring adequate hydration, mobility, and sensory input
- Medication Review: Minimizing high-risk medications
- Environmental Supports: Providing orientation cues and appropriate lighting
- Consistent Caregivers: Maintaining familiarity during episodes of delirium
- Addressing Underlying Causes: Treating infections, pain, constipation, or other triggers
Studies show that multicomponent delirium prevention programs can reduce delirium incidence by 30-40% in at-risk elderly patients, including those with dementia (Kales et al. 547).
End-of-Life Care
Providing quality end-of-life care for people with advanced dementia requires specialized approaches:
Evidence-Based Approaches
- Advance Care Planning: Engaging in discussions early in the disease course when possible
- Comfort-Focused Care: Emphasizing comfort and quality of life rather than prolongation of life
- Symptom Management: Proactively addressing pain, dyspnea, and other distressing symptoms
- Avoiding Burdensome Interventions: Minimizing hospitalizations and invasive procedures when consistent with goals of care
- Supporting Families: Providing education about the natural course of advanced dementia
- Maintaining Dignity: Continuing person-centered approaches through the end of life
- Sensory Comfort: Providing familiar music, gentle touch, and calm environment
Research indicates that advance care planning can reduce unnecessary hospitalizations by 50% and increase the likelihood of dying in the preferred location by 60% for people with dementia (Livingston et al. 169).