失智症老人的疼痛

Pain in Elderly People with Dementia

老化及慢性疾病常會伴隨認知障礙疾病的增加，如阿茲海默症、血管型失智症、額顳型失智症等。這些疾病不僅造成腦部組織和神經傳導系統的損傷，也影響患者的口語及非口語溝通能力。以疼痛概念而言，因其極度仰賴個體的主觀詮釋和耐受度，故要評估認知障礙老人的疼痛並非易事；因此必須尋求有效偵測失智症患者疼痛的解決之道。本文系統性閱覽過去十年相關文獻，針對失智症老人疼痛難以被評估的現況、與適用於失智症老人的疼痛定義作陳述；此外更進而檢視確認失智症老人疼痛之障礙因子。系統評讀後發現，評估障礙主要衍生於三大因素：(一)早期典型的操作化疼痛定義，並不適用於捕捉臨床認知障礙不等之失智症老人的疼痛；(二)失智症老人確切的疼痛線索（口語和發聲、行為線索、生理反應）不清楚；㈢疼痛測量方式與評估來源應用上的不適當。為處理上述問題，本文簡介一份適用於不等認知障礙之失智老人（可口語及非口語）的完整疼痛評估模式。基於相關文獻的閱覽與討論，本文建議臨床於評估失智症老人疼痛時，應採用多重測量方式與多面向評估來源以收集疼痛資訊；且未來於研究上，也應持續測試完整疼痛評估模式應用於確認失智症老人疼痛的可行性。

Aging is associated with an increased risk of cognitive impairment, such as Alzheimer’s disease, vascular dementia and frontotemporal dementia. These diseases not only impair brain tissues and the nervous system, but also affect patients' verbal and non-verbal communicative ability. It is difficult, for instance, to assess pain in the cognitively impaired elderly because pain perception draws heavily on a patient's subjective interpretation and tolerance level. To seek an effective solution for pain detection in patients with dementia is therefore essential. From a systematic literature review covering the past decade, this paper presents a synopsis of the difficulty of pain assessment in the elderly with cognitive impairment, changes in the academic concept of pain, and explores factors resulting in obstacles to pain recognition. The obstacles to pain assessment derive mainly from three general factors. Firstly, classic definitions of early stage pain are inappropriate when applied to the elderly with cognitive impairment. Secondly, pain indicators are also unclear for this population. Thirdly, pain instruments and informants are ineffective in evaluating elderly patients with varying cognitive levels. To address these obstacles, a sound, multifaceted model of pain assessment for elderly patients with different severities of cognitive impairment is presented. On the basis of the above literature review, multiple methods for detecting aspects of pain in elderly poeple with cognitive impairment is recommended. To test the feasibility of the multidimensional model of pain assessment, further study is needed.