How Senior Caregivers Can Better Recognize Pain in Residents Who Cannot Self-Report

Pain management for senior care residents is a complex issue due to the challenges of managing chronic health conditions, age-related changes, and, in some cases, cognitive impairment. However, managing pain becomes even more challenging for residents who cannot self-report their symptoms. An inability to communicate pain can lead to delayed treatment and underrecognition, making it essential for caregivers in memory care settings to use alternative assessment methods to identify pain and ensure all residents receive appropriate treatment.

Read on to learn seven key strategies for recognizing, assessing, and managing pain in residents who cannot verbally communicate their discomfort.

1. Establish an Understanding of Normal Resident Behavior

Eric Collett, CEO and founder of A Mind for All Seasons

Residents who cannot verbally communicate their pain may still exhibit behavioral signs of discomfort. Eric Collett, CEO and founder of A Mind for All Seasons, is a brain health and dementia expert and a licensed residential care administrator. He emphasizes the importance of being able to recognize abnormal behavior in residents, meaning staff members must know residents well enough to recognize when their behavior changes.

According to Collett, individuals with dementia often don’t register pain the same way they used to, so it shows up in their behavior. For example, an individual with a distended bladder may become agitated, pace, or wander into other people’s rooms. An aching tooth may prompt a resident to not want to eat, or they may eat because they’re hungry, but throw things or hit the table because of the pain they experience.

2. Assume Pain is Possible

Caregivers should consider pain a potential cause of behavioral changes or physical reactions, even when residents deny feeling discomfort. “Always assume pain is a possible contributor,” says Collett.

He recalls an instance where a woman missed the toilet, slipped, and broke her hip. When a nurse palpated her leg, the woman guarded the leg and grimaced. When the nurse asked her if it hurt, she said no, but still pulled back. “Part of her system registered the pain, and the rest of it didn’t,” Collett explains. “Staff need to understand that when someone says they’re not in pain, that might not be true.”

3. Look for Small Changes

Anneli Kumpula, NP, co-founder of Elevate Hospice

Pain doesn’t always present as major behavioral changes. Anneli Kumpula, NP, a board-certified family and psychiatric nurse practitioner and the co-founder of Elevate Hospice, says individuals in pain may protect the affected area. They may become restless or withdrawn, or resist personal care.

Other signs may be more subtle, with pain manifesting as sleep disturbances or increased wandering at night. Changes in mobility can also indicate pain, such as an altered gait or difficulty lifting objects that were once easy to manage.

4. Avoid Compartmentalizing

It might seem that separating pain-related behaviors and symptoms from symptoms of dementia and anxiety could give a clearer understanding of the pain a resident experiences, but Collett cautions against compartmentalizing too much.

“Trying to compartmentalize is often a way to explain away behavior,” he says. “It ignores the fact that all of us change our behavior when we’re in pain, whether that pain is physical or emotional. When the brain is deteriorating, it amplifies normal human experience.”

Collett encourages memory care staff to avoid explaining a resident’s behavior as “just the dementia talking,” when interpreting behavior, and instead ask, “What is this person communicating?”

“Start from the fact that this is a human being, and every human experiences pain, emotional distress, and ups and downs,” he advises.

5. Assess and Reassess

Staff should assess residents for pain as soon as they notice signs of concern. Kumpula recommends incorporating regular pain assessments into routine care, even when residents show no new signs of discomfort. Residents may require more frequent assessments depending on their conditions.

After treatment begins, staff should monitor for signs of improved comfort, such as better sleep, easier movement, and reduced restlessness. They should also watch for potential side effects and report and document them promptly.

6. Ensure Staff Receive Appropriate Training

Pain management training should be a standard part of staff training. Staff members should be trained in skills such as how to recognize nonverbal pain signs, how to use assessment tools, and how to document observations and provide safe pain management.

Following initial training, staff should receive regular refresher sessions to reinforce their knowledge and ensure they can confidently and appropriately respond to residents’ pain, ultimately supporting residents’ overall quality of life.

7. Focus on Listening and Observing

Staff who are attentive listeners and observers are better equipped to recognize pain that residents may be unable to communicate. Encouraging these skills, along with maintaining consistent caregiving assignments, can help staff become familiar with residents’ usual behaviors and identify even subtle changes that may signal pain.

The human connection and familiarity that develop over time are invaluable for recognizing even the subtlest signs of pain. “Caregiving is something AI can’t solve,” explains Collett. “You learn to know what someone is going through by watching them closely over and over. There are things about other people we know but can’t always put into words, and we only know them if we really pay attention.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.