Yes, I believe that the in the elderly, tolerance for pain decreases. IMO, an elder in pain deserves not only pain relief measures via prescribed Rx or OTC analgesics, but also palliative measures like linament or heating pad. They also need our compassion. Many times they cannot adequately express the source of their pain, or they may exxagerate it due to a state of agitation (catch-22 there). In the case you describe, the dentist should have given your Mom an Rx for pain. With the elderly, the discomfort from the extractions may last longer than usual, and on top of that she has a "fabber" (temporary bridge?) on top of sore gums. The older we get, the longer it takes for us to heal. We will all be in their shoes some day. Please advocate for your mother's well-being and get her something for her pain.
Pain is a very individual matter in which fear and anxiety play a large role. it is necessary to understand the whole body and it's functions before the level of pain can be adequately estimated. The bottom line is that if the patient says they are in pain they have pain and they have the right to have it relieved. Healthcare professionals use what is called the pain scale which goes from one to ten. Ten being the worst possible pain the person can imagine. there are images that go with the scale and the face begins looking comfortable to screwed up in agony. I heard a pain expert recently describe the way pain medications should be calibrated and I hope I don't get this wrong. You first need to understand how long the drug takes on average to work given by different routes. So if you are giving it by mouth there is usually relief from a immediate relief med in about 30 minutes. If it is still just as bad when the 40 minute time is reached the original dose should be doubled and so on until the patient is pain free. Once the pain free stage is reached the dose can be gradually reduced or the interval extended until an acceptable (to the patient) level is reached . This does take a lot of experience and bedside observation. It is very important not to let pain get out of control because it takes much more medication to obtain relief. The focus should not be simply on the obvious cause of the pain but being aware of the whole person. Are they in an uncomfortable position, too hot, too cold, thirsty, is the bladder full do they need to empty their bowels. Have they developed infection in a wound. Applying heat or cold may help. Soaking in a bath or hot tub. gentle massage is good too. Soothing herbs such as lavender are calming and soft music. All of these things play a part in pain management. be careful with candles because the flicker can trigger migrains or seizures. Pain management at this level can only be achieved with things like morphine because the meds like Vicoden and Tylenol #3 contain other compounds such as Tylenol or asprin and large doses of these cause other damage to the body. Doctors tend to grossly under prescribe pain medication both from ignorance and fear of being seen as overprescribing narcotics. Oncologists are usually good as are hospice medical directors. I have no experience of pain management clinics. My experience has been that many elderly people in the general population not the dementias do tolerate a great deal of pain without complaint but others may not agree with that.. The moaning that many people do makes it difficult to assess but if you stop and listen carefully you may find that if it follows the respirations in the same rhythm it is just noise but if it is irregular it usually indicates pain and I stress this even in the unconscious patient close to death which is why it is necessary to continue at least a low dose. If they have been on narcotics for a period of time they can experience withdrawal symptoms. There are other things such as acupuncture, reflexology and hypnosis but I have no experience with those. Experience and training are vital in managing and I would not expect a home health aide licensed or not to be responsible for assessing the level of pain. That is not to say such a person is not capable of doing so and making a patient comfortable, I just would not give them that responsibility Dealing with agitation and restlessness and especially noise are extremely stressful in the home where often a single caregiver does the job alone 24/7 so it is important to seek any relief that can be provided.
In response to the harsh answers regarding my mother's broken tailbone.... Mom REFUSED to see a doctor because she was so paranoid that we would have her committed. With that much paranoia, you would think she would have sense enough not to go to the front door, hang off the porch, and scream at the top of her lungs that she couldn't get her mail (which was just to the right of her) because -as she said- "broke her back." If the neighbors would have heard her, THEY would have reported her to authorities to have her psychologically evaluated.
I have no doubt that a broken tailbone hurts (I looked it up on the internet before making judgement on my mother's actions)....my point is that my mother screamed bloody murder even laying in the bed without moving for several minutes. In my childhood, she denied us the right to scream if we were in pain....I ask for the same consideration from an ADULT.
And as for being heartless......How would you feel if I told you my mother just had a MAJOR stroke 3 weeks ago and I have been her #1 advocate? Her doctor said Mom would never walk again and would probably never be able to talk or communicate again...and that the rest of her life would probably be spent in a nursing home. ****REALLY???**** I would not give up on that lady! I FOUGHT for her right to receive physical, occupational, and speech therapy. TODAY (just 3 weeks later), she walks, goes to the bathroom by herself, is feeding herself, uses the magnetic alphabet board that **I** made for her to spell words, and even uses a pencil & paper to write words. Her doctor thought I was crazy. I'm glad the therapy department at St Patrick's Hospital in Lake Charles, LA didn't think so. I'm so glad they believed Mom could do it!!!!
There are neurological conditions that produce intense pain, which are often dismissed by physicians and civilians alike because they have either never seen it nor experienced it. My Mom screamed when I tried to cover her with a sheet. I mean screamed in agony. The Hospice nurse explained that nerve receptors were changing and any movement or motion would produce unbearable pain. Yes, some people with dementia scream a lot. But there is palliative care and it is cruel to make assumptions about another's pain. Soldiers on the battlefield have been known to shoot beloved comrades because of their pain. This is not a behavioral issue. This is human existence, look up the meaning of "compassion" and stop watching out for yourself only.
My husband has dementia and is in a nursing home and I find he can't handle pain. There is no longer the ability to reason and understand what is happening and all they seem to be concerned with is their comfort.
I don't think most people, especially caregivers, are "insensitive" to the pain of other people, I truly think most are unaware of the serious nature of pain.
I have been in the position of experiencing all three kinds of pain problems. OMG, you say, there are THREE KINDS? Yes, that has been my experience (and others may choose to add their own perception and interpretation) and here they are:
1) As a paramedical esthetician, I took care of many Plastic and Reconstructive post-procedure patients from full face lifts to nose jobs, from tummy tucks 2 liposuction. Tho the majority were elective surgeries, I can tell you there is still a lot of pain. Over and over again I witnessed the under medication of the patient by the doctor who was in my opinion relatively insensitive to the pain the patient was going through. With the doctor's experience, you would think they would know better. In the beginning with doctors who didn't know me, they actually thought I was exaggerating the patients pain. As they came to know me and realized that I was honestly advocating for the patients, the individual doctors started becoming more and more educated about the pain after effects of their surgeries, which they didn't seem to have understood from all the years of experience. Now, I ask you, if a doctor doesn't understand this, how can they participate in educating a caregiver? No, what happens is caregivers have to learn by trial and error, and unless they have prior experience with someone else, its on a case by case basis similar to reinventing the wheel each time.
2) I have also cared directly or indirectly for 8 people with different forms of dementia and one person with Lou Gehrig's disease (ALS). ALL have had pain in one form or another in different parts of their body and because of the nature of the dementia people being poor informants and the ALS man being unable to communicate, the pain was very frustrating to them. My mom who passed in January at 94-1/2 had severe osteoarthritis. Before her drug-induced dementia, she had had and ankle fusion, bilateral hip replacements and a knee replacement in addition to several eye surgeries and other dermatological surgeries. I just can we referred to her as Bionic and the truth was if she had not gotten to the age she was, she would have needed her other knee replaced as well as both of her shoulders. She was in severe pain all the time but she had hepatitis B and was unable to take NSAIDs, van had hallucinogenic reactions to vicodin, so she was put on darvocet, which undoubtedly contributed to her heart problem - atrial fibrillation - one of the reasons darvocet was completely removed from the market. My poor mom was in pain and driven to tears in many instances because of her shoulders. Many years before, she had opted not to have shoulder replacements because she said she didn't walk on her shoulders. Many yrs later, it appeared that that had been an ill-advised decision because her pain was excruciating and now all she had was tramadol an extra strength tylenol. It wasn't enough and her orthopedic doctor wanted to put her on morphine but my sister, my mom's health POA by subterfuge, who barely ever spent time around by mom or her pain, would not agree and managed to convince my moms PCP that it wasn't "the right thing". So my mom lived every day of her last 3 years in serious pain.
3) In my own case, I have what my doctor calls the worst fibromyalgia she's ever seen and in addition need double hip replacement. I have what is called a fixed deformity of my hips, so although I use a rolling Walker to get around, i leaving at a 30 degree angle and that puts a lot of pressure on my hands. In effect, I walk with my hands, and my hips and muscles hurt and every step is painful. I also have an incurable condition called venous insufficiency which, depending on the level of swelling in my legs, is painful either only be low the knee or sometimes including the knee and several inches up the thigh, making walking just that much more uncomfortable. If you're getting the idea that I have a lot of pain, you're on the right track. My condition has crept up and come on over a number of years, and I have learned to adapt and accommodate as best I can. I take tylenol codeine 4 because even the strongest vicodin or Norco isn't effective and my ortho says I'm probably going to have to move to oxycontin or morphine. Now that my mom passed away, I thought I would be moving directly into having my hip replacement surgery. There is a complication however in that doing one at a time will greatly compromise my rehabilitation but doing both together is not safe as my ortho tells me the mortality rate is not good for a double hip replacement. What to do, what to do? In the meantime I can explain to you that I deal with my pain and have it under control but if I do something as simple as slightly jam my tongue so into the wheel of my rollator, the pain produced is so exquisite that I burst into tears and can't get control of myself for 10 or 15 minutes. This is also true of any other small accidents that should not under normal circumstances produce the pain reaction that I have.
Please forgive me for being so long winded about this answer. Pain is very subjective and experiential. I have seen doctors and non caregiving visitors expressed the idea to a pain patient that, oh, it can't be that bad. But I take the same attitude that psychologists teach us when it comes to child molestation: if they say they've been molested, believe them. Identical for pain patients: if they say they're in pain, first of all believe them. More pain patients are telling the truth then not; they deserve sympathy and empathy and to have their complaint addressed and investigated.
My mother suffered with arthritis for many years, but she never complained and kept going. A few years into her dementia, I too noticed that her tolerance for pain became less. In fact, as her dementia has progressed, all of her senses seem to be out of wack. Also, sometimes older people won't take pain medication because they are afraid of getting addicted, so it is hard to get their pain under control.
My answer was not harsh, but if your mother broke her tailbone, or even bruised her tailbone, she should have went to a hospital, for medical treatment, whether she wanted to go or not, because they are so excruciatingly painful.
Sometimes, it is best (for everybody concerned) if people we take care or get the medical treatment they need and deserve, that is why we are their caretakers.
Sometimes their decisions about themselves run into self-neglect, which even if they do it to themselves is still abuse, than to go along with their fears, which even if you agree or suspect there is some truth to it, all of that stuff is documented.
About your feelings of survival and PT, I have had three strokes, if not for determination to remain independent, I would have been in a nursing home unable to walk or talk and certainly not able to advocate for the rights of my 86 year old.
I did twelve years out get to make and walk across the stage of my own college graduation.
Never Underestimate the Nature of Human Will. Never Underestimate the Nature of the Human Mind.
Yeah. It takes some serious rationalizing and self-distracting mental power to power through pain. Folks with dementia are not going to be able to filter out fear and pain that way, and yeah, at the same time, they are more scared and immobilized under the circumstances. Mercy is one thing and pity is another - people in pain need medication and mercy, but not too much pity; most kinds of pain only get worse if they are allowed to immobilize you more than necessary. That's why rehab people have such a bad rep for being mean and heartless. :-)
Pain management at this level can only be achieved with things like morphine because the meds like Vicoden and Tylenol #3 contain other compounds such as Tylenol or asprin and large doses of these cause other damage to the body.
Doctors tend to grossly under prescribe pain medication both from ignorance and fear of being seen as overprescribing narcotics. Oncologists are usually good as are hospice medical directors. I have no experience of pain management clinics. My experience has been that many elderly people in the general population not the dementias do tolerate a great deal of pain without complaint but others may not agree with that.. The moaning that many people do makes it difficult to assess but if you stop and listen carefully you may find that if it follows the respirations in the same rhythm it is just noise but if it is irregular it usually indicates pain and I stress this even in the unconscious patient close to death which is why it is necessary to continue at least a low dose. If they have been on narcotics for a period of time they can experience withdrawal symptoms. There are other things such as acupuncture, reflexology and hypnosis but I have no experience with those.
Experience and training are vital in managing and I would not expect a home health aide licensed or not to be responsible for assessing the level of pain. That is not to say such a person is not capable of doing so and making a patient comfortable, I just would not give them that responsibility
Dealing with agitation and restlessness and especially noise are extremely stressful in the home where often a single caregiver does the job alone 24/7 so it is important to seek any relief that can be provided.
Mom REFUSED to see a doctor because she was so paranoid that we would have her committed. With that much paranoia, you would think she would have sense enough not to go to the front door, hang off the porch, and scream at the top of her lungs that she couldn't get her mail (which was just to the right of her) because -as she said- "broke her back." If the neighbors would have heard her, THEY would have reported her to authorities to have her psychologically evaluated.
I have no doubt that a broken tailbone hurts (I looked it up on the internet before making judgement on my mother's actions)....my point is that my mother screamed bloody murder even laying in the bed without moving for several minutes. In my childhood, she denied us the right to scream if we were in pain....I ask for the same consideration from an ADULT.
And as for being heartless......How would you feel if I told you my mother just had a MAJOR stroke 3 weeks ago and I have been her #1 advocate? Her doctor said Mom would never walk again and would probably never be able to talk or communicate again...and that the rest of her life would probably be spent in a nursing home. ****REALLY???**** I would not give up on that lady! I FOUGHT for her right to receive physical, occupational, and speech therapy. TODAY (just 3 weeks later), she walks, goes to the bathroom by herself, is feeding herself, uses the magnetic alphabet board that **I** made for her to spell words, and even uses a pencil & paper to write words. Her doctor thought I was crazy. I'm glad the therapy department at St Patrick's Hospital in Lake Charles, LA didn't think so. I'm so glad they believed Mom could do it!!!!
I have been in the position of experiencing all three kinds of pain problems. OMG, you say, there are THREE KINDS? Yes, that has been my experience (and others may choose to add their own perception and interpretation) and here they are:
1) As a paramedical esthetician, I took care of many Plastic and Reconstructive post-procedure patients from full face lifts to nose jobs, from tummy tucks 2 liposuction. Tho the majority were elective surgeries, I can tell you there is still a lot of pain. Over and over again I witnessed the under medication of the patient by the doctor who was in my opinion relatively insensitive to the pain the patient was going through. With the doctor's experience, you would think they would know better. In the beginning with doctors who didn't know me, they actually thought I was exaggerating the patients pain. As they came to know me and realized that I was honestly advocating for the patients, the individual doctors started becoming more and more educated about the pain after effects of their surgeries, which they didn't seem to have understood from all the years of experience. Now, I ask you, if a doctor doesn't understand this, how can they participate in educating a caregiver? No, what happens is caregivers have to learn by trial and error, and unless they have prior experience with someone else, its on a case by case basis similar to reinventing the wheel each time.
2) I have also cared directly or indirectly for 8 people with different forms of dementia and one person with Lou Gehrig's disease (ALS). ALL have had pain in one form or another in different parts of their body and because of the nature of the dementia people being poor informants and the ALS man being unable to communicate, the pain was very frustrating to them. My mom who passed in January at 94-1/2 had severe osteoarthritis. Before her drug-induced dementia, she had had and ankle fusion, bilateral hip replacements and a knee replacement in addition to several eye surgeries and other dermatological surgeries. I just can we referred to her as Bionic and the truth was if she had not gotten to the age she was, she would have needed her other knee replaced as well as both of her shoulders. She was in severe pain all the time but she had hepatitis B and was unable to take NSAIDs, van had hallucinogenic reactions to vicodin, so she was put on darvocet, which undoubtedly contributed to her heart problem - atrial fibrillation - one of the reasons darvocet was completely removed from the market. My poor mom was in pain and driven to tears in many instances because of her shoulders. Many years before, she had opted not to have shoulder replacements because she said she didn't walk on her shoulders. Many yrs later, it appeared that that had been an ill-advised decision because her pain was excruciating and now all she had was tramadol an extra strength tylenol. It wasn't enough and her orthopedic doctor wanted to put her on morphine but my sister, my mom's health POA by subterfuge, who barely ever spent time around by mom or her pain, would not agree and managed to convince my moms PCP that it wasn't "the right thing". So my mom lived every day of her last 3 years in serious pain.
3) In my own case, I have what my doctor calls the worst fibromyalgia she's ever seen and in addition need double hip replacement. I have what is called a fixed deformity of my hips, so although I use a rolling Walker to get around, i leaving at a 30 degree angle and that puts a lot of pressure on my hands. In effect, I walk with my hands, and my hips and muscles hurt and every step is painful. I also have an incurable condition called venous insufficiency which, depending on the level of swelling in my legs, is painful either only be low the knee or sometimes including the knee and several inches up the thigh, making walking just that much more uncomfortable. If you're getting the idea that I have a lot of pain, you're on the right track. My condition has crept up and come on over a number of years, and I have learned to adapt and accommodate as best I can. I take tylenol codeine 4 because even the strongest vicodin or Norco isn't effective and my ortho says I'm probably going to have to move to oxycontin or morphine. Now that my mom passed away, I thought I would be moving directly into having my hip replacement surgery. There is a complication however in that doing one at a time will greatly compromise my rehabilitation but doing both together is not safe as my ortho tells me the mortality rate is not good for a double hip replacement. What to do, what to do? In the meantime I can explain to you that I deal with my pain and have it under control but if I do something as simple as slightly jam my tongue so into the wheel of my rollator, the pain produced is so exquisite that I burst into tears and can't get control of myself for 10 or 15 minutes. This is also true of any other small accidents that should not under normal circumstances produce the pain reaction that I have.
Please forgive me for being so long winded about this answer. Pain is very subjective and experiential. I have seen doctors and non caregiving visitors expressed the idea to a pain patient that, oh, it can't be that bad. But I take the same attitude that psychologists teach us when it comes to child molestation: if they say they've been molested, believe them. Identical for pain patients: if they say they're in pain, first of all believe them. More pain patients are telling the truth then not; they deserve sympathy and empathy and to have their complaint addressed and investigated.
Sometimes, it is best (for everybody concerned) if people we take care or get the medical treatment they need and deserve, that is why we are their caretakers.
Sometimes their decisions about themselves run into self-neglect, which even if they do it to themselves is still abuse, than to go along with their fears, which even if you agree or suspect there is some truth to it, all of that stuff is documented.
About your feelings of survival and PT, I have had three strokes, if not for determination to remain independent, I would have been in a nursing home unable to walk or talk and certainly not able to advocate for the rights of my 86 year old.
I did twelve years out get to make and walk across the stage of my own college graduation.
Never Underestimate the Nature of Human Will. Never Underestimate the Nature of the Human Mind.
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