Recognising Signs of Pain in a Parent Who Can't Easily Express It

Pain is hard enough to cope with when you can describe it. But what happens when your parent cannot easily tell you they are hurting? For older people living with dementia, or with communication difficulties after a stroke, or simply with a lifelong reluctance to complain, pain can go unnoticed and untreated, causing real and needless suffering.

Learning to recognise the signs is one of the most valuable and compassionate things a family, or a carer, can do. Here is how to spot pain in a parent who cannot easily put it into words.

Why pain so often goes unrecognised

There are a few reasons pain in older people is missed so often, and understanding them is the first step to catching it.

Some people cannot communicate it. Dementia can make it hard for someone to say they are in pain, or to know where it hurts. A stroke or other condition may affect speech. Some people are unable to express it in words at all.

Many people downplay it. A great many older people are stoical about pain. They may not want to complain, or to be a burden, or they may believe, wrongly, that pain is simply a normal part of getting older that must be put up with.

It gets misread. Perhaps most importantly, pain often shows itself as a change in behaviour, and that change gets blamed on something else. New agitation in a person with dementia, for example, is frequently assumed to be "just the dementia," when in fact the person is in pain and cannot say so.

Why it matters so much

Unrecognised pain is not a small thing. It causes genuine, unnecessary suffering, and it drives all sorts of knock-on problems: distress and agitation, low mood, poor sleep, reduced movement, loss of appetite, and withdrawal from the things a person enjoys.

And here is a message worth holding onto firmly: pain is not an inevitable part of ageing that simply has to be endured. In the great majority of cases, it can be treated or eased. Recognising it and getting it addressed can transform an older person's comfort, mood and dignity. No one should have to suffer pain in silence.

The signs to look for

Since your parent may not be able to tell you in words, the key is to watch for other cues. Pain often reveals itself through:

Facial expressions, such as grimacing, frowning, wincing, a tense or frightened look, or a clenched jaw.

Sounds, such as groaning, moaning, whimpering, crying out, sighing, or noisy breathing, particularly when moving.

Body language and movement, such as guarding or protecting a part of the body, rubbing an area, tensing up, restlessness or fidgeting, rocking, limping, or a new reluctance to move at all.

Changes in behaviour, which can go either way. Some people become agitated, irritable or even aggressive. Others become unusually quiet, withdrawn or low. Confusion may appear or worsen.

Changes in daily patterns, such as sleeping badly, eating less, or losing interest in usual activities.

The single most useful thing to look for is a change from how your parent normally is. It is the new agitation, the new reluctance, the sound they do not usually make, that most often signals something is wrong.

Watch especially during movement and care

Here is a practical tip that helps enormously. Pain very often shows itself most clearly when a person moves, or during personal care such as washing, dressing or being helped to move.

So if your parent winces, cries out, tenses, or resists at these moments, take it seriously. In particular, resisting care that they would usually accept is a common and easily missed sign of pain, rather than simple reluctance. Someone who suddenly does not want to be moved or touched in a certain way may well be hurting.

Look for the cause

When you suspect pain, it is worth thinking about what might be causing it, as some causes are easily treated once found. Common culprits include:

• a wound, sore, or pressure area on the skin
• an infection, such as a urinary tract infection, which can also cause sudden confusion
• constipation, which is a very common and overlooked cause of discomfort
• an injury from an unnoticed fall or knock
• dental or mouth problems
• joint pain or arthritis
• something as simple as a full bladder, or ill-fitting shoes or clothing

Our guide to UTIs and sudden confusion explains more about how a physical problem can show up as a change in behaviour.

What to do

If you suspect your parent is in pain, please do not dismiss it as just their age or their condition. Instead:

• look for an obvious cause you can see or address
• tell their GP, describing the signs you have noticed and when they happen, such as on movement or during care, which is genuinely helpful information
• trust your instinct. If you sense something is wrong, that is worth acting on

A GP can assess the situation and treat the pain. Reassuringly, healthcare professionals have proper ways of assessing pain even in people who cannot describe it themselves, including those living with dementia, so your parent's pain can be taken seriously and managed even when they cannot explain it.

How a live-in carer helps

This is an area where having a consistent carer who truly knows your parent makes a real difference. Because they are with your parent day in and day out, a live-in carer comes to know their normal demeanour intimately, and is therefore well placed to notice the subtle changes that signal pain, the slight wince, the new reluctance, the sound that is not usually there.

A familiar carer will often pick up on discomfort that a rushed visit, or someone who does not know the person, would miss entirely. They can then help with comfort and positioning, flag their concerns promptly to you and the GP, and make sure your parent's pain is recognised and addressed rather than quietly endured. That continuity, and that attentiveness, is one of the quiet but genuine benefits of live-in care.

No one should suffer in silence

Your parent should never have to bear pain alone and unnoticed simply because they cannot easily express it. By learning to read the signs, and with attentive, consistent care, pain can be spotted, understood and treated, protecting your parent's comfort, wellbeing and dignity.

If you would like to talk through how we support the comfort and wellbeing of the people we care for, we would be glad to help.

Book a free care advice call, or give us a ring on 020 3970 9900.

This guide offers general information and is not medical advice. If you think your loved one may be in pain, please speak to their GP or another healthcare professional, who can assess and treat it properly.