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How Do You Know If A Senior With Dementia Is In Pain?

A caregiver sits at the bedside of a senior lady who is lying in bed.

Dementia is a cognitive disease that causes memory loss and personality changes. Here are some signs that a dementia patient is experiencing pain:

  • Facial changes like grimacing
  • Tensing or rubbing an area
  • Twitching or fidgeting
  • Restlessness
  • Shouting
  • Groaning
  • Anxiety

Dementia patients can feel pain the same as anyone else, but their ability to express it diminishes due to the disease.

Since pain can worsen dementia and reduce quality of life, understanding verbal and nonverbal pain cues and responding to them swiftly is a must.

Let’s take a closer look at the verbal and nonverbal indicators of pain to pay attention to.

Appetite Changes

Pain can dull one’s appetite and sometimes make eating physically difficult. Monitor if a dementia patient’s appetite suddenly changes.

If they haven’t recently started a new medication (or adjusted their dosage) and you’re serving the same meal they usually enjoy, they might be eating less (if at all) because of their pain.

Stiff Posture

Does the dementia patient seem stiff? Do you notice this stiffness more when in certain positions, such as sitting up or lying down? This can also indicate pain.


Mood changes from pain are common.

The dementia patient may become quieter and less engaged in everyday activities they usually enjoy. They might also seem sullen or even depressed.

Sleeping A Lot Or Much Less

Excessive pain can prevent a dementia patient from sleeping. However, this sign is harder to miss, as insomnia is common with cognitive disorders.

Oppositely, sleeping too often can become a problem as the patient tries to mitigate or escape the pain.

Grimacing Or Frowning

These are more overt signs of pain that most of us can easily recognize. However, if the dementia patient is regularly in a sour mood, even frowning and grimacing can be overlooked as pain indicators.

Anxiety Or Fear During Daily Tasks

Does the dementia patient suddenly seem anxious about completing basic daily tasks like showering, dressing, eating, or using the bathroom?

This fear might make you think something else is afoot, but it could be nervousness at causing pain by completing these tasks. 

Heavy Breathing

Listen to the way the patient breathes. Does their breathing seem strained and labored during activities even if they aren’t physically exerting themselves?

This could indicate they’re in pain, especially if you’ve noticed other symptoms.


This is another subtle sign, but frequent sighing could be the dementia patient’s nonverbal expression of discomfort.


Crying is one of the clearest indicators the dementia patient is in pain, as it’s a reaction most of us have to intense discomfort.

Moaning Or Groaning

Does the patient groan or moan a lot when sitting or lying down? Do they do this when awake and asleep? This is another can’t-miss sign that they’re dealing with recurring pain.

Rubbing The Affected Area

Here is yet another obvious sign of pain, as rubbing an area that hurts is something many of us do.

It’s an attempt to alleviate the pain and perhaps the patient’s way of indicating to you that this is where it hurts.

Twitching Or Fidgeting

Does it seem like the dementia patient can’t get comfortable? Do they constantly shift in their seat or bed? Fidgeting and twitching are subtle pain signs.


Although it might seem counterintuitive to be on one’s feet if in pain, pacing is nevertheless an indicator.

The dementia patient may attempt to lessen their pain by being mobile or distract themselves from it.

Shouting Or Calling Out

Lastly, pay attention to verbal cues like shouting or calling out. The patient might not say they’re in pain outright, but these signs express that something is wrong.

Can Chronic Pain Worsen Dementia?

We’ve established that dementia patients experience pain but don’t always express it, but what about the effects pain can have on dementia? For instance, can chronic pain make dementia worse?

It can, says Dementia Australia. Chronic pain can impact a dementia patient’s thinking and brain functioning, even accelerating the rate of mental deterioration.

Further, a 2023 PNAS study found that chronic pain – which the article defines as pain that lasts for more than three months – can increase one’s dementia and cognitive decline risks.

The more pain sites one person has, or the more sources of chronic pain, the higher the risk.

The researchers concluded that the hippocampus of a chronic pain sufferer at 60 years old was up to a year older in a person with one chronic pain site versus someone with none.

Two chronic pain sites aged the hippocampus by two years, and the hippocampus volume was four times smaller in those with five+ pain sites.

These two pieces of data underscore the need to address pain when you begin feeling it, whether you’re 20 or 60.

Treating pain when you’re younger can prevent it from becoming a recurring issue that will plague you when you’re older.

Even if you’re an otherwise healthy senior without any dementia risk, you shouldn’t ignore lasting pain. It could put you on the road to cognitive decline.

If other family members have dementia and you know you’re at an elevated risk, you must prioritize pain remediation.

It’s also important for patients with dementia to be understood so their pain doesn’t continue to worsen their condition.

If you suspect the dementia patient in your care is in pain, ask them specific questions.

For example, point to the area you think hurts and ask them if it aches.

Ask yes or no questions to facilitate simple responses and use the signs in the above section to confirm the presence of pain.

Speak to the senior’s doctor about pain alleviation measures you can take, whether it’s something simple like over-the-counter NSAIDs or a prescription treatment like stronger painkillers or physical therapy.

When Should Palliative Care Be Offered To Individuals With Dementia?

Palliative care reduces symptom severity and improves quality of life, making it an ideal option for dementia patients. When should you introduce palliative care?

There’s no specific time for a dementia patient to undergo palliative care.

Some adult children might insist on this care immediately after the dementia diagnosis, as the symptoms of the cognitive disease will only get more severe as it progresses.

Others might wait until the dementia worsens and then seek palliative care.

Dementia is incurable, so palliative care only makes the patient more comfortable. It can be combined with curative measures such as medication or used on its own.

The dementia patient can receive palliative care as long as deemed fit, whether that’s months or years.

Although palliative care won’t erase a patient’s dementia, we still must underscore its significance.

Reduced pain and discomfort in dementia patients make them easier to care for, lessening caretaker and family stress.

Further, the care could slow the dementia, so there’s never a wrong time to begin.

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