Assessment Of Pain In Older People Research Articles

Assessing pain in older people with normal, mildly impaired or severely impaired cognition.

Pain is a relatively common experience among older people, but unrelieved pain has significant functional, cognitive and emotional consequences for this population. A comprehensive and accurate pain assessment is essential for effective pain management. Self-report tools are suitable to assess pain in older people with normal or mildly impaired cognition, while observational tools are suitable for use with those with significant cognitive impairment or communication difficulties. However, pain assessment in older people can be challenging. The use of one tool on its own is rarely sufficient and it is crucial to involve family carers in assessment of pain in older people with severe cognitive impairment. This article discusses different tools and strategies, including the benefits and limitations, for assessing pain in older people.

Pain descriptors and adaptation of Short Form McGill Pain Questionnaire 2 (SF-MPQ-2) for older people in Brunei Darussalam

Background: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is common in older people, and tends to be under-reported and under-treated. In addition to quantifying pain severity using the visual analogue scale (VAS), use of the translated Short-Form McGill Pain Questionnaire (SF-MPQ-2) to identify pain descriptors may assist with pain assessment in older people. Aims: identify pain descriptors for different pain aetiology in older people using the adapted SF-MPQ-2 Brunei Malay version and compare pain severity assessments using the VAS and SF-MPQ-2. Patients and methods: A prospective study using the translated SF-MPQ-2 in older people admitted or seen in clinic under Orthopaedics and Geriatrics specialties between November 2018 and February 2019. Results: There were 75 participants, with 21 pain descriptors used. The main descriptors for fractures, osteoarthritis or muscle/tendon problems were identified. Despite pain medication, more than a third still experienced moderate to severe pain. However, almost all were satisfied with the pain management. There was a statistically significant difference between pain severity between the VAS and SF-MPQ-2, with the VAS possibly underestimating pain. Conclusions: The adapted SF-MPQ-2 appears feasible for use with older people in Brunei. Further studies are required to formally validate the SF-MPQ-2 in older patients and with specific medical conditions, such as diabetes or surgery.

Holistic pain assessment in older people and older people living with dementia.

Pain occurs in a wide range of diseases and long-term conditions associated with ageing and can affect every aspect of an individual's life, reducing their ability to recover, their independence and their quality of life. The assessment of pain is an important aspect of nurses' role and requires them to obtain detailed information on how the older person experiences pain and how pain is affecting their life. However, there are many challenges to effective pain assessment in older people, including challenges concerning communication and cognition. This article provides an overview of pain assessment in older people, particularly those living with dementia, based on the author's expertise and on relevant literature, notably the recently revised UK national guidelines on the assessment of pain in older people.

The Assessment of Pain in Older People: UK National Guidelines.

We are facing a huge increase in the older population over the next 30 years. This brings an anticipated increase in the prevalence of chronic pain and with this comes the challenge of assessment of pain in many varied settings. Our first iteration of this document was published in 2007. But there has been a proliferation of literature and research since then, so we have developed a new set of guidelines. Different patterns and sites of pain were seen in men and women. Age differences suggest that pain prevalence increased with age up to 85 years and then decreased. The available studies on barriers and attitudes to pain management point towards an adherence to bio-medically orientated beliefs about pain, concern amongst clinicians in relation to activity recommendations, and a negative orientation in general towards patients with chronic painful conditions. A multidisciplinary approach to the assessment and treatment of pain is essential, but the assessment is a complex process which is hampered by many communication issues, including cognitive ability and socio-cultural factors. Such issues are part of the UK ageing population. Structured pain education should be implemented that provides all health professionals (whether professionally or non-professionally trained) with standardised education and training in the assessment and management of pain according to level of experience. Although subjective, patient self-report is the most valid and reliable indicator of pain and it may be necessary to ask questions about pain in different ways in order to elicit a response. A number of valid and reliable self-report measures are available and can be used even when moderate dementia exists. The Numerical Rating Scale or verbal descriptors can be used with people who have mild to moderate cognitive impairment. For people with severe cognitive impairment Pain in Advanced Dementia (PAINAD) and Doloplus-2 are recommended. PAINAD and Doloplus-2 scales continue to show positive results in terms of reliability and validity. There has been no recent evaluation of the Abbey pain scale although it is widely used throughout the UK. There is a need for more research into pain assessment using the collaborative role of the multidisciplinary team in all care settings. Self-report questionnaires of function are limited in their ability to capture the fluctuations in capacity and ability. The concentration on items of relevance to the population of interest means that issues of personal relevance can be obscured. Strong associations were seen between pain and depressed mood with each being a risk factor for the other. Additionally, loneliness and social isolation were associated with an increased risk of pain. Clinicians should be cognisant that social isolation and or depressive signs and symptoms may be indicators of pre-existing pain or a predictor of future pain onset. There are a number of evidence based guidelines on pain assessment in older people with or without cognitive impairment from around the world, including Australia and Europe.

Nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting.

The aim of this study was to determine nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting. Pain is highly prevalent among older people, yet is often under-recognised and undertreated in people with dementia. People with dementia can lose the ability to report pain and it is the role of the nurse to identify and appropriately assess pain, to provide effective treatment. This requires nurses to have sufficient knowledge and training in the assessment and management of pain in residents with dementia; however, research suggests deficits in this area. A cross-sectional survey design was used to determine nurses' knowledge and attitudes to pain assessment in dementia. A questionnaire comprising three sections was distributed to 96 registered nurses across 17 nursing homes in a health-care trust in a UK region. A total of 32 responses were obtained (response rate 33%). The majority of nurses had a good knowledge in relation to the assessment and management of pain in residents with dementia. There was, however, some uncertainty among nurses over analgesic choice, the safety of opioid use in dementia, and the use of dementia-specific pain assessment tools for residents with no cognitive impairment. The main barriers to effective pain assessment for older people with dementia were workload pressures, poor staffing and lack of medical support. This study highlights the need to develop pain education programmes and clear guidance specifically designed for nurses caring for older people with dementia. It also emphasises the need for better communication and co-ordination of pain treatment for nursing home residents with dementia.

The complexity of pain assessment in older people.

Pain is common in older people and its assessment is an important part of the nurse's role. Asking people about their pain is considered the most accurate and reliable assessment because of the subjective nature of pain. A number of simple and easy-to-administer self-rating scales are available to measure pain intensity. To rate their pain, however, people need to understand the request, as well as recall and interpret the painful signal. Observing specific behaviours associated with pain is advocated when communication and cognitive function are impaired, for example, in people with advanced dementia. A number of pain assessment tools have been developed that involve observation of some or all of the behaviours. The aim of this article is to highlight the importance of pain assessment, discuss the various pain assessment scales and tools available and identify some of the factors that can make comprehensive assessment of pain in older people and those with cognitive impairment complex.

Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment.

Pain is prevalent among older people, yet is often under-recognised and undertreated in people with dementia. The nurse has a central role in identifying and appropriately assessing pain in order to provide effective treatment. Research however suggests there are significant deficits in this area. To explore the evidence on nurses' knowledge and attitudes to pain assessment in older people with dementia. A systematic narrative review of peer-reviewed articles published between 2000 and 2014. Seven electronic data bases (CINAHL, MEDLINE, PsycInfo, Wiley, Pubmed, ProQuest and OVID) were searched and articles focusing on nurses knowledge and attitudes on pain assessment towards people with dementia. Research participants within the studies reviewed were to include registered nurses involved in the assessment and management of pain in older adults with dementia from across all healthcare settings (e.g. dementia units, nursing homes, community and acute settings). Data were systematically analysed from 11 papers. Using an inductive approach for thematic content analysis informed by the theory of planned behaviour, five themes were identified. These included: 1) Challenges in diagnosing pain in dementia 2) Inadequacies of pain assessment tools 3) Time constraints and workload pressures 4) Lack of interdisciplinary teamwork and communication 5) Training and education. Nurses play a key role in the effective management of pain through the use of pain assessment tools, behavioural observation, and analgesic choice. Pain assessment in dementia remains challenging for nurses due to the complexity and individualisation of pain behaviours. The accessibility of appropriate training, workforce stability and a standardised approach to pain assessment are key to the successful management of pain in older people with dementia.

Pain assessment tools for older people with cognitive impairment

This article summarises and critiques various tools available for the assessment of pain in older people with cognitive impairment. Definitions of pain are numerous and are not always relevant to people with cognitive impairment because these individuals are often unable to describe or communicate their pain. This makes it difficult for healthcare professionals to assess the absence or presence of pain in these patients. The aim of this article is to establish which of the available pain assessment tools are most appropriate for use in older people with cognitive impairment. From a review of the literature, the authors conclude that pain assessment in older people with any degree of cognitive impairment is complex and there is no gold standard.

Fresh approach needed to pain assessment in older people

Fresh approach needed to pain assessment in older people

Pain assessment in older people with dementia: literature review

Pain assessment in older people with dementia: literature review

Pain assessment in older people with dementia: literature review

This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers. Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain. Searches were conducted of CINAHL, Medline and other databases for the period 1993-2007 using the search terms pain, dementia, assess*, barrier* and obstacle*. Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute. Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools. More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.

Determining factors that have an impact upon effective evidence‐based pain management with older people, following colorectal surgery: an ethnographic study

The aim of this project was to examine pain management practices with older people admitted to the colorectal unit of an acute hospital trust. Although pain assessment and management are judged to be a priority, little research has examined the care older people receive in the acute surgical setting. Thus, pain in older people (65 years and over) can be under recognized and unrelieved. With the number of older people requiring surgery increasing, it is important to identify factors in the practice context that enhance or inhibit effective pain management. The project drew upon an in-depth ethnographic approach. Sixty-two hours of around the clock, non-participant observation of nursing practice was completed. Thirty-nine (78%) nurses and forty-six (42%) patients were observed. Seven (6%) additional patients participated in pre- and postoperative interviews and 35 (90%) nurses completed the Nursing Work Index--Revised Questionnaire. Holistic pain assessment for older people was found to be deficient in the acute surgical setting. Nurses appeared unaware of the importance of addressing the particular pain needs of older patients. Inflexible analgesic prescriptions provided the mainstay treatment of pain, with minimal consideration given to non-pharmacological strategies. Older people wanted to be active participants in their care. However, existing pain management practices disempowered older patients, making them reluctant or unable to discuss their pain with ward staff. Comprehensive pain assessment, improved documentation and proficient communication, inclusive of older patients, are necessary to improve pain management practices. It is imperative that patients, nurses, doctors and Acute Pain Service work in collaboration to challenge pain management practices and implement change. The project demonstrated some of the multiple and complex factors that affect the older persons' pain experience and identified three action research cycles for further development work.

A literature review exploring how healthcare professionals contribute to the assessment and control of postoperative pain in older people

Little research has examined the care older people receive in the acute surgical setting. Although pain assessment and management are judged to be a priority in nursing, often pain, in older people, is undermanaged for a variety of reasons. Factors such as stoicism, communication and ageism can shape both the patients' and nurses' attitude towards the perception of pain which subsequently affects pain management. Through a review of the literature, this paper aims to: (i) identify how healthcare professionals contribute to the assessment and control of postoperative pain in older people and (ii) explore potential barriers to achieving more advantageous pain control in this group. It is suggested that to improve pain management there is a need to individualize pain assessment for older people and to assist clinicians with enhancing their education and decision-making abilities in this field. This may best be achieved by supporting a programme of change to develop the skills of staff and encouraging learning through reflective practice. There is however a need for further research in this area.

Pain assessment in older people: problems and solutions

The presence of pain greatly diminishes quality of life. This article, the first of two, outlines some of the problems and suggests solutions for assessment.

Principles of pain assessment in older people--Part 2.

Principles of pain assessment in older people--Part 2.

Principles of pain assessment in older people – part 1

Principles of pain assessment in older people – part 1