Cognitive Behavioral Approach For Older Adults

Psychological factors are known to contribute to how people experience and cope with pain. However, as people age, they experience normative age-related changes in psychological functioning. Thus, much of what is known about psychology and pain may not necessarily apply to older adults, unless it has specifically been tested in older populations. This is a particularly important point, because pain remains a major problem for millions of older adults. Furthermore, it is expected that the populations of older adults in America will increase significantly in the coming years, as people are living longer now that at any other point in history. Given that psychology changes across the lifespan, and that pain is a problem in older populations, this

The aim of this review is to examine what is the most appropriate method of pain assessment and management when working with clients with cognitive impairment.

Dealing with aging dementia patients can be a challenge in and of itself. However, when healthcare providers need to include regulating pain as well, the challenge becomes even greater. Pain management with cognitively impaired patients is a constant problem within geriatric care in modern healthcare facilities (Zwakhalen et al 2006). The reduced self capacity to report pain in its true degrees then makes pain management a challenge for physicians and healthcare providers (Husebo et al. 2007). Thus, research aims to explore effective measures for observing and reporting pain management within aging dementia patients.

Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include

Recognizing that the prevention of chronic disease and promoting population health is the key to controlling health care expenditure, the inclusion of pain management is a positive aspect of the legislation. While chronic pain is not in the top leading chronic diseases, the cost to the health care system is higher than heart disease and diabetes combined.2 This paper will discuss Title IV - Prevention of Chronic Disease and Improving Public Health. Subsection D - Support for Prevention and Public Health Innovation of the PPACA, including the funding of the United States Department of Health and Humans Services (HHS) for research in public health services and the examination of best prevention practices. One focus of this part of this provision is research and evaluation of pain management, the assessment, and treatment standards through an Institute of Medicine Conference on Pain Care.3

Aim/ purpose of study: Conglomeration of current data on pain and pain management for patients with dementia.

Secondly, priori power calculation showed a sample size of 52 was needed to reach a power of 0.8 with a large effect size. However, only 42 participants were successfully recruited, which reduced the power of the current study. However, previous studies with similar sample sizes (Pincus et al., 1996) found evidence of cognitive biases in chronic pain patients. On the other hand, we assumed a large effect size based on

In order to identify and prevent persistent pain in elderly population with dementia, Monacelly et al. (2013) conducted a study in a nursing home in Italy by using Doloplus-2 pain assessment tool. The participants were patients (n=23) with moderate to severe dementia and were unable to express the feeling of pain. Researchers obtained consent from the management and designated legal guardians of the patients. The purpose of the study was to observe the pain symptoms of the same group of elderly population for a period of one year and evaluate the effectiveness of the pain management by using the Doloplus-2 diagnostic pain assessment tool. As an initial part of the study, presence of pain was confirmed in participated patients by using the Doloplus-2

Implementing interventions to reduce ED encounter for the senior population begins with identifying barriers. The number one issue that contributes to these encounters is the lack of education surrounding what constitutes an emergency (Uscher-Pines, Pines, Kellermann, Gillen & Mehrotra, 2013). Using patient activation measures to assess how engaged clients are in their care. This can give the care providers a starting point on what areas of education are lacking and where more attention needs to be focused (“Patient Activation Measure”, 2017). These measures allow patients to set goals and develop a plan for achieving the goals. In addition, these patients would benefit from a coaching model to assist with identifying medical and

“Pain is a complex, multidimensional experience that can cause suffering. [While] pain is inevitable, suffering is optional” (Kinder, 2014, p. 114). The control of pain is, as Kinder puts it very complex, without appropriate measures it can be easily side stepped especially in the elderly. To ensure patient center care it is important that all aspect of one’s quality of life is address, this is emphasizing by pain being a component of vital signs. Being a vulnerable population the elderly is often under assessed as they minimized their problems so as not to be a burden in addition to the fact that they may believe that their pain is a normal part of aging.

It is a challenge to manage pain in older adults. The course of action, effect and

There is a growing geriatric population of people with dementia (the subpopulation) throughout the world that are living in pain constantly. Because dementia as a condition with multifaceted symptomology manifested by advancing overall decline of cognitive ability, it causes severe and distinctive barriers to pain assessment and pain management in this subpopulation. The existence of multiple comorbidities, polypharmacy and the declining cognition in this subpopulation results in a much more complex pain symptomology. Zwakhalen, Hamers, Abu-Saad, and (replaced & with and) Berger, (2006), explain that common behaviors associated with pain may be absent or difficult to interpret in this subpopulation because some dementia symptoms may be an indication of pain, but such behavior, however, might also be incorrectly interpreted as a symptom of dementia. Therefore, pain in this subpopulation is exceptionally challenging to evaluate and manage as a result of this difficulty.

Pain is defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is always subjective.” (Jarvis, 2016) In our society today, the older adults and older adults who suffer from dementia are poorly assessed in terms of pain assessment. Studies have shown that about 35-48% of older adults living at home suffer from chronic pain, another 45-85% of older adults living nursing homes lives with chronic. Older adults suffer from chronic pain as most suffer from conditions that can lead to chronic pain. The health care professional with the proper pain assessment skills can better manage and treat pain in the older adult. The assessment

Much of the literature and research related to the use of cognitive-behavioral therapy in the treatment of chronic pain is rather new. Overall, upon reviewing the available literature, it appears as though research is focused on determining what particular chronic pain populations experience the most success with CBT-based treatments.

The most common reason that people seek medical care is pain, and pain is the leading cause of disability (Peterson & Bredow, 2013, p. 51; National Institute of Health, 2010). Pain is such an important topic in healthcare that the United States congress “identified 2000 to 2010 as the Decade of Pain Control and Research” (Brunner L. S., et al., 2010, p. 231). Unfortunatelly, patients are reporting a small increase in satisfaction with the pain management while in the hospital (Bernhofer, 2011). Pain assessment and treatment can be complex since nurses do not have a tool to quantify it. Pain is considered the fifth vital sign, however, we do not have numbers to guide our interventions. Pain is a subjective expirience that cannot be shared easily. Since nurses spend more time with patients in pain than any other healthcare provider, nurses must have a clear understanding of the concept of pain (Brunner, et al., 2010). Concept analysis’ main objective is to clarify ideas, to enhance critical thinking, and to promote communication (Rodgers & Knafl, 2000). This paper will examine the concept of pain using Wilson’s Steps of Concept Analysis (Rodgers & Knafl, 2000).