Pain in Centenarians: When to Seek Medical Advice

Aging?

Hello, Dr.
Shen.
My grandmother is 100 years old and has dementia.
She usually does not like to move but can still walk by herself.
She has no other health issues and is not taking any supplements.
She only visited a traditional Chinese medicine doctor last month for a cold and cough.
The problem is that recently she keeps saying she is in pain, but when I hold her hand or foot, she says it hurts.
Sometimes she says it doesn't hurt.
What could be the reason for this? Does she need to see a doctor? Thank you.

Xiao Yu, 20~29 year old female. Ask Date: 2004/09/02

Dr. Ouyang Wenzhen reply Geriatrics

Hello, Xiaoyu.
Individuals with dementia can also have physical illnesses and have the right to seek medical treatment.
Your grandmother is experiencing pain in her hands and feet, which raises concerns about poor peripheral circulation or peripheral neuropathy due to deficiencies in vitamin B12 or folate.
Please take her to a large hospital's neurology department or geriatric psychiatry for a thorough blood test and neurological examination.
Wishing you all the best.
Sincerely, Ouyang Wenzhen, Department of Geriatric Psychiatry, Chianan Psychiatric Hospital.

Reply Date: 2004/09/02

More Info

Understanding pain in centenarians, especially those with conditions like dementia, can be quite complex. In your case, your grandmother, who is 100 years old and has dementia, is expressing pain intermittently, which raises several important considerations.

Firstly, it's essential to recognize that pain perception can change with age and cognitive decline. Older adults, particularly those with dementia, may have difficulty articulating their pain or may express it in ways that are not typical. For instance, they might say they are in pain when touched, which could be a sign of discomfort or sensitivity rather than actual pain. This phenomenon is sometimes referred to as "pain expression" and can be influenced by various factors, including psychological state, previous experiences with pain, and even environmental factors.

The fact that your grandmother sometimes says she is in pain and sometimes does not could indicate a fluctuating condition. This could be due to several reasons:
1. Neuropathic Pain: As people age, they may develop neuropathic pain, which is caused by damage to the nerves. This type of pain can be unpredictable and may not always correlate with physical findings.

2. Musculoskeletal Issues: Even if she does not have any diagnosed diseases, the aging process can lead to conditions like arthritis or general musculoskeletal pain, which can cause discomfort when pressure is applied.

3. Cognitive Factors: Dementia can affect how pain is perceived and reported. Sometimes, individuals may express discomfort due to frustration or confusion rather than actual physical pain.

4. Psychological Factors: Anxiety, depression, or other psychological issues can manifest as physical complaints, including pain. Given her age and condition, it is not uncommon for older adults to experience psychological distress, which can exacerbate feelings of pain.

5. Infection or Other Medical Issues: Although she does not have any known diseases, it is still possible for infections or other medical issues to arise, especially in older adults. Conditions like urinary tract infections (UTIs) can sometimes present with vague symptoms, including pain.

Given these considerations, it is advisable to consult with a healthcare professional. Here are some steps you can take:
- Medical Evaluation: A thorough evaluation by a physician is essential. They can assess her overall health, review her medications (if any), and conduct necessary tests to rule out underlying conditions that may be causing her discomfort.

- Pain Assessment Tools: Healthcare providers can use specific tools designed for assessing pain in individuals with cognitive impairments. These tools can help gauge the intensity and nature of the pain your grandmother is experiencing.

- Non-Pharmacological Interventions: Depending on the findings, non-drug approaches such as physical therapy, gentle exercises, or even massage may help alleviate discomfort. Additionally, ensuring a comfortable environment and addressing any potential sources of anxiety can be beneficial.

- Monitoring: Keep a diary of her pain episodes, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for healthcare providers in diagnosing and managing her condition.

In conclusion, while it is not uncommon for centenarians, especially those with dementia, to express pain in varying degrees, it is crucial to seek medical advice to ensure that any underlying issues are addressed. Pain management in older adults is a delicate balance, and a tailored approach that considers both physical and psychological aspects is essential for improving their quality of life.

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