Post by norbert1 on Nov 23, 2007 22:59:54 GMT -5
411- Alzheimers topics
contents of this post ---
- ASSESSING AND TREATING PAIN
- The connection between UTI's and AD decline
-----------------------------------.
ASSESSING AND TREATING PAIN
--------- ASSESSING PAIN -------
Susan asks, “So how do I know if he's really hurting or not? He only complains to me and denies any pain with everyone else.”
Assessing pain can be a real problem. Eventually the person will have trouble vocalizing where something hurts, and loses knowledge of words to describe the extent of pain; or loses language altogether. This causes a real problem because doctors need a way to quantify pain to justify treatment.
Pamphlet “Pain in Dementia” by the American Geriatrics Society
www.healthinaging.org/public_education/pain/pain_dementia.pdf
Zenes pamphlet (above) is a good general discussion of things that indicate pain. It mentions using an assessment tool. The 1-10 smiley face chart, developed for children, does not work well for dementia. Associating a particular frown to a level of pain is too abstract for a dementia patient. They may do better with simple descriptions, such as "hurts a little", moderately, a lot, etc.
Discussion of Pain scales used in dementia.
www.mgh.harvard.edu/painrelief/Pain%20Topics/Pain_assess_dementia.htm
The tool that seems to work the best for people with dementia is the PAINAD scale, which was developed by late-stage dementia experts Hurley and Volicer. The painad assigns values to extent of difficulties of on Breathing, Negative Vocalization, Facial Expression, Body Language and Consolability
www.lumetra.com/resource-center/index.aspx?id=369
has a link to the PAINAD tool, and discussion of filling it out.
There are other tools out there, that include things like distractibility.
Treating Pain
healthlink.mcw.edu/article/967581724.html
www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1043
Pain discussion thread
alzheimers.proboards32.com/index.cgi?board=ADgen&action=display&thread=1195875637
--- TREATING PAIN ---
Treating pain is a difficult issue. It turns out that you can use the common over the counter anegesics like asperine, tylenol, advil, etc. For stronger pain, you have to go to a narcotic based medication. There is nothing in between.
Here is information I gathered on pain treatment
A major goal of hospice is the control of pain. The concept of pain treatment follows the WHO (World Health Organization) pain treatment “ladder”:
• Mild pain can be treated with a medicine such as acetaminophen (Tylenol) or other NSAID medication.
• Moderate pain will require a moderate opioid, usually a combination formulation with an opioid as one of the ingredients. Common drugs in this class are Tylenol with codeine, Percodan (Aspirin w/oxycodone), Percocet (acetaminophen w/oxycodone) and Vicodin (acetaminophen w/ hydrocodone).
• Strong pain requires a strong narcotic, such as morphine or Dilaudid. For patients with a stable level of pain, Fentanyl patches are emerging as a good way to deliver a constant level of pain control.
When stronger opioids are used, hospice will be vigilant for their common side effects (sedation, nausea, constipation, and dry mouth) and institute treatments to minimize them.
-------------------
What is Oxycontin
OxyContin Tablets are a controlled-release oral formulation of oxycodone hydrochloride indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time.
oxycodone, is a semi-synthetic narcotic with multiple actions qualitatively similar to those of morphine;
------------------/
So my comments
Generally, a narcotic is going to cause confusion in a person with Alzheimers. However, it is generally felt that a person with alzheimers will function better with pain effectively treated, even considering the confusion caused by the narcotic. (Pain causes delirium and confusion, so the pain relief should more or less offset the confusion caused by the narcotic, if prescribed at an appropriate level.) And pain needs to be effectively treated; it is a basic quality of life issue.
Another concept in treating of pain - It is important to keep pain adequately treated, because getting “break through” pain under control requires a much higher level of meds.
There is much more attention to effective treatment of pain now. It has been shown in several studies that people with Alzheimers receive less pain medication than non-demented people with the same conditions. So there is a push to look for and treat pain. And Nursing Home surveyors are making sure that pain is being treated when inspecting nursing homes. It is now considered the 5th vital sign.
-------------------------------------------------------------------.
What's the connection between UTI's and AD decline?
Q - I see all over the message board when a patient has a downward turn or "episode" of any kind, many many people refer to UTI's as being a possible underlying cause. What is the connection? And why don't we see this kind of connection being made with the common cold or the flu which seems to be a more frequent occurrence.
A - The elderly in general and especially those with dementia (because of lowered level of cognitive reserve) are susceptible to delirium. In dementia, UTIs cause a mild form of delirium that produces a decline in function and increase in confusion.
de•lir•i•um. A temporary state of mental confusion and fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.
Google - dementia UTI delirium
Inflammatory Response To Infection And Injury May Worsen Dementia
www.sciencedaily.com/re.../09/080916215205.htm
Double trouble: When delirium complicates dementia
www.nursingcenter.com/p...ticle.asp?tid=812348
Dementia Versus Delirium
http://www.selfhelpmagazine.co...le/dementia-delirium
“Delirium can be caused by virtually any medical condition. A urinary tract infection, reaction to drugs, low blood pressure, dehydration, even sensory deprivation for hospitalized patient.”
A comment on one line in this article. -- “Delirium is a true medical emergency.” -- The level of delirium caused by a UTI is not as severe as when caused by a more major illness and would not rise to the level of a “medical emergency”, but would produce a change of behavior. . . . However, a bladder infection can move up to the kidneys, where it can get into the blood stream creating sepsis. That IS a life threatening medical emergency.
Look at it another way, anything that produces stress on the body of a person with dementia will cause an increase in confusion and possible behavior issues. UTI, pain, dehydration or exhaustion will produce such results.
The complicating issue in dementia is that we can tell when they have a fever (from flu) or a cold, but they cannot or do not tell the caregiver that they have a UTI. And in dementia, they can have a silent UTI which does not exhibit the traditional symptoms.
contents of this post ---
- ASSESSING AND TREATING PAIN
- The connection between UTI's and AD decline
-----------------------------------.
ASSESSING AND TREATING PAIN
--------- ASSESSING PAIN -------
Susan asks, “So how do I know if he's really hurting or not? He only complains to me and denies any pain with everyone else.”
Assessing pain can be a real problem. Eventually the person will have trouble vocalizing where something hurts, and loses knowledge of words to describe the extent of pain; or loses language altogether. This causes a real problem because doctors need a way to quantify pain to justify treatment.
Pamphlet “Pain in Dementia” by the American Geriatrics Society
www.healthinaging.org/public_education/pain/pain_dementia.pdf
Zenes pamphlet (above) is a good general discussion of things that indicate pain. It mentions using an assessment tool. The 1-10 smiley face chart, developed for children, does not work well for dementia. Associating a particular frown to a level of pain is too abstract for a dementia patient. They may do better with simple descriptions, such as "hurts a little", moderately, a lot, etc.
Discussion of Pain scales used in dementia.
www.mgh.harvard.edu/painrelief/Pain%20Topics/Pain_assess_dementia.htm
The tool that seems to work the best for people with dementia is the PAINAD scale, which was developed by late-stage dementia experts Hurley and Volicer. The painad assigns values to extent of difficulties of on Breathing, Negative Vocalization, Facial Expression, Body Language and Consolability
www.lumetra.com/resource-center/index.aspx?id=369
has a link to the PAINAD tool, and discussion of filling it out.
There are other tools out there, that include things like distractibility.
Treating Pain
healthlink.mcw.edu/article/967581724.html
www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1043
Pain discussion thread
alzheimers.proboards32.com/index.cgi?board=ADgen&action=display&thread=1195875637
--- TREATING PAIN ---
Treating pain is a difficult issue. It turns out that you can use the common over the counter anegesics like asperine, tylenol, advil, etc. For stronger pain, you have to go to a narcotic based medication. There is nothing in between.
Here is information I gathered on pain treatment
A major goal of hospice is the control of pain. The concept of pain treatment follows the WHO (World Health Organization) pain treatment “ladder”:
• Mild pain can be treated with a medicine such as acetaminophen (Tylenol) or other NSAID medication.
• Moderate pain will require a moderate opioid, usually a combination formulation with an opioid as one of the ingredients. Common drugs in this class are Tylenol with codeine, Percodan (Aspirin w/oxycodone), Percocet (acetaminophen w/oxycodone) and Vicodin (acetaminophen w/ hydrocodone).
• Strong pain requires a strong narcotic, such as morphine or Dilaudid. For patients with a stable level of pain, Fentanyl patches are emerging as a good way to deliver a constant level of pain control.
When stronger opioids are used, hospice will be vigilant for their common side effects (sedation, nausea, constipation, and dry mouth) and institute treatments to minimize them.
-------------------
What is Oxycontin
OxyContin Tablets are a controlled-release oral formulation of oxycodone hydrochloride indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time.
oxycodone, is a semi-synthetic narcotic with multiple actions qualitatively similar to those of morphine;
------------------/
So my comments
Generally, a narcotic is going to cause confusion in a person with Alzheimers. However, it is generally felt that a person with alzheimers will function better with pain effectively treated, even considering the confusion caused by the narcotic. (Pain causes delirium and confusion, so the pain relief should more or less offset the confusion caused by the narcotic, if prescribed at an appropriate level.) And pain needs to be effectively treated; it is a basic quality of life issue.
Another concept in treating of pain - It is important to keep pain adequately treated, because getting “break through” pain under control requires a much higher level of meds.
There is much more attention to effective treatment of pain now. It has been shown in several studies that people with Alzheimers receive less pain medication than non-demented people with the same conditions. So there is a push to look for and treat pain. And Nursing Home surveyors are making sure that pain is being treated when inspecting nursing homes. It is now considered the 5th vital sign.
-------------------------------------------------------------------.
What's the connection between UTI's and AD decline?
Q - I see all over the message board when a patient has a downward turn or "episode" of any kind, many many people refer to UTI's as being a possible underlying cause. What is the connection? And why don't we see this kind of connection being made with the common cold or the flu which seems to be a more frequent occurrence.
A - The elderly in general and especially those with dementia (because of lowered level of cognitive reserve) are susceptible to delirium. In dementia, UTIs cause a mild form of delirium that produces a decline in function and increase in confusion.
de•lir•i•um. A temporary state of mental confusion and fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.
Google - dementia UTI delirium
Inflammatory Response To Infection And Injury May Worsen Dementia
www.sciencedaily.com/re.../09/080916215205.htm
Double trouble: When delirium complicates dementia
www.nursingcenter.com/p...ticle.asp?tid=812348
Dementia Versus Delirium
http://www.selfhelpmagazine.co...le/dementia-delirium
“Delirium can be caused by virtually any medical condition. A urinary tract infection, reaction to drugs, low blood pressure, dehydration, even sensory deprivation for hospitalized patient.”
A comment on one line in this article. -- “Delirium is a true medical emergency.” -- The level of delirium caused by a UTI is not as severe as when caused by a more major illness and would not rise to the level of a “medical emergency”, but would produce a change of behavior. . . . However, a bladder infection can move up to the kidneys, where it can get into the blood stream creating sepsis. That IS a life threatening medical emergency.
Look at it another way, anything that produces stress on the body of a person with dementia will cause an increase in confusion and possible behavior issues. UTI, pain, dehydration or exhaustion will produce such results.
The complicating issue in dementia is that we can tell when they have a fever (from flu) or a cold, but they cannot or do not tell the caregiver that they have a UTI. And in dementia, they can have a silent UTI which does not exhibit the traditional symptoms.