My mother-in-law lives with us. She is in early stages of dementia. Sometimes it’s hard to tell if she is in pain. My husband (her son) always assumes she’s hurting and seems to make things worse by being overly sympathetic. Are there some reliable signs of pain we can use to know for sure when she’s hurting?

For people who tend to catastrophize pain, it’s a natural response to assume others are in greater pain than they actually are. Caregivers such as your husband who perceive their own pain as excessive may become overly concerned about others’ pain. This may be what you are observing.

Nurses and doctors use a variety of ways to measure pain in older adults who are cognitively impaired. Sometimes dementia is the problem. Others suffer from strokes or other neurologic disorders.

For patients who can see but can’t speak, a verbal scale is used. The patient is shown the scale and asked to point to the number that matches their pain. For example, zero is no pain and one is slight pain. The highest number on the scale is a six for pain as bad as it can be.

Sometimes the only way to know is by observed behavior. The patient may become agitated or confused. If confusion is a normal part of the dementia, then watch for increased confusion. The person in pain may moan, gasp, or cry out. Breathing may become more labored. The patient may refuse to move or move slowly by bracing against or holding onto furniture.

Sleep disturbance, weight loss, and depression are other signs of uncontrolled pain or pain that is too much for the person to bear. It may be helpful to make an appointment with the doctor. Take a list of concerns, observations, and questions. You may not have an answer right away but this will help set a baseline for later comparison.