The Assessment of Discomfort in Dementia (ADD) Protocol focuses on the evaluation of persons with dementia that may represent discomfort and encompasses physical, affective, and social dimensions of pain.
Indicators of discomfort:
1. Facial expression: grimacing, frowning, blinking, tightly closed or widely open eyes, frightened, weepy, worried, sad
2. Mood: Irritability, confusion, withdrawal, agitation, aggressiveness
3. Body language: tense, wringing hands, clenched fists, restless,
rubbing/holding body part, hyper- or hypoactive, guarding body part, noisy
4. Voice: Moaning, mumbling, chanting, grunting, whining, calling out,
screaming, crying, verbally aggressive
5. Behavior: change in appetite, sleep mobility, gait, function, participation,
exiting, wandering, physically aggressive, socially inappropriate
or disruptive, resists care
If potential pain behaviors are identified, the protocol consists of the following steps:
Step 1: Assessment of physical signs and symptoms
Step 2. Current/past history of pain
Step 3. If steps 1 and 2 are negative, assess environmental pressures, pacing of activity/stimulation, meaningful human interaction, and intervene with nonpharmacological comfort interventions.
Step 4: If unsuccessful, medicate with non-narcotic analgesic per written order.
Step 5: If symptoms persist, consult with physician/other health professional or medicate with prn psychotropic per written order.
See reference for more information.
Kovach C, Noonan P, Griffie J, Muchka S, Weissman D. The Assessment of Discomfort in Dementia Protocol. Pain Management Nursing 2002;3(1),16-27.