Sources of Discomfort in Nursing Home Residents with Dementia

The assessment of pain and discomfort among individuals with dementia is complicated by the difficulty such individuals face in identifying the source of their discomfort, as well as the variety of physical ailments that often accompany dementia. A study recently published in JAMA Internal Medicine examines an alternative approach to existing measures of pain and discomfort for individuals with dementia, which usually include asking residents to rate their level of pain, or calling on observers to estimate the physical pain the resident may be experiencing.

The alternative approach used in the study emphasizes asking agitated residents about their comfort, inquiring about potential sources of discomfort in their immediate environment, and making observations about potential sources of discomfort (e.g., is the resident sitting in a potentially uncomfortable position). Researchers used a scale called the Sources of Discomfort Scale (SODS), and administered half of the residents a standard scale for pain.

There was a significant correlation between pain and the number of sources of discomfort identified by the SODS. The SODS identified a mean number of three sources of discomfort per resident, suggesting that there may be a high baseline rate of discomfort among residents with dementia. The most common source of discomfort among study participants was feeling tired or sleepy, and about half of participants had also been remaining inactive in the same place for two or more hours. About one-quarter of participants who were agitated were also in areas with insufficient light, or appeared uncomfortable in their seats.

As the authors note, this source- and context-based approach to detecting discomfort points caregivers to immediate interventions to reduce the discomfort, such as encouraging some brief physical activity or providing better ambient light around the resident. Asking residents about potential sources of discomfort, along with systematically monitoring potential discomfort sources in the care environment, might point to relatively simple environmental modifications to improve quality of life in care settings.


Cohen-Mansfield J, Thein K, Marx MS, et al. Sources of discomfort in persons with dementia. JAMA Internal Medicine (2013); 173(14): 1378–1379.

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