Pain Evaluation and Management in Patients with Dementia: A Retrospective Study in a Medical Department of a Tertiary Hospital

Abstract

Introduction: Pain is common among elderly patients and poses specific challenges in dementia due to impaired communication and limited use of validated assessment tools.
Methods: To assess the prevalence, characteristics, and management of pain in hospitalized patients with dementia, compared with those without, we conducted a retrospective observational study including all patients admitted to an internal medicine ward between December 5–7, 2022. Cognitive status was determined by the assistant medical team. Patients were excluded if they did not have record of pain assessment, if they died or were discharged before the 72 hours-period evaluation. Pain was evaluated using the Numeric Rating Scale and the Pain Assessment in Advanced Dementia (PAINAD) scale. Demographic, clinical, and analgesic data were analysed according to the WHO analgesic ladder.
Results: A total of 114 patients were included, 54.4% with dementia, median age 81 (IQR 13.0). Overall pain prevalence was 45.6%, with no significant difference between groups (p=0.67). The Numeric Rating Scale was used in 24.6% of all cases and PAINAD in 9.6% of patients with dementia. No moderate or severe pain was documented in this group. Most patients (88.6%) with pain had at least one analgesic prescribed, with no differences in opioid use between the two groups. No non-pharmacological interventions were recorded.
Conclusion: Pain was frequent but often underrecognized and undertreated in patients with dementia. Structured assessment protocols and team training are essential to improve pain management in this population.