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 A person may not say, “My back hurts,” but instead act agitated or withdrawn.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.
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