The Absence Of Chronic Pain In Older Adults

H., Bell, J., Karttunen, N. M., Nykänen, I. A., M., & Hartikainen, S. A. (2013). Analgesic Use and Frailty among Community-Dwelling Older People. Drugs & Aging, 30(2), 129-136. doi:10.1007/s40266-012-0046-8. The purpose of this study was determine if frailty played a part in susceptibility to increased pain levels with adverse effects related to inadequately treated pain. The goal was to determine if there was different analgesic (prescription and nonprescription) use among varying level of determined frailty. Frailty levels of participants were determined using the Cardiovascular Health Study (CHS) regards to weight loss, low physical health, weakness, slowness and exhaustion. Participants were classified as robust, pre-frail or frail. The participants defined as robust had none of the CHS

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

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

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.

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.

As we all know, lots of our elders are very so much plagued by joint and muscle anguish at the present time. It is also a shocking indisputable fact that the quantity of more youthful men and women are additionally experiencing continual joint pains which influence their nice of existence.

As people grow older, they develop dental problems which lead to nutritional intake issues. Cognitive function declines affecting memory, decision making, conversing, and problem solving. In addition, falls can occur with mental status disturbances. Lack of social interaction, depression, and anxiety also crop up in the elderly. Sleep patterns are altered by restless legs, snoring, and disrupted breathing sequences. At times, pain can be constant from arthritis, osteoarthritis, or other medical issues (Tabloski, 2014).

Long term condition (LTC) is a health problem that cannot be cured, at present, but can be managed by medication or therapies’ (Snodden., 2010: p1). There are more than 15 million people in England that are suffering from long term conditions (Department of Health., 2013). Long-term conditions are more common in older people. The percentages of people of over 60 having a LTC is 58 per cent compared to under that is 14 per cent (Department of Health, 2012). LTC is also more predominant in more deprived groups, such as the poorest social class as it has 60 per cent higher prevalence than of those in the richest social class. (Department of Health, 2012).

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.

According to Ruoff, (2002); Brown, Kirkpatrick, Swanson & McKenzie, (2011), “Between 80% and 85% of the elderly living in nursing homes suffer from chronic pain disorders” ( As cited in Lombard, et al., 2015, p.1140). OM is a part of this percentage of elderly that has been living in pain for over ten years. In the first section of this paper, this author will be questioning OM about his perception of pain, and in the second part of this paper, personal reflections about the answers received will be given. This author will also do a detailed assessment of OM living condition and educate him on how to prevent fall by keeping his environment safe.

“The control of pain is the key to all other care”(Raiman 1998). This is especially true within old age psychiatry as if a client is in pain it may be impossible to recognise a pure diagnosis of agitation or depression and intervene accordingly when there is the possibility that these symptoms may be reactive due to inadequate pain relief. The key to therapeutic success is how well are the symptoms being relieved. Untreated pain in the client with dementia can delay healing, disturb sleep and daily activity, reduce quality of life and prolong hospitalisation (Horgas 2003).

“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.

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

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

Sheryl Green and colleagues designed a cognitive behavioural approach to pain specifically tailored to the needs of older adults. The sample consisted of 46 seniors in the treatment group and 49 in the control (Green, Hadjistazropoulos, Hadjistavropoulos, Martin, & Sharpe, 2009). In the treatment group, participants were given a 10-week pain management program with a cognitive behavioural orientation. The treatment was standardized according to a manual that described the goals and targets of each session. Several measures of pain, including the Geriatric Pain Measure (GPM), the Modified Pain Beliefs Questionnaire (PBQ), the Pain Severity Subscale of the Multidimensional Pain Inventory - Section 1 (MPI), the Shortened Daily Hassles Scale