Ageing

4. Health

4.5. Pain

Pain is a subjective and comprehensive feeling, and if you know why it hurts, the pain is easier to handle. There is less knowledge about how elderly people with disabilities express their pain. Pain is almost a non-existent topic in literature on older adults with ID.

Recurrent acute musculoskeletal pain is a frequently reported symptom in older people, as is pain in other organ systems, related to ageing of those organs. Additionally, it has been postulated that the ageing brain may experience more pain (1). It is a higher proportion of women that have chronic pain (12), and cerebral palsy has a clear physical influence on premature ageing, which often causes problems with pain, concentration and immobility (13). 

Chronic pain is overlooked and untreated, especially in people with inadequate communication (12).Chronic pain in adults and elderly with ID is more common than previously thought. Acute pain can become chronic and psychological causes must always be investigated. Regular medication with analgesic can make it difficult to diagnose the degree of pain in people with ID (1).

Pain that is not recognized, or poorly managed, can affect the quality of life. Studies show that pain is not often on the checklist of health personnel and not something the family or closest providers consider when they assess health status and behaviour change (1, 14). Ordinary health service staff lack practice and knowledge in how to communicate with and understand persons with ID. This can result in the mainstream health system to provid poor services and there is a constant inability of health services to properly detect pain or diseases in those with ID (14). For some years, there are developed assessment tools for pain for persons with ID. However, even today these assessment tools are still in the stage of development.

_{Photo: Lars Aage Hynne}

While persons with mild ID, who have potential communication skills, need to be educated in the effective communication of pain or distress, the family and staff need to be able to recognise signs of pain and distress in persons with severe ID and limited verbal capabilities.

When people with ID are unable to communicate with words, they express their pain in other ways:

• Adaptive behaviour, i.e. rubbing of the affected area, avoiding certain movements
• Autonomic changes, i.e. increased/decreased pulse, blood pressure, sweating 
• Facial expressions, i.e. grimacing
• Hyperactive behaviour
• Self-injurious behaviour
• Self-distracting behaviour, i.e. rocking, pacing, biting hand, gesturing,
• Sleep disturbance
• Vocal responses
• Withdrawal, low mood

ACTIVITY:

Watch the video about identifying and assessing pain (24). When you watch the video, ask yourself if your child/sibling/client have any symptoms of pain and what you can do about it.