Pain Management In Older Adults Research Articles

Nursing Practice Variations in Pain Management in Older Adults With Dementia Admitted to an Acute Geriatrics Unit During the COVID-19 Pandemic.

The current retrospective descriptive study evaluated nursing practice variations on pain management in older adults with dementia admitted to an acute geriatrics unit (AGU) before (2018) and during (2021) the coronavirus disease 2019 (COVID-19) pandemic. Data were gathered from electronic health records. Pain intensity was evaluated a median of 1.9 times per day of stay in the pre-COVID-19 sample, whereas in the COVID-19 sample, the median was 0.7 times per day of stay. Median number of analgesic administrations per day of stay and mean percentage of clinical care records that mentioned pain were higher in patients admitted during the pandemic. Variations in nursing care organization in the AGU due to the COVID-19 pandemic had an impact on the patterns of pain management nursing practice in older adults with dementia. [Research in Gerontological Nursing, 16(4), 173-182.].

Evaluation of art making activity as a pain management strategy for older adults and their experience using an art making intervention.

Chronic pain is a common and bothersome experience for older adults. Consequently, pain management is critical to maintaining their function and well-being. Art making, a non-pharmacological approach, has gained empirical support and is used for functional and cognitive improvement in older adults. However, it has rarely been used to manage chronic pain. The purpose of this descriptive qualitative study was to understand older adults' experience using a newly designed art making intervention and its influence on their pain. Overall, 11 older adults used the intervention and reported its quality to be appropriate. Moreover, older adults reported that art making was an engaging, diversional activity which reduced their pain severity and improved their mood. The findings of this study will be used to inform a future pilot study to assess the impact of art making on pain management in older adults with chronic pain.

Pain Management in Older Adults with Chronic Wounds.

Older people often suffer from different types of ulcers, with the most prevalent being chronic leg ulcers (CLUs) and diabetic foot ulcers. There are major issues in the current medical approach because these ulcers are hard to heal, and, in the case of CLUs, very painful and with a high frequency of relapse. Older people complain of pain more frequently than young people, frequently due to a combination of painful chronic wounds with other comorbidities (e.g. arthritis, peripheral arterial disease, vertebrogenic pain syndrome). However, chronic pain appears to be managed better by older people because the pain sensitivity is downregulated and the pain threshold is higher in older people. Pain management of chronic wounds is often insufficient, especially in older individuals. It is highly important to use non-traumatic wound dressings and pay attention to patients' feelings and fears because pain in chronic ulcers can impair wound healing. Key factors include good preparation for dressing change and adequate analgesia, ideally a combination of topical and oral agents.

Pain Management for Older Adults Living with Dementia: Perspectives from African American Family Caregivers

African American older adults living with dementia are at increased risk for under-assessed and under-treated pain. This risk is even greater for those of lower socioeconomic status. The purpose of this study is to characterize family caregivers’ perspectives on pain assessment and management in the context of advance care planning for their loved one living with dementia. A convergent mixed methods approach will be used to gather descriptive, cross-sectional data within a community-based participatory design process with the impetus to develop targeted interventions.

Development and psychometric assessment of barriers to postoperative pain management in dementia scale: A mixed methods exploratory study

Background: Identifying the barriers to acute pain management in older adults with dementia needs appropriate instruments adapted to the cultural structure of each community. Such an instrument can help to provide effective interventions. Objectives: This study aimed to develop and psychometrically validate Barriers to Postoperative Pain Management in Dementia Scale (BPPMDS) from the nurses' point of view. Methods: This methodological study was conducted in 2019–2020. In the first phase, semi-structured interviews with 15 nurses and literature review were conducted for item generation. In the second phase, face, content, and construct validity and reliability of the instrument were assessed. Results: In the first phase, 67 items were produced. In the second phase, the number of items reduced to 39 after the assessment of face, content, and construct validity. Exploratory factor analysis showed that the BPPMDS has three factors (i.e., older adult-related factors, health care provider-related factors, and system-related factors), which explain 57.57% of the total variance. The Cronbach's alpha coefficient of the scale was 0.956. Conclusions: The BPPMDS can be used as a valid and reliable scale to measure postoperative acute pain management in older patients with dementia and hip fracture.

Acceptance and Commitment Therapy and Exercise: Can They Help Older Adults Manage Chronic Pain?

Chronic pain is common among older adults and affects their physical and psychological well-being. While exercise can reduce pain and promote physical functions, psychological interventions may enhance pain management by addressing the psychosocial contributors to the prolonged pain. Acceptance and Commitment Therapy (ACT) is a psychological intervention that emphasizes on psychological flexibility, values, and mindfulness. This approach may be particularly helpful in dealing with chronic pain, where symptoms can be beyond one’s control. This single group pre-post study investigated the feasibility and efficacy of an intervention combining ACT and exercise for chronic pain management in older adults. The intervention consisted of 16 sessions delivered over eight weeks. ACT and exercises were modified according to the individual’s capability when needed. Clinical outcomes regarding pain severity and interference, pain acceptance, value of life, depression, anxiety, and physical functioning were assessed. Twenty-four older adults attended all sessions and completed the assessments. Preliminary results showed that, while participants experienced similar level of pain after the intervention, they reported less pain interference on mood and enjoyment of life, and improved chronic pain acceptance, pain self-efficacy, success at living their values, committed action, depressive symptoms, physical functioning in the lower body strength, aerobic and endurance, agility and dynamic balance, and upper body strength (all p<.050). This study lends support to the feasibility of a combined ACT and exercise intervention for chronic pain management in older adults. The efficacy of ACT may not be directly on reducing pain, but on increased psychological flexibility to co-live with pain.

Excellence in Rehabilitation of Aging Persons Award: Developing a Function-Focused Approach to Pain Management for Older Adults with Chronic Low Back Pain

Abstract The overarching goal of our research program is to improve physical function and participation in older adults with chronic musculoskeletal conditions, particularly low back pain (LBP). Despite the fact that LBP is a common problem for older adults and is associated with poor outcomes in this vulnerable age group, little research has focused on LBP in people over age 65. With minimal research available, clinicians do not have clear evidence-based guidance regarding management of older adults with LBP. This presentation will focus on our pathway towards developing a focused treatment algorithm designed to prevent and address the pain-related disability found in older adults with LBP. Our work has largely focused on the identification of potentially modifiable "rehabilitation risk factors" that are associated with pain and functional limitations, as well as the development of interventions to address these risk factors. Specifically, we will discuss our findings relative to trunk muscle impairments and clinical hip impairments in the context of the older adult with low back pain.

How Do Family Caregivers’ Values Influence Pain Management for Older Adults with Dementia?

Professional caregivers rely on formal training when managing pain among patients with dementia, but family caregivers (FCGs) lack this foundation. Instead, FCGs use informal sources that may reflect a values-driven decision-making process. Few studies have examined how FGCs’ personal values impact pain management for dementia patients. We sought to examine the influence of personal values on pain management among FCGs for community-dwelling older adults with dementia using qualitative descriptive methods. Twenty-five adult FCGs, aged from 29 to 95, were recruited in central Virginia. Participants were predominantly white, married, female, and high school graduates. We conducted semi-structured interviews that were audio recorded and analyzed using constant comparative analysis. Four themes emerged: 1) Priority for pain management: when quality of life is valued over other factors (i.e., length of life), priorities focused on no pain, leading to better pain management; 2) Moral perspectives: negative views toward drugs, especially opioids, led to less use and greater report of pain; 3) Beliefs about alternative therapy: negative views led to less likely use of non-traditional approaches and reports of more pain, and 4) Personal experience of pain: past personal experiences of pain (negative or positive) influenced the priority placed on pain management and the FCG’s ability to provide effective pain management. The diverse views held by FCGs demonstrate a value-based process and suggest a modifiable factor in pain management. Helping FCGs reflect biases while reinforcing values that improve pain management would lead to improve pain and quality of life for older adults with dementia.

99 ASSESSMENT AND MANAGEMENT OF PAIN IN OLDER ADULTS WITH ACUTE FRACTURE ADMITTED UNDER AN ORTHOPAEDIC SERVICE

Abstract Background Older adults with acute fractures often have suboptimal pain control, in particular those with cognitive impairment. Effective pain management improves rehabilitation engagement and earlier discharge from acute care. Our study aimed to evaluate pain management of older adults with acute fracture admitted under an orthopaedic service in a tertiary hospital. Methods Prospective review of patients over 65 years with an acute fracture admitted under an orthopaedic service. Review of chart, medication prescription and pain status. Data included type of fracture, comorbidities, cognitive status and analgesia prescribed. Data analysed using Excel. Results 40 inpatients included. Median age 82 years (range 65-93 years), 70% female. 53% had cognitive impairment, ranging from mild to severe dementia. 75% had &amp;gt;5 regular medications pre-admission. 80% had &amp;gt;5 comorbidities. Two-thirds (73%) had an acute hip fracture. Most (80%) inpatients had a surgical intervention, the remaining were managed conservatively. Analgesia prescriptions included paracetamol for almost all patients (95%), non-steroidal anti-inflammatory drugs for 3 (8%) and regular opioids in only 3 (8%). 43% of patients reported pain at time of data collection. 13% had analgesia changed in the 24 hours beforehand. Pain adversely affected function in 205 and mobility in 28%. 2 patients were unable to verbalise pain however no pain scales or visual assessments were used. Documentation of pain assessment was best by nurses (100%) followed by doctors (60%) and allied health professionals (40%). Conclusion Older adults with acute fracture are often multimorbid with cognitive impairment. This patient population are often untreated for pain with suboptimal pain assessment and analgesia review or prescriptions. Consequently we developed a pain policy for use on our orthopaedic service as a guide for effective pain assessment and management for older adults with acute fracture.

Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study.

BackgroundPain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports.ObjectiveWe aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain.MethodsA total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed.ResultsIn the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder.ConclusionsVoice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions.

Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults

Chronic pain, and the ethical management thereof, is the single most imperative health issue of this decade. Although a growing majority of individuals with chronic pain are middle-aged, the largest proportion of sufferers are older adults. Shifting tides in practice and research have led to population-focused approaches to pain management; however, the practice of many healthcare providers remains reactive and individualistic, limiting the discovery and implementation of long-term solutions for pain management in older adults. Yet, nurses and other health professionals have an opportune position to provide expert pain care by proactively providing evidence-based care for patients systematically. The purpose of this article is to stimulate discussion on three paradigms important to population-focused pain management: (1) prevention; (2) restoration and rehabilitation; and (3) palliation, which are in line with current national policy initiatives for improving patients’ care experience, improving overall health and quality of life, and reducing associated health care costs.

Pain management in community-dwelling older adults with moderate-to-severe dementia.

This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.

Pain management nursing practice assessment in older adults with dementia.

AimTo assess pain management nursing practice in older adults with dementia through electronic health records (EHR).DesignRetrospective study.MethodsData were collected from EHR related to pain management in older adults with dementia treated at the Acute Geriatrics Unit (AGU) of a university hospital in early 2018.ResultsEHR related to the pain of 111 patients were reviewed. Pain intensity was assessed at admission in 88% of patients and a median of 1.9 times per day of stay. A disproportionate number of the assessments (39%) occurred during the late shift. A median of 1 drug per day was administered. Pain was recorded in 28% of patients’ care plans, and non‐pharmacological interventions were recorded in 12%.In conclusion, exist variability in pain management nursing practice in older adults with dementia. Admission diagnosis correlated with the analgesic administration schedule, the number of drugs administered and the number of pain nursing annotations.

The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study.

chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population. we examined the association between opioid use, and changes in cognitive function of older adults. prospective study. community dwelling older adults. study population consisted of 2,222 individuals aged 65-69years at baseline from the Personality and Total Health Through Life Study in Australia. medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models. cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use. prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.

Determining the impact of age and sex on the psychophysical and neurophysiological response to thermal pain across the adult lifespan.

AimsDetermine sex‐ and age‐associated psychophysical and neurophysiological differences in the processing of pain across the adult lifespan.DesignPreliminary, exploratory, cross‐sectional study.MethodsUsing psychophysics (to measure intensity and unpleasantness) and functional magnetic resonance imaging blood oxygenation level dependent methods (to measure stimulus‐evoked brain activation), we will examine sex‐ and age‐associated differences in thermal pain processing and their underlying neurophysiology in a broad range of healthy adults (ages 30–89). We will acquire resting state functional connectivity data for secondary analyses exploring whether resting state connectivity predicts psychophysical and neurophysiological responses to thermal pain. To examine the effects of altered blood flow, we will acquire resting‐state arterial spin labeling magnetic resonance imaging data to quantify resting cerebral blood flow. We will interpret findings in the context of a proposed neural model of pain, ageing, and sex. Study funding was received in June of 2014. Ethical approval was obtained from the Vanderbilt University IRB prior to study initiation.ConclusionExploring the biological reasons for age‐ and sex‐associated differences in pain processing will increase our understanding of pain in older adults. The paucity of neurobiological evidence to support best practice pain management in older adults places these individuals at risk for poor pain management.ImpactPoorly treated pain in older adults is a critical public health problem associated with a poor quality of life and increased healthcare costs. Understanding how age and sex have an impact on central processing of pain across the lifespan is a critical step toward improving personalized pain medicine.

Medication and healthcare utilization variation among older adults with pain.

While pain is very common in older adults, the associated impact on daily life, including usage of medication and healthcare, varies considerably and often pain remains inadequately treated. It is not clear what is associated with this variation. Latent class analysis (LCA) is a model-based approach to identifying underlying subgroups in a population. In this study LCA was used to examine biopsychosocial risk classes of adults aged 50years and older, who were often troubled by pain, from The Irish Longitudinal Study on Ageing (TILDA), (n=2,896), and the associations with future medication and healthcare use. Four biopsychosocial risk classes (Low Biopsychosocial Risk, Physical Health Risk, Mental Health Risk, High Biopsychosocial Risk) were identified, with the 'High Biopsychosocial Risk' class accounting for 24% of older adults with pain. This class were much more likely to use medication and healthcare services when followed up across three waves of the TILDA study. In contrast, the Physical Health Risk and the Mental Health Risk classes reported lower usage of medication and healthcare at waves 2 and 3. Amongst the higher risk classes of older adults who are troubled by pain, there is considerable consumption of medication and healthcare services evident. Given our ageing population and significant number of adults in this high risk class, there is a need to optimize current pain management approaches among older adults. Intensive non-pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring. While pain is very common in older adults, the usage of medication and healthcare varies considerably and often pain remains inadequately treated. Given our ageing population and the significant number of older adults reporting high biopsychosocial risk (24%), there is a need to optimize current pain management approaches. Intensive non-pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring.

Attitudes of Older Adults With Chronic Musculoskeletal Pain Toward Virtual Reality

Older adults are especially susceptible to chronic musculoskeletal (MSK) pain. Pharmacological treatment often provides inadequate relief and overuse can lead to adverse events. Preliminary research has demonstrated the effectiveness of virtual reality (VR) distraction therapy for chronic pain. Understanding attitudes of older adults towards VR distraction therapy will help develop and optimize this therapy for this population. Therefore, the purpose of this study is to explore the attitudes and treatment acceptability towards the use of immersive VR distraction therapy of older adults suffering from chronic MSK pain. This descriptive, exploratory study used mixed methods. Data collection consisted of a consent process, eligibility screening, survey completion, 2 VR simulations (passive and active) lasting 10-minutes each, and either a focus group or interview. Survey data was used to measure: pain intensity and interference, pain catastrophizing, treatment acceptability, usability, and side effects. A total of 21 older adults completed the study. Treatment acceptability was high with an average score of 32.5 out of 40. However, average usability scores (62.9 out of 100) indicated a need for system improvements. Few participants (14%) experienced moderate to severe side effects. The following themes were identified: 1) VR is an enjoyable distraction; 2) Perceived effectiveness depends on chronic pain experience; 3) VR simulation experiences should be individualized; 4) Design considerations to improve usability in older adults; 5) Recommendations for future directions. The findings from this study can inform intervention design considerations and future directions for the use of VR technology for chronic pain management in older adults.

Pain Management and Cognitive Function Among Older Adults in China

Chronic pain and cognitive decline are common age-related conditions affecting a large segment of older populations. Little is known about the pathway of cognitive functioning during the course of pain management in older adults. The current study aimed to examine the association between chronic body pain management and cognitive function over time among Chinese older adults. A total of 792 respondents aged 60 and above from urban and rural households in 28 provinces, 150 counties/districts, and 450 communities were selected from the China Health and Retirement Longitudinal Study (2013–2015). Cognitive function was measured in three domains: episodic memory, mental status, and global cognitive function. Difference-indifferences approach and mixed-effects linear regression models were employed to assess the association between chronic body pain management and cognitive function over time. Scores of mental status were found to decline slower by 0.49 unit (SE = 0.22, p < 0.05) in respondents who received pain management using analgesics, complementary and alternative medicine, or both from 2013 to 2015 after controlling for basic demographic and health confounders. Chronic pain management was associated with slower decline in domain-specific cognitive function, mental status over time. Findings of the study may contribute to understanding the mechanism of change in diverse cognitive abilities attributable to pain symptoms. More research is needed to elucidate the mediating effect of pain on cognitive decline, which could lead to testing of the impact of pain management on cognitive function among older population in both clinical and community settings.

Facilitators, Barriers, and Solutions in Pain Management for Older Adults with Dementia

BackgroundAlthough qualitative studies have been conducted to identify barriers and facilitators that influence the pain management of older adults with dementia, as far as we know, only a very recent study (Andrews et al., 2019) has used participatory action research (PAR) as a methodology for studying pain management. It allows nurses to examine and improve their practice based on their realities and within their context. AimTo reflect on nursing practice and identify facilitators and barriers in the management of pain in older adults with dementia and to propose actions for improvement. DesignWe used qualitative participatory action research. Participants/SettingsTen nurses from the geriatric acute care unit of a university hospital in Spain were recruited through convenience sampling. MethodsData were generated through a written questionnaire and three focus groups. ResultsOne of the main facilitators the participants identified was professional experience. The main barriers they identified were lack of knowledge and skills and lack of time. The participants proposed two main improvements: (1) a training program consisting of three courses (pain evaluation and management, dementia and pain, and pharmacology) and (2) the creation of a specific register for nurses to record patients’ pain. ConclusionsInvolving nurses directly in research on their practices can result in precise proposals for improvements based on their needs and oriented toward improving the quality of care. Moreover, our results confirm previous findings in other countries.

Pain management and cognitive function among older adults: an exploratory study of the China Health and Retirement Longitudinal Study.

Chronic pain and cognitive decline are common age-related conditions affecting a large segment of older populations. Little is known about the pathway of cognitive functioning during the course of pain management in older adults. The study aimed to examine the association between chronic body pain management and cognitive function over time among Chinese older adults. A total of 792 respondents aged 60 and above from urban and rural households in 28 provinces, 150 counties/districts, and 450 communities were selected from the China Health and Retirement Longitudinal Study (2013-2015). Cognitive function was measured in three domains: episodic memory, mental status, and global cognitive function. Difference-in-differences approach and mixed-effects linear regression models were employed to assess the association between chronic body pain management and cognitive function over time. Scores of mental status were found to decline slower by 0.49 unit (SE = 0.22, p < 0.05) in respondents who received pain management using analgesics, complementary and alternative medicine, or both from 2013 to 2015 after controlling for basic demographic and health confounders. Chronic pain management was associated with slower decline in domain-specific cognitive function, mental status over time. Findings of the study may contribute to understanding the mechanism of change in diverse cognitive abilities attributable to pain symptoms. More research is needed to elucidate the mediating effect of pain on cognitive decline, which could lead to testing of the impact of pain management on cognitive function among older population in both clinical and community settings.