Kovach et al reported the Assessment for Discomfort in Dementia (ADD) protocol for patients with advanced dementia. This can help to guide pain-relief measures for these patients. The authors are from Marquette University, Medical College of Wisconsin and Lakeland Nursing Home.
Patient selection: late-stage dementia
Behavioral signs associated with discomfort:
(1) tense body language
(2) sad facial expressions
(3) fidgeting
(4) perseverant verbalizations
(5) verbal outbursts
Non-pharmacological comfort interventions and then scheduled analgesics (initially non-narcotic) are given if discomfort is suspected. An effective intervention should reduce the observed behavioral signs. The physician is consulted if pain-related behaviors persist.
Nonpharmacologic comfort interventions:
(1) music therapy
(2) sensory stimulation
(3) soothing verbal communication and/or touch
(4) busy hand activities
(5) therapeutic massage
(6) cold or heat therapy
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