Patient Centered Pain Control Of Elderly People With Dementia

Research has shown that there are several organizations and active advocates who are working on pain management problems to face this public health issue. The following establishments involve: The American Academy of Pain Medicine, Institute of Medicine, and American Pain Society and many for-profit and nonprofit organizations are also working at different level towards pain management. Most specifically, the IOM has been devoted to studying pain and its consequences on individuals, the healthcare system, as well as on government (IOM, 2011).

5. Zwakhalen, S., Hof, C., & Hamers, J. (2012). Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. Journal Of Clinical Nursing, 21(21/22), 3009-3017. doi:10.1111/j.1365-2702.2012.04313.x

As with all older adults, clients with dementia present with chronic conditions such as arthritis and acute pain experienced in the aging and the end of life process. Moss (2002) gives evidence that most elderly clients who move into long-term care will die in an institution either a nursing home or a hospital many of whom will have dementia. She states that 91% have a strong co morbid condition likely to cause pain.

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.

Persistent pain has psychological and social implications for daily life. It can severely limit an individual’s ability to work and be a productive member of society and decreases quality of life. In the face of increasing stigma and barriers to care, patients are struggling to procure the legal medications that alleviate their debilitating pain.

The mentality of some patients that are prescribed painkillers is that it will cure whatever illness they may have and permanently take away the pain; however painkillers, are supposed to be used to reduce pain for a short period of time to bring comfort to a patient. Due to this mentality, it is becoming more common to run to pain medications; even when some pain can be treated with other methods. In order to start to cure this epidemic, patients need to be compliant with how they are supposed to properly use these types of medications. (Grounder,

A great deal of investment in terms of research has yielded copious information regarding the individual phenomena of sleep and pain. These two subjects have even been studied to a substantial degree in specific populations, the older adult population being one of these. However, study of the interaction between these two phenomena has only recently begun to be of great notice. This interaction, though lately established in the literature, has not been adequately studied in many populations. In particular this inadequacy is notable for the older adult population. A search of the database Academic Onefile using keywords “older adults”, “sleep” and “pain” produced no literature involving all three. The literature used in this review was found with individual searches of “sleep” and “pain”, “older adults” and “sleep”, and “older adults” and “pain”. This issue is of great importance to nurses and other clinicians due to the increasing age of the patient population seen in practice (Berman, Snyder, Kozier, & Erb, 2012), and due to the pervasive difficulties with sleep and pain faced by older adults.

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

Despite the fact that pain is universally recognized as a part of the healing process, ways to minimize its impact on patients have not been aggressively pursued. The modern perspective of pain merits the use of painkillers for both short term and chronic pain, but studies suggest that the likelihood of drug dependence increases with the intensity of the pain, extent of drug use, and frequency of drug use. (Elander, Duarte, Maratos, & Gilbert, 2013). Patients may prefer not to use painkillers such as opioids due to debilitating side effects and fear of developing dependence, yet there are few alternative methods taught to patients to help manage pain.

There is a growing geriatric population of people with dementia 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 population. The existencee of multiple comorbidities, polypharmacy and the declinining cognition in this population result in a much more complex pain symptomology. Zwakhalen, Hamers, Abu-Saad, & Berger, (2006), explain that common behaviors associated with pain may be absent or difficult to interpret in this population 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 population is exceptionally challenging to evaluate and manage as a result of this difficulty.

When one feels that they are experiencing pain, anxiety, or sickness whether it is mild or severe, one quick and easy solution is to head straight to the doctor’s office. A patient will describe his or her symptoms of pain to the doctor and more likely than not that doctor will prescribe the patient some type of prescription drug or pain reliever. Writing patient prescriptions and taking drugs for pain has become a socially acceptable standard in society and has also become an essential part of medicine. Today, Americans are spending millions of dollars every year on drugs, both illegal and legal, and both for medical and often non-medical use. However, what many do not realize is that the widespread increase of drug using in America

According to the Alzheimer’s Society (2013) pain is still poorly detected and undertreated in people with dementia admitted to acute hospital sectors. This is because those with dementia or with more than mild cognitive impairment can often find it difficult to express that they are in pain or are unable to articulate the level of pain that they are in (Banicek,2010). As the

Pain is subjective, caring for patients in pain can be very challenging especially those patients with a severe debilitating persistent illness. Several factors determine a patient’s tolerance and management of pain which include, age, cultural background, causative agents, and psychological issues with the patient. At several occasions through my nursing experiences have cared for several patients in pain, have come to a belief that pain can be challenging to manage in some cases when we health care workers don’t understand different kinds of ailments and the severity of pain accompanied with them. For instance, patients suffering from sciatica nerve pains respond differently from patients suffering from a headache. At one point I cared for

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (1979). Pain is actually the culprit behind warranting a visit to a physician office for many people (Besson, 1999). Notoriously unpleasant, pain could also pose a threat as both a psychological and economic burden (Phillips, 2006). Sometimes pain does happen without any damage of tissue or any likely diseased state. The reasons for such pain are poorly understood and the term used to describe such type of pain is “psychogenic pain”. Also, the loss of productivity and daily activity due to pain is also significant. Pain engulfs a trillion dollars of GDP for lost work time and disability payments (Melnikova, 2010). Untreated pain not only impacts a person suffering from pain but also impacts their whole family. A person’s quality of life is negatively impacted by pain and it diminishes their ability to concentrate, work, exercise, socialize, perform daily routines, and sleep. All of these negative impacts ultimately lead to much more severe behavioral effects such as depression, aggression, mood alterations, isolation, and loss of self-esteem, which pose a great threat to human society.

Pain is a complex subject that can be confusing for those who suffer with it and is often misunderstood by health care professionals, including physiotherapists. The International Association for the Study of Pain (1979, p.249) defines pain as