Nurses... How do you recognise pain?

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MIL is in her 80s and has dementia.
A couple of months ago she had a fall and has quickly gone downhill.
She sleeps 95% of the time and isn't at all alert when she briefly wakes up.
DH is very worried that she may be in pain but mightn't be able to communicate this to anyone. He has asked her but gets no response.
Can staff recognise pain? How?
Thanks

I would be wondering why she's not alert. Is her GP aware of this? She might have an underlying condition that is making her more sleepy. Has she been assessed recently by drs? Is she on any medication? That might need reviewing.

Some indications of pain might be restlessness, grimacing, loss of appetite, reluctance to mobilise, etc.

Is she in hospital or at home?

WHy does he think it's pain ?

The not being alert doesn't suggest pain to me but I wouldn't rule it out either.

I take it she's not on any pain killers already? or if she is on a regular one it may be making her drowsy.

It's very difficult to spot in patients with Dementia. Usually it's recognising patients crying out when we move them, or aggressive behaviour. A retest study.found regular paracetamol showed a significant decrease in agitation in patients with Dementia. I ask family as well - when you know someone well you are more likely to recognise changes.
There are biological signs too like increased breathing rate, raised temperature, high blood pressure.
I would suspect she has a hypoactive delirium. symptoms include poor response, sleeping for long periods. That's quite common post trauma event such as a fall - I'd ask the doctor if they've investigated her symptoms, making it clear it's not normal. Hth.

IME in someone with dementia pain presents itself in behaviour thats not usual for that person, so stopping mibilising, refusing food, grimacing and often lashing out at care givers / refusing to cooperate with certain aspects of care. The problem is it's really hard to identify if those things are caused by pain or by deterioration in dementia. If your dh is worried and his mother is not taking any analgesia, first step would be regular paracetamol prescription and thats not likely to cause side effects.

Had the GP done a medication review recently - maybe something she takes is causing her to be sleepy? Or maybe she needs investigation to check.she's not e.g anaemic or hypothyroid as.these, amongst other things can worsen confusion.

Hi

Thank you so much for the responses.

The fall happened in her care home and she has been in hospital ever since. They don't seem to know what is wrong. She may be having pain relief but staff haven't said so. She certainly isn't being treated her anything.
She isn't really eating nor drinking and we feel she has given up and wants to just die.
We see no obvious signs of pain and nothing from things you mention above. I will tell DH to ask if she is being given any analgisics.
It is so sad to see her like this.

Thanks

You should definitely make the staff aware that she is not as alert as she was before the fall .
She may well have given up and this is her response which is very difficult for you and your dh to see. Have a word with the staff preferably the Dr or Nurse in charge and see what they think .Is she settled and calm or drowsy due to medication?
If she's been there for a few months they may be thinking the same as you and has probably been checked for UTI , Chest Infection to rule these out aswell.

Yes I agree with
ggirl don't just accept this - I think it's very likely there's a reversible medical cause. They should definitely investigate. Keep pushing!

Just had another thought about this. When you said she had a "fall" - did someone see it happen? Just if she was found on the floor, then it may not just have been a mechanical fall - it could have been a stroke / tia etc, which may account for the changes she had rather than any injury from the fall?. I would assume that when she was admitted to hospital, they would have assessed and investigated for those thinggs.

Also, it may well be that this is the end phase of her dementia. I've looked after patients before, similar to how you describe your MIL, and after everything was investigated, it was decided that it was end stage dementia, and treatment aim was to manage distressing symptoms rather than cure anything. The problem is that unlike other diseases e.g cancer, it is difficult to properly diagnose this as the end of life pathway for someone with dementia can be very unpredictable.

I hope you get some answers soon.

Just a quick response ... I hav just got in and need sleep.

MIL was physically very fit pre-fall. She was playing 'football' when she fell.

Hopefully the Dr will be aware of that , but if you're unsure tell them again!
She may very well have had a stroke/tia at time of fall .
Has she had ct scans of her head to rule out a bleed ? Agree also with the poster who mentioned she may have taken a step for the worse in vascular dementia which tends to deteriorate in steps.
But you need to talk to the medical and nursing team to reassure yourself that all has been done..sounds like the communication is dire tbh.

MIL died yesterday.

Thanks for your responses. DH was reassured that his mum wasn't in pain.

I'm so sorry to hear about your MIL.

membership card, so sorry for your and your DH's loss
I hope you have many lovely memories of her

I'm sorry to hear that she died. I'm glad your DH had some reassurance from our comments.
You take care of DH and yourself

oh i am so sorry to hear that but I am glad she was peaceful

Sorry to hear that.