Author: Swikruti Kar

When caring for someone with dementia, recognizing pain is not always straightforward. People with dementia may struggle to communicate clearly—especially about discomfort or pain. They might not be able to tell you what hurts, where it hurts, or even when it started. As a result, caregivers must become attentive observers, picking up on nonverbal signs and changes in behavior that may indicate pain.

Why Recognizing Pain in Dementia Is So Important

Pain affects not just the body, but a person’s mood, behavior, and overall well-being. When left untreated, it can lead to agitation, sleep problems, or even depression in individuals with dementia. But because they often can’t express pain in typical ways, it’s critical that caregivers learn how to identify and manage it through alternative approaches.

How Can You Tell If a Person with Dementia Is in Pain?

Knowing the person is key. Understanding their baseline behavior, medical history, and personal cues helps caregivers spot when something is “off.” Signs of pain may include:

• Grimacing or facial expressions of discomfort

• Restlessness or repetitive movements

• Moaning or calling out

• Withdrawal or aggression

• Refusing to eat or sleep

Are There Ways to Relieve Pain Without Medication?

Absolutely. While medications can play an important role in managing pain, there are many non-drug strategies that can provide relief and improve comfort:

• Gentle massage to relax muscles and improve circulation

• Repositioning the person regularly to avoid pressure and stiffness

• Playing soothing music to ease anxiety and reduce pain perception

• Light exercise or walking (as appropriate) to improve mobility

• Maintaining a clean and calming environment

• Adjusting the room temperature to a comfortable level

• Offering companionship—a calming voice, a held hand, or reassuring presence

• Monitoring subtle behavioral changes that may indicate hidden pain

These small, thoughtful acts can make a big difference in the daily lives of people with dementia.

Acute Pain vs. Chronic Pain: What’s the Difference?

Understanding the type of pain is crucial for treatment:

• Acute pain has a sudden onset, often indicating a new issue or injury. It needs prompt assessment, and a physician should be notified right away.

• Chronic pain is ongoing and typically stems from long-term conditions such as arthritis or back pain. This type of pain may already be managed with scheduled medications and requires regular monitoring.

How Dementia Affects the Perception of Pain

In people with dementia, the brain’s ability to perceive and interpret pain becomes impaired. This means:

• A minor injury might feel overwhelmingly painful

• A serious injury might go unnoticed

This disruption can make it extremely challenging to assess their pain accurately. That’s why understanding their medical history, behaviors, and communication patterns is essential.

Managing Pain: A Proactive Approach

To prevent or control pain effectively:

• Identify whether the pain is acute or chronic

• Administer medications on schedule if prescribed

• Use non-medical strategies consistently

• Observe daily behaviors for subtle changes

As caregivers, the role is to be a voice for those who may not be able to speak for themselves. By combining knowledge, compassion, and observation, we can recognize pain early and provide the comfort every person deserves.

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When caring for someone with dementia, it’s easy to focus on managing behaviors—especially when those behaviors are difficult, confusing, or distressing. But what if the real cause isn’t cognitive decline alone, but something else entirely—like pain?

Pain Often Hides Behind Behavior

People with dementia may not be able to clearly express when they’re in pain. Instead, that discomfort often shows up in how they act. Common behaviors like:

• Pacing up and down hallways

• Repeatedly calling out

• Refusing care

• Pushing caregivers away

…can all be signs that the person is hurting.

These behaviors are not simply “part of dementia”—they may be the person’s only way of saying, “I don’t feel right.”

Why Pain Is Often Overlooked

Dementia affects memory, communication, and the ability to describe sensations. A person may not say, “My back hurts,” but instead act agitated or withdrawn. Unfortunately, this often leads to misinterpretation. Behaviors may be labeled as aggression, anxiety, or restlessness, without considering pain as a root cause.

The Importance of a Pain Assessment

Before turning to medications like antipsychotics or sedatives to manage behavior, it’s critical to assess for pain. A proper pain assessment—using both observation and tools designed for people with cognitive impairment—can reveal what words may not.
In many cases, once pain is treated (with medication, physical therapy, or other interventions), the behavior improves—or stops altogether.

Caring With Understanding

Recognizing pain as a possible trigger for challenging behaviors can change everything. It shifts the focus from “managing behavior” to “relieving suffering.” This not only improves the person’s quality of life but also creates a more compassionate, responsive approach to care.

Using the CARES® Approach, caregivers can better recognize when challenging behaviors in dementia may be signs of unspoken pain—and respond with empathy, assessment, and appropriate support.

Helping someone with dementia starts with empathy, understanding, and the right tools. To support you on this journey, we’re offering 10% OFF any training and certification program with promo code BeautifulAugust at checkout. Take the next step in providing compassionate, informed care. Offer valid through Aug 31, 2025.

Pain is a deeply personal and often invisible experience. For individuals with dementia, this invisibility can become even more profound—leading to pain that goes unnoticed, untreated, and misunderstood. Although many chronic health conditions are known to cause pain, research shows that pain is reported in people with dementia only about half as often as in people without dementia facing similar conditions. This raises an important question: do people with dementia feel less pain?

The Answer Is Likely No.

It’s far more likely that pain is simply going unrecognized. Dementia can impair a person’s ability to communicate clearly, making it difficult for them to describe pain, its location, or its intensity. As a result, caregivers and healthcare professionals may miss the subtle signs that something is wrong.

Why Recognizing Pain in Dementia Matters

Understanding a person’s history with chronic pain is critical. Untreated pain doesn’t just cause discomfort—it can impact a person’s overall behavior, interactions, and ability to perform daily tasks. Pain can be mistaken for confusion, agitation, or even aggression. But at its core, that behavioral change may be a cry for help.

Common Health-Related Sources of Pain

Pain in people with dementia is often due to common physical conditions, many of which can go unnoticed. These include:

• Arthritis or Joint Disease: Joint pain is one of the most common causes of discomfort, especially in long-term care settings. Up to 80% of residents in such facilities may have joint pain.

• Constipation: A very common but often overlooked source of discomfort.

• Bed Sores: Especially in those who are immobile or bedridden.

• Dental Problems: Cavities, infections, or gum disease may go unnoticed.

• Dry Mouth: May cause discomfort and difficulty eating or speaking.

• Urinary Retention: Discomfort from not fully emptying the bladder.

• Foot Issues: Overgrown toenails or unnoticed sores.

• Respiratory Issues: Shortness of breath or chest discomfort.

• Heartburn or Ulcers

• Cancer or other chronic illnesses

• Mental Health Concerns: Anxiety, depression, and worry can also contribute to perceived or actual pain.

Environmental Factors That Add to Discomfort

Pain doesn’t always originate from the body. Environmental discomfort can also affect people with dementia:

• Room Temperature: A space that’s too hot or too cold can cause physical distress.

• Noise: Overstimulating environments can lead to discomfort or anxiety.

• Uncomfortable Surfaces: Hard or unsuitable beds and chairs can cause physical pain, especially over time.

When Tasks Become Painful

Everyday activities may also become sources of distress:

• Physical Pain: Tasks like buttoning a shirt or brushing hair may hurt due to arthritis or other conditions.

• Emotional Pain: Struggling with a task may lead to embarrassment, agitation, or withdrawal.

Communication Barriers: The Biggest Challenge

Perhaps the most significant challenge is that people with dementia may not be able to describe what hurts—or where. Sometimes, the pain they feel may not even match the part of the body they refer to. This mismatch makes it even harder for caregivers to identify and treat the issue.

What Can Be Done?

To provide effective care, it’s essential to:

• Know the person’s medical and pain history.

• Be alert to nonverbal cues, such as facial expressions, moaning, restlessness, or changes in behavior.

• Consider environmental adjustments—reduce noise, ensure comfortable temperatures, and use soft surfaces.

• Break tasks into smaller, manageable steps to reduce frustration and physical strain.

• Consult healthcare professionals who understand how dementia affects communication and pain perception.

Pain is personal, but when someone is unable to express it, it becomes the caregiver’s responsibility to notice the signs. By taking a thoughtful, patient, and CARES® Approach, we can ensure that people with dementia are not left to suffer in silence.

To better support someone living with dementia, it’s essential to build your understanding and skills. As part of our commitment to caregivers and healthcare professionals, we’re offering 10% OFF any training and certification program with promo code BeautifulAugust at checkout—valid through Aug 31, 2025. Let us help you make the journey a little easier.

When someone has dementia, recognizing their discomfort or pain isn’t always straightforward. They may not be able to say, “I’m in pain,” especially as the disease progresses. However, just because they can’t explain it doesn’t mean they aren’t feeling it. As a caregiver, family member, or healthcare provider, you play a vital role in noticing signs of pain and helping ensure the person gets the comfort and care they need.

Why Is It Hard to Spot Pain in Dementia?

Dementia, including Alzheimer’s disease, affects the brain’s ability to process and communicate. This means that as the condition progresses, the person’s ability to describe or even recognize their pain often decreases. The signs can be subtle or easily mistaken for other issues such as confusion, agitation, or fatigue.
Understanding how communication changes through each stage of dementia can help you better recognize signs of pain and discomfort.

How Pain Communication Changes Through the Stages of Dementia

Normal Thinking (No Dementia)

A person without dementia can describe their pain clearly—where it hurts, how much it hurts, and what makes it better or worse. They may even be able to provide a detailed history, helping caregivers or medical professionals treat it more effectively.

Early Stage Dementia

In the early stage, most people can still talk about their pain. However, they may forget certain details, such as when it started or how long it’s been bothering them. While they may still be able to communicate well, caregivers should be prepared to ask follow-up questions for more clarity.

Middle Stage Dementia

In this stage, communication becomes more difficult. People might struggle to find the right words to describe their pain or may need prompting. They might say things like “I don’t feel right” or “Something’s wrong” instead of directly saying they’re in pain.
What to watch for:

• Vague or unusual descriptions of discomfort

• Repeating phrases like “Help me” or “Make it stop”

• Facial expressions showing distress

Late Stage Dementia

In the late stage, people often lose the ability to speak clearly or at all. Pain is often shown through behaviors rather than words.
Signs may include:

• Moaning, groaning, or shouting

• Facial grimacing or frowning

• Restlessness or fidgeting

• Rocking or repetitive movements

• Sudden changes in mood, such as increased irritability or aggression

It’s important to note: Not all moaning or restlessness is due to pain, but it can be a strong indicator—especially if it’s new or happens suddenly.

End of Life

In the final stage of dementia, verbal communication may stop altogether. You’ll need to rely fully on physical and behavioral cues. Agitation, groaning, clenched fists, or changes in breathing could all signal discomfort or pain.

What You Can Do as a Caregiver or Team Member

You are often the first to notice when something seems off. If you think someone with dementia is in pain:

• Speak up immediately: Report your concerns to a nurse, doctor, or supervisor.

• Give details: What did you see or hear? When did it start? Has anything helped or made it worse?

• Trust your instincts: If something doesn’t seem right, it probably isn’t.

Your attention and care can make a huge difference in a person’s comfort, especially when they cannot speak for themselves.
You are their voice. Your awareness matters.

Caring for someone with dementia means noticing even the quiet signs of discomfort. We’re here to support you in this journey—get 10% OFF any training and certification program with code BeautifulAugust at checkout. Offer valid through Aug 31, 2025.

Mealtimes can be a comforting part of the day for people living with dementia—if done thoughtfully. A calm, inviting environment combined with respectful assistance and cultural sensitivity can make a big difference in whether someone eats well and enjoys the experience. Let’s explore how you can apply what you’ve learned about mealtime support to help make eating easier, more enjoyable, and more successful.

Create a Supportive Mealtime Environment

A well-thought-out environment helps people with dementia focus on the meal and enjoy the process of eating. Here are several easy yet effective ways to set the stage for a pleasant dining experience:

• Reduce distractions. Turn off the TV, radio, or loud conversations that might overwhelm or confuse the person.

• Make the space feel like home. Use tablecloths, soft lighting, or a vase with fresh flowers to create a warm and familiar setting.

• Include them naturally. Invite individuals with dementia to join the table as you would at home. A friendly invitation can make them feel welcomed and included.

• Appeal to the senses. Let the aroma of fresh bread or a warm casserole fill the room before a meal—smells often stimulate appetite.

• Consider seating arrangements. Who sits next to whom matters. Familiar faces or calm companions can help reduce anxiety.

• Promote physical activity before meals. A short walk or light stretching beforehand may help stimulate hunger.

• Offer purpose and participation. Ask them to help set the table or assist with meal prep. Even simple tasks like folding napkins can foster a sense of usefulness.

• Host themed mealtime events. A mid-afternoon tea party with hats and light refreshments can add joy to the day and turn eating into a social experience.

• Encourage social interaction. Introduce tablemates to one another—shared moments at the table can foster connections.

Keep Hydration Fun and Frequent

Getting enough fluids can be especially difficult for those with dementia, but there are creative ways to make hydration more appealing:

• Host a daily “happy hour.” Serve colorful, non-alcoholic drinks like fruit spritzers or smoothies in fun cups or glasses.

• Offer hydrating treats. Popsicles, gelatin, or water-rich fruits like melon, grapes, or oranges are great options.

• Use every opportunity to offer fluids. Bring water each time you enter a room or after a trip to the bathroom.

• Make hydration mobile. Walk the hallways with a juice cart and offer drinks to everyone. A smile and a cheerful offer can go a long way.

To support your journey, enjoy 10% OFF any CARES® training or certification with code BeautifulAugust at checkout. Offer valid through Aug 31, 2025.

When caring for someone with dementia, mealtimes can often feel like a challenge. But with the CARES® Approach, we are reminded that eating and drinking “well” isn’t just about nutrition. Mealtime is far more than a routine—it’s a meaningful experience, a moment of connection, and often the highlight of the day for many people.

For individuals living with dementia, especially in the later stages, engaging during mealtimes becomes not only important but essential. Here’s why—and how—you can make those moments truly count.

Why Engagement at Mealtime Matters

We often forget that food brings people together. It’s not just about what’s on the plate—it’s about the environment, the company, and the comfort that mealtimes offer. For those with dementia, these moments help preserve dignity, encourage interaction, and even stimulate positive memories.

When caregivers create a thoughtful, engaging mealtime environment, it can:

• Reduce agitation and confusion

• Encourage better appetite and hydration

• Promote a sense of normalcy and belonging

• Foster emotional connections

Simple Ways to Create a Meaningful Mealtime Environment

Here are some practical and compassionate ways to enhance the mealtime experience for someone with dementia:

1. Sit Besides, Not stand over

Instead of standing over the person while feeding them, sit down and stay at their eye level. This small change can shift the experience from clinical to caring. Standing over someone can feel impersonal or even demeaning, while sitting shows presence, respect, and attentiveness.

2. Make It a Conversation, Not a Task

Don’t just serve the food—talk about it. Describe the textures, aromas, or flavors. Ask what they liked eating in the past. Even if verbal responses are limited, your tone and smile offer reassurance and warmth. Mealtimes are opportunities to connect, not just complete a task.

3. Curate the Environment

Consider placing the person with others they are comfortable around—perhaps friends, family, or familiar caregivers. If that’s not possible, gentle background music can create a calming and pleasant atmosphere. These sensory touches can turn an ordinary moment into something memorable.

4. Focus Your Attention

If you’re helping someone eat, focus on them. Avoid talking over or around them with others in the room. A divided conversation may make the person feel excluded or overlooked. Even a quiet meal can feel meaningful when you’re fully present with them.

Every mealtime is a chance to nourish not just the body, but also the heart and soul. Using the CARES® Approach—focused on Connection, Attention, Respect, Engagement, and Support—can help transform meals into comforting and enriching experiences for people with dementia.
Remember, it’s not just about food—it’s about how we share it.

Make mealtimes more meaningful. Learn how to connect, engage, and care with confidence using the CARES® Approach. Get 10% OFF any training or certification program with code BeautifulAugust at checkout. Offer valid through Aug 31, 2025.

This is the final step in the CARES® Approach—and one that truly shapes the mealtime experience. Sharing with others about what happens during meals is essential in dementia care. It helps everyone involved in caregiving stay aligned, leading to more thoughtful, consistent support at the table.

Whether it’s a new food the person enjoyed, a calm way that helped reduce resistance, or a small sign of discomfort—sharing these observations helps the person with dementia feel better understood and cared for. It also builds stronger communication and trust among the care team and family.

When sharing your mealtime experience, keep these points in mind:

1. Clearly describe what the person ate, how they reacted, and what strategies you used.

2. Note what made things easier—or harder—during the meal.

3. Include specific details that might help others continue what works.

4. Don’t overlook the small things—they often make a big difference.

5. Always share with compassion and respect.

Remember: sharing isn’t just about reporting what happened. It’s about creating a supportive circle around the person—where everyone contributes to making mealtimes calm, dignified, and nourishing.

If mealtimes feel overwhelming while caring for someone with dementia, the CARES® Approach offers practical guidance—like the importance of sharing with others to create a supportive care environment. To help you get started, enjoy 10% OFF any training or certification program with code BeautifulAugust. Offer valid through Aug 31, 2025.

In dementia care, it’s not just about offering support—it’s about offering the right support. That’s why the fourth step in the CARES® Approach, “E – Evaluate What Works,” is so important. After you’ve connected, assessed, and responded, the next key step is to pause and reflect: Is this working well for the person in my care?

When it comes to eating well, evaluating what works becomes even more essential. People living with dementia may face challenges with appetite, food preferences, chewing, or swallowing. Caregivers need to be observant and flexible to ensure mealtimes are not only safe, but also enjoyable.

Learning Through Example: Barb and Ann

This is a very informative interaction between Barb, a nurse, and Ann, a woman with dementia. Their mealtime routine offers a powerful lesson in how thoughtful caregiving can encourage better food intake and emotional comfort.

Here are some key takeaways from Barb’s approach:

• She prepares Ann for what’s next
Before offering each bite, Barb lets Ann know what she is about to do. This simple explanation helps Ann feel more in control and less startled by unexpected actions.

• She observes and adjusts
Barb carefully watches Ann’s reactions and constantly checks in— “How is that bite?” This helps her identify what Ann enjoys and when to slow down or pause.

• She stays calm and patient
Barb’s calm demeanor creates a relaxed environment, which helps ease Ann’s anxiety and makes eating a more comfortable experience.

• She knows Ann’s best time for meals
Understanding that breakfast is typically the best meal of the day for Ann, Barb puts extra effort into making that experience a success—both nutritionally and emotionally.

• She respects Ann’s preferences
Barb doesn’t push foods Ann dislikes. If something doesn’t go over well, she doesn’t offer it again. This builds trust and makes mealtime a more positive experience.

• She creates a calm eating environment
Keeping distractions, noise, and clutter away helps Ann focus on her food and feel safe—an important factor in dementia-friendly dining.

Why This Matters

Mealtime is more than just eating. For someone with dementia, it’s a deeply sensory and emotional experience. By evaluating what works—like Barb does—you create a supportive space where the person feels heard, respected, and nourished.

It’s not just about the food. It’s about how it’s offered, when it’s offered, and where it’s offered. All these things matter.

Your Role as a Caregiver

As a caregiver, your job is part observation, part intuition, and part adjustment. What worked yesterday may not work today—and that’s okay. The key is to stay engaged and responsive.

Ask yourself:

• Is the person enjoying the food?
• Are they showing signs of stress or calm?
• Should I try a different environment or time of day?
Sometimes the smallest change—a softer voice, a quieter room, a better time—can make the biggest difference.

If mealtimes feel challenging when caring for someone with dementia, the CARES® Approach can help guide you. We’re here to support you on this journey—enjoy 10% OFF any training and certification program with code SunnyJuly at checkout. Offer valid through July 31, 2025.

When caring for someone with dementia, helping them eat well is more than just offering food—it’s about understanding behavior around food, their needs and responding in ways that make them feel safe, respected, and comfortable. The CARES® Approach provides a helpful framework for dementia care, and the third step—Respond Appropriately—is especially important during mealtimes.

Understanding Behavior Around Food

People with dementia may refuse to eat, get distracted, become frustrated, or have difficulty using utensils. These behaviors aren’t random—they often reflect underlying needs or discomfort. Responding appropriately requires recognizing these signs and adjusting your approach based on what you know about the person.

Use What You Know About Them

Each person has unique food preferences, habits, and routines developed over a lifetime. Use this knowledge to make meals more familiar and enjoyable:

• Favorite Foods: Serve dishes they’ve always loved.
• Cultural Preferences: Respect traditions or dietary restrictions.
• Mealtime Routines: Stick to familiar times and settings for meals.

For example, if someone always ate lunch at noon with soft music playing, recreating that experience may help them feel more at ease and willing to eat.

Respond with Calm and Care

A person may become upset or confused during mealtime. If they push food away or say they’ve already eaten, avoid correcting them. Instead, gently encourage or offer an alternative. How you respond can reduce anxiety and encourage better eating habits.

Be Flexible and Patient

Eating might take longer. They may need visual cues, hand-over-hand guidance, or even finger foods. Be prepared to adapt as their needs change, always with a focus on dignity and comfort.

Create a Positive Environment

Minimize distractions, offer foods with appealing colors and smells, and sit at eye level while offering support. A calm and inviting atmosphere can make a big difference.

Helping someone with dementia eat well begins with understanding and support—and we’re here to help you every step of the way. To make that journey a little easier, enjoy 10% OFF any training and certification program with code SunnyJuly at checkout. Offer valid through July 31, 2025.

Mealtimes can be a source of comfort and connection—but for people living with dementia, they can also become moments of confusion or distress. That’s why the CARES® Approach includes a crucial second step: Assess Behavior. Understanding the “why” behind a person’s actions during meals can help caregivers create a more positive, calm, and nourishing experience.

Why Assessing Behavior Matters

Behavior is a form of communication, especially for someone with dementia who may struggle to express their needs with words. If a person refuses to eat, leaves the table repeatedly, or takes food from others, these behaviors aren’t random—they’re signals. The key is to assess what the person might be trying to communicate through their actions.

Observing and Identifying Patterns

Start by observing what’s happening during meals. Ask yourself questions such as:

• When does the behavior occur? Is it only at lunch or dinner?
• Where is it happening? At the dining table, in a group setting, or somewhere more private?
• Who is present? Does the person behave differently depending on who else is at the table?

By noticing these patterns, you may uncover important clues. For example, if someone leaves the table when it’s noisy, they may be overwhelmed by the environment. If they take food from others, they may be confused about which plate is theirs.

Assessing behavior is not about judgment—it’s about curiosity and compassion. It’s about taking the time to truly see the person behind the behavior and meeting their needs with patience and understanding. When we look beyond the surface, we often find simple, meaningful ways to improve the dining experience for people living with dementia.

Supporting someone with dementia begins with understanding and compassionate care. To help you on that journey, we’re offering 10% OFF any training and certification program with code SunnyJuly at checkout—valid through July 31, 2025.