Frost focuses on comfort measures, education, when intervening pain
Monday December 3, 2007 -- Deron Hamel
Keeping people comfortable and using “every day kind of remedies first” is a major focus of staff members at Frost Manor when tending to residents exhibiting agitation.

Nancy Lafete, a registered nurse at the Lindsay long-term care home, says discomfort often triggers agitation in residents who have dementia.

This is, she adds, can lead to a misdiagnosis of the cause of the behaviour exhibited, which, in turn, can mean a person needing pain-and-comfort measures is instead given psychotropic medication to ease the agitation.

Over the years, Frost Manor — like other OMNI long-term care homes — has curbed its use of psychotropic medication, instead seeking to identify whether or not behaviours are the result of pain issues.

“Most times you’ll find that when a resident is in discomfort, they will display behaviours that some people may perceive as needing a psychotropic, as opposed to pain and comfort measures,” says Lafete.

Hot packs and repositioning are often utilized in lieu of medications as the first step in treating agitation in a resident with dementia.

“(We use) your every day kind of remedies first,” she says.

Lafete says there have been “numerous” examples of residents at Frost Manor who were agitated but following a regime of comfort measures and proper pain management, these behaviours eased.

At the heart of this shift in culture is education, notes Lafete.

By educating frontline staff and physicians they get an idea of what types of pain symptoms to look for in residents, she adds.

“They’re the eyes that see what’s going on, and if they notice a slight change in someone’s eating pattern, their sleeping pattern, their rest cycle at night, they’re the ones that have to be educated to let us know and we can assist them by educating them on comfort measures,” says Lafete.

When comfort measures don’t work for a resident, the next step is to look at pain medicine, she adds.

Observation is an important factor in determining the difference between agitation resulting from pain and agitating resulting from cognitive issues in residents with dementia.

To overcome this challenge, Lafete says staff members need to have knowledge of a resident’s every day behaviour so they can better spot agitation caused by pain when it occurs.