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“The Ones Who Can't Complain”: Lessons Learned About Discomfort and Dementia

Kovach, Christine R. PhD, RN

Feature Topic: The Lived Experience

Asessing and treating physical pain and affective discomfort in people who can no longer report on their internal states is quite challenging. Since little is known about best practice in pain management for people with dementia, health care providers often learn while “in the trenches.” This article reports one person's professional journey in trying to understand the needs of people with dementia. In addition, a clinical tool, the Assessment of Discomfort in Dementia (ADD) Protocol will be described as a systematic method for improving recognition and treatment of discomfort in clinical practice.

Associate Professor in the School of Nursing and Center Scientist at the Center on Age and Community at the University of Wisconsin–Milwaukee, Milwaukee, Wisconsin. She conducts research to improve care provided to people with dementia including studies on pain assessment and treatment, bathing, therapeutic activity, and the environment of people with dementia.

Address correspondence to: Christine R. Kovach, PhD, RN, University of Wisconsin – Milwaukee, Cunningham Hall, P.O. Box 413, Milwaukee, WI 53201-0413. Telephone: (414) 229-6233; fax: (414) 229-6474; e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.