Abstract
BackgroundAlthough untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care. Practice nurse-led, comprehensive geriatric assessments (CGAs) may increase access to tailored pain care for frail, older people who live at home. To explore this, we investigated whether new pain cases were identified by practice nurses during CGAs administered as part of an intervention with the Geriatric Care Model, a comprehensive care model based on the Chronic Care Model, and whether the intervention led to tailored pain action plans in care plans of frail, older people.MethodsWe used cross-sectional data from the older Adults: Care in Transition (ACT) study, a 2-year clinical trial carried out in two regions of the Netherlands. Practice nurses proactively visited older people at home and administered an in-home CGA that included an assessment of pain. Pain care-related agreements and actions (pain action plans) based on CGA results were described in a tailored care plan. We analyzed care plans of 781 older people who received a first-time CGA by a practice nurse for the presence of pain, pain location and cause, new pain cases, and pain action plans. We used descriptive statistics to analyze our data.ResultsWe found that 315 (40.3 %) older people experienced any type of pain. Practice nurses identified 20 (10.6 %) new pain cases, and 188 (59.7 %) older people with pain formulated at least one therapeutic or non-therapeutic pain action plan together with a practice nurse. More than half of the older people whose pain had already been identified by a primary care physician wanted a pain action plan. Most pain action plans consisted of actions or agreements related to continuity of care.Discussion and conclusionPractice nurses in primary care can contribute to expanding older people's access to tailored pain care. Future researchers should continue to direct their focus at ways to overcome the barriers that restrict older people’s access to pain care.
Highlights
Untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care
Care plan data show that 315 (40.3 %) of the 781 frail, older people who received a first time comprehensive geriatric assessment (CGA) reported any type of pain
The aim of this study was to explore whether practice nurse-led CGAs could expand access to pain care for frail, older people who live at home
Summary
Untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care. Practice nurse-led, comprehensive geriatric assessments (CGAs) may increase access to tailored pain care for frail, older people who live at home. Pain can cause adverse health outcomes such as depression, anxiety, cognitive impairment and social isolation, which negatively impacts on older people’s health and social wellbeing, and, consequentially, increases the burden on health care systems [4, 10, 18, 20,21,22,23]. It is essential that health professionals in primary care expand access to pain care by recognizing pain problems at an early stage and by providing pain care that is tailored to the older person’s individual need
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