1
|
Holmes A, Wang W, Chang YP. Psychosocial Characteristics by Pain Presence and Limitations Among Older Adults. J Gerontol Nurs 2024; 50:27-34. [PMID: 38959509 DOI: 10.3928/00989134-20240618-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE To compare psychosocial outcomes of older adults according to pain experience. METHOD Using cross-sectional 2021 data from the National Health and Aging Trends Study, we examined psychosocial characteristics in older adults (N = 3,376) divided into three groups: no pain, pain without activity limitations, and activity-limiting pain. RESULTS In multiple regression models, older adults with activity-limiting pain compared to those without pain had significantly higher depression, anxiety, and fear of falling, as well as reduced positive affect, self-realization, self-efficacy, resilience, and social participation. Older adults with non-activity-limiting pain had significantly higher social participation than those without pain, but no differences in self-realization, self-efficacy, or resilience. CONCLUSION Pain is strongly associated with all psychosocial outcomes, especially in older adults with activity-limiting pain. Future research should examine the impact of self-realization, self-efficacy, resilience, and social participation on activity limitations. [Journal of Gerontological Nursing, 50(7), 27-34.].
Collapse
|
2
|
Faul AC, D’Ambrosio JG, Cotton SG, Dobson MM, Furman CD, Gordon BA, Linzy K, Yankeelov PA. FlourishCare Model of Integrated Care: The Validation of the Flourish Index-Revised. THE GERONTOLOGIST 2024; 64:gnae042. [PMID: 38721939 PMCID: PMC11184524 DOI: 10.1093/geront/gnae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study validates the Flourish Index-Revised (FI-R), a tool evaluating integrated healthcare models. The original Flourish Index (FI) was developed in 2018 and has been refined to align with the FlourishCare (FC) Model (Model) for geriatric primary care. RESEARCH DESIGN AND METHODS The Model provides integrated biopsychosocial healthcare to older adults. The FI-R uses 25 quality-of-care indicators and 7 contextual community indicators. The FI-R was validated with Categorial Principal Components Analysis (CATPCA) using a sample of 949 patients 50+ who were mostly female (73%), non-Hispanic White (70%), living in urban areas (90%), and married (29%), single (22%), or divorced (19%). The mean age was 73.46 (standard deviation [SD] = 10.86) and mean years of education was 14.30 (SD = 2.14). RESULTS CATPCA showed a 4-dimensional structure of biological, psychological, and 2 social determinants of health (SDOH) subdomains: health behaviors and community. Final selection of indicators was based on total variance accounted for >0.30, absolute values of item loadings >0.45, and not having cross-loadings >0.45 on 2 factors. Internal consistency (Cronbach's alpha) for the determinants were biological = 0.75, psychological = 0.76, SDOH:community = 0.70, SDOH:health behaviors = 0.50, and total FI-R = 0.95. Sensitivity to change was shown for the total FI-R, psychological determinants, and SDOH:health behaviors, but not for biological determinants. DISCUSSION AND IMPLICATIONS The validation of the FI-R shows promise for its usability to evaluate integrated healthcare models using existing measures in electronic health systems. More work is needed to improve the incorporation of SDOH:sociodemographics into the FI-R.
Collapse
Affiliation(s)
- Anna C Faul
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Joseph G D’Ambrosio
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
- Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Samantha G Cotton
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
- Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Molly M Dobson
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
| | - Christian D Furman
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
- Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Barbara A Gordon
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Katherine E Linzy
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
| | - Pamela A Yankeelov
- Trager Institute, University of Louisville, Louisville, Kentucky, USA
- Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
3
|
Honda H, Ashizawa R, Kameyama Y, Hirase T, Arizono S, Yoshimoto Y. Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study. Eur Geriatr Med 2024; 15:719-727. [PMID: 38512605 DOI: 10.1007/s41999-024-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities. METHODS This 24-month prospective cohort study included older adults aged 65 years or older using Japanese long-term care insurance services. Chronic pain, defined as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, defined as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates. RESULTS Among 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was significantly associated with fall-related injuries (hazard ratio: 5.487, 95% confidence interval: 1.211-24.853, p = 0.027). CONCLUSIONS Chronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.
Collapse
Affiliation(s)
- Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, 3453 Mikatahara-cho, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan.
| | - Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, 3453 Mikatahara-cho, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan
| | - Tatsuya Hirase
- Division of Physical Therapy Science, Graduate Course of Health and Social Work, Kanagawa University of Human Services, Yokosuka, Japan
| | - Shinichi Arizono
- School of Rehabilitation Science, Seirei Christopher University, Hamamtsu, Japan
| | - Yoshinobu Yoshimoto
- School of Rehabilitation Science, Seirei Christopher University, Hamamtsu, Japan
| |
Collapse
|
4
|
Neuwersch-Sommeregger S, Köstenberger M, Pipam W, Demschar S, Trummer B, Breschan C, Likar R. Pain in Austrian hospitals: evaluation of 1089 in-patients. Wien Med Wochenschr 2024; 174:69-78. [PMID: 36441358 DOI: 10.1007/s10354-022-00984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the existence of internationally consistent guidelines for the management of pain, efficient regional anesthesia techniques, safe pain medications, and organizational structures, e.g., acute pain services, various studies have shown that pain is still common among both surgical and non-surgical in-patients. OBJECTIVE The primary objective of this study was to evaluate, on a multi-center basis, the point pain prevalence of surgical and non-surgical in-patients. We further analyzed pain intensities, in-hospital pain triggers, pain-related impairments, pain assessments, patient information about pain, and patient satisfaction with pain therapy. This benchmark information should lead to better implementation of pain management strategies and thus improve health care quality. METHODS We surveyed all adult in-patients in three general hospitals in Austria (general hospital Klagenfurt am Wörthersee, general hospital Villach, general hospital Wolfsberg) on the index day with two standardized questionnaires for both surgical and non-surgical patients. RESULTS Overall, a pain prevalence of 40.0%, with no statistically significant difference between surgical and non-surgical patients, was shown. Higher pain prevalence in female patients, high pain prevalence in the age group 18-30 years, and highest pain prevalence in the age group over 90 years old was found. Overall pain intensity was relatively low, but unacceptable maximum pain within the preceding 24 h was shown. Different in-hospital pain triggers like patient's care and mobilization were found. Our survey has shown that pain has an impact on personal hygiene, mobilization, mood, sleep, and appetite. However, patients were very satisfied with their pain therapy. CONCLUSION Medical staff and nurses have to be sensitized to the urgent need to improve pain management strategies.
Collapse
Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria.
- Medical University of Graz, Graz, Austria.
| | - Markus Köstenberger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Wolfgang Pipam
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Susanne Demschar
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Brigitte Trummer
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Christian Breschan
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Rudolf Likar
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
5
|
Patrick KS, Gunstad J, Spitznagel MB. Pain in the Context of Virtual Neuropsychological Assessment of Older Adults. Arch Clin Neuropsychol 2024; 39:157-166. [PMID: 37644879 PMCID: PMC10879923 DOI: 10.1093/arclin/acad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results. METHOD The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing. RESULTS Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms. CONCLUSIONS Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.
Collapse
Affiliation(s)
- Karlee S Patrick
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Mary B Spitznagel
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| |
Collapse
|
6
|
Pommier W, Minoc EM, Morice PM, Lescure P, Guillaume C, Lafont C, Fischer MO, Boddaert J, Thietart S, Lelong-Boulouard V, Beauplet B, Villain C. NSAIDs for Pain Control During the Peri-Operative Period of Hip Fracture Surgery: A Systematic Review. Drugs Aging 2024; 41:125-139. [PMID: 37880500 DOI: 10.1007/s40266-023-01074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Hip fracture (HF) mostly affects older adults and is responsible for increased morbidity and mortality. Non-steroidal anti-inflammatory drugs (NSAIDs) are part of the peri-operative multimodal analgesic management, but their use could be associated with adverse events in older adults. This systematic review aimed to assess outcomes associated with NSAIDs use in the peri-operative period of HF surgery. METHODS This systematic review was conducted according to the PRISMA guidelines. Three databases (PubMed/EMBASE/Cochrane Central) were used to search for clinical trials and observational studies assessing efficacy, safety and impact of NSAIDs use on non-specific post-operative outcomes, such as functional status and post-operative complications. RESULTS Among the 1320 references initially identified, four provided data on efficacy, four on safety and six on non-specific post-operative outcomes (three randomized controlled clinical trials, three observational studies). Mean study population ages ranged from 68 to 87 years. Two studies found that NSAIDs were effective on pain control, but two studies found conflicting results on opioid sparing. No increased risk of acute kidney injury was observed, while results concerning bleeding risk and delirium were conflicting. No study has found any effect of NSAIDs use on walk recovery. Quality of evidence was high for pain control, but low to very low for all the other studied outcomes. CONCLUSIONS The use of NSAIDs may be effective for pain control in the peri-operative period of HF surgery. However, safety data were conflicting with low levels of certainty. Further studies are needed to assess their benefit-risk balance in this context. The research protocol was previously registered on PROSPERO (registration number: CRD42021237649).
Collapse
Affiliation(s)
- Wilhelm Pommier
- Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
| | - Elise-Marie Minoc
- Normandie Univ, UNICAEN, INSERM U1075, COMETE, Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
| | - Pierre-Marie Morice
- Normandie Univ, UNICAEN, INSERM U1086, ANTICIPE, Department of Pharmacology, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
| | - Pascale Lescure
- Normandie Univ, UNICAEN, INSERM U1075, COMETE, Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
| | - Cyril Guillaume
- Normandie Univ, UNICAEN, INSERM U1075, COMETE, Department of Palliative Care, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
| | - Claire Lafont
- Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
| | | | - Jacques Boddaert
- Département de Gériatrie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Sara Thietart
- Département de Gériatrie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Véronique Lelong-Boulouard
- Normandie Univ, UNICAEN, INSERM U1075, COMETE, Department of Pharmacology, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
| | - Bérengère Beauplet
- Normandie Univ, UNICAEN, INSERM ANTICIPE, U1086, Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France
- Normandy Interregional Oncogeriatric Coordination Unit, 28 Rue Bailey, 14000, Caen, France
| | - Cédric Villain
- Normandie Univ, UNICAEN, INSERM U1075, COMETE, Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, 14000, Caen, France.
| |
Collapse
|
7
|
Qureshi I, Harris T, Pathan SA, Qureshi RS, Al-Bakri F, Thomas SH, Azad AM. What adult patients prefer for reporting their pain levels, and frequency of reassessment when in the emergency department. Am J Emerg Med 2023; 73:11-16. [PMID: 37573661 DOI: 10.1016/j.ajem.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES This study interviewed adult patients presenting to the emergency department (ED) for various pain conditions enquiring about their preferred tool for reporting pain severity and preferred time interval between initial assessment and subsequent pain reassessments. METHODS A prospective observational (cross-sectional) study was conducted in adult patients with acute pain in a tertiary care hospital ED setting. Patients' initial pain score was recorded using NRS (numerical rating scale) pain scale, and appropriate analgesia offered. Once the patient had been evaluated by an attending physician, a research team member interviewed the patient regarding the pain reassessment time and preferred pain assessment tool. The pain assessment tools evaluated in this study were NRS, PS (picture scale or face pain scale), VRS (verbal rating scale), and VAS (visual analogue scale). The patients were presented with the four pain assessment tools (in their primary language) through an audio-visual on an electronic tablet display. RESULTS 200 (138 male, mean age 36.5 ± 11.17) patients participated in the study. With increasing age, pain reassessment interval increased by 0.19 min (95% CI 0.03-0.36 min). Males requested pain reassessment 6.7 min (95% CI 2.2-10.8) faster than females. In this study, the preferred interval for pain reassessment was reported as a mean of 22.8 (SD + -13.6) minutes. There was no relationship reported between time reassessment and pain severity (P = 0.22). Out of 200 subjects, irrespective of the initial pain scores, 100 preferred NRS. NRS was preferred by patients with mild to moderated pain due to the perception of being faster. However, patients with severe pain choose a non-NRS scale to prioritize accuracy. CONCLUSION There was no influence found between the initial pain severity scores and the desired frequency of pain reassessment. However, associations were identified between the time for pain reassessment interval and age, sex, and geographical region. Patients with severe pain preferred PS or VRS while patients with mild/moderate pain preferred the NRS.
Collapse
Affiliation(s)
- Isma Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tim Harris
- Blizard Institute, Queen Mary University London, UK
| | - Sameer A Pathan
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute, Queen Mary University London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raheel S Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Faten Al-Bakri
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Blizard Institute, Queen Mary University London, UK; Beth Israel Deaconess Medical Center and Harvard Medical School, United States of America
| | - Aftab M Azad
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
8
|
Taylor JL, Clair CA, Gitlin LN, Atkins S, Bandeen-Roche K, Abshire Saylor M, Hladek MD, Riser TJ, Thorpe RJ, Szanton SL. Acceptability and Feasibility of a Pain and Depressive Symptoms Management Intervention in Middle-Aged and Older African American Women. Innov Aging 2023; 7:igad096. [PMID: 38094930 PMCID: PMC10714909 DOI: 10.1093/geroni/igad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives The intersection of race, gender, and age puts older African American women at high risk of experiencing comorbid pain and depressive symptoms. The purpose of this study was to assess the feasibility and acceptability of a 12-week behavioral activation intervention to target self-selected goals related to pain and depressive symptoms in middle-aged and older African American women. Research Design and Methods This randomized waitlist control study included 34 self-identified African American women, 50 years of age or older, with moderate-to-severe chronic pain and depressive symptoms. The intervention consisted of 8 in-person or virtual 1-hour visits with a nurse. Follow-up acceptability assessments were conducted with 10 participants. Results The average age of the participants was 64.8 (standard deviation [SD] 10.5). They reported an average pain intensity score of 7.0 (SD 1.9) out of 10 and an average Patient Health Questionnaire-9 depressive symptoms score of 11.9 (SD 4.0) at baseline. Of the 34 participants who consented, 28 (82.4%) women started the intervention and 23 (82.1%) completed the intervention. Participants described the study as useful and beneficial. Participants recommended including a group component in future iterations. Effect sizes at 12 weeks were -0.95 for depressive symptoms indicating a substantial decrease in experienced depressive symptoms, but pain intensity was virtually unchanged (+0.09). Discussion and Implications The findings of this study demonstrate that the intervention is acceptable among middle-aged and older African American women and their personal goals were met. Including a group component and identifying effective ways to decrease attrition rates will be key in the next steps of development for this intervention. It is crucial to provide tailored, nonpharmacological approaches to pain, and depression symptom management in older adult populations who experience inequities in pain and mental health outcomes. This study emphasizes the importance of participant-driven goal-setting interventions.
Collapse
Affiliation(s)
- Janiece L Taylor
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Catherine A Clair
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shelbie Atkins
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karen Bandeen-Roche
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Tiffany J Riser
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah L Szanton
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Kaps D, Siebers HL, Betz U, Pfirrmann D, Eschweiler J, Hildebrand F, Betsch M, Huthwelker J, Wolf C, Drees P, Konradi J. Creation and Evaluation of a Severity Classification of Hyperkyphosis and Hypolordosis for Exercise Therapy. Life (Basel) 2023; 13:1392. [PMID: 37374174 DOI: 10.3390/life13061392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The rise in the occurrence of musculoskeletal disorders, such as thoracic hyperkyphosis (THK) or lumbar hypolordosis (LHL), is a result of demographic changes. Exercise therapy is an effective approach that can reduce related disabilities and costs. To ensure successful therapy, an individualized exercise program adapted to the severity of the disorder is expedient. Nevertheless, appropriate classification systems are scarce. This project aimed to develop and evaluate a severity classification focused on exercise therapy for patients with THK or LHL. A multilevel severity classification was developed and evaluated by means of an online survey. Reference limits of spinal shape angles were established by data from video rasterstereography of 201 healthy participants. A mean kyphosis angle of 50.03° and an average lordosis angle of 40.72° were calculated as healthy references. The strength of the multilevel classification consisting of the combination of subjective pain and objective spinal shape factors was confirmed by the survey (70% agreement). In particular, the included pain parameters were considered relevant by 78% of the experts. Even though the results of the survey provide important evidence for further analyses and optimization options of the classification system, the current version is still acceptable as therapeutic support.
Collapse
Affiliation(s)
- David Kaps
- Center for Mental Health, Hospital Stuttgart-Bad Cannstatt Hospital, 70374 Stuttgart, Germany
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
- Institute of Social Science, Media, and Sports, Johannes Gutenberg-University Mainz, 55128 Mainz, Germany
| | - Hannah L Siebers
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation (IPTPR), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Daniel Pfirrmann
- Institute of Social Science, Media, and Sports, Johannes Gutenberg-University Mainz, 55128 Mainz, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics and Trauma Surgery, University Hospital Erlangen of the University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Janine Huthwelker
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, 52074 Aachen, Germany
| | - Claudia Wolf
- Institute of Physical Therapy, Prevention and Rehabilitation (IPTPR), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Trauma Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Jürgen Konradi
- Institute of Physical Therapy, Prevention and Rehabilitation (IPTPR), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| |
Collapse
|
10
|
Wandrey JD, Behnel N, Weidner E, Dummin U, von Dincklage F, Tafelski S. Behaviour-based pain scales: Validity and interrater reliability of BPS-NI and PAINAD-G on general wards. Eur J Pain 2023; 27:201-211. [PMID: 36326568 DOI: 10.1002/ejp.2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Measuring pain intensity in patients unable to communicate is a challenge on general wards. Observation-based pain scoring tools have been used for patients with dementia or in critically ill intensive care unit (ICU) patients. However, there is no established or validated assessment tool for non-ICU patients without dementia related cognitive deficiencies who cannot communicate. The "Behavioural Pain Scale Non-Intubated" (BPS-NI) and the "Pain Assessment In Advanced Dementia-German" (PAINAD-G) are potential tools to fill this gap. METHODS This study was performed with verbal non-ICU patients on general wards at Charité Berlin. Two assessors independently rated pain intensity using the BPS-NI and the PAINAD-G along with patients' self-ratings on the Numeric Rating Scale (NRS). The interrater-reliability of BPS-NI and PAINAD-G was calculated and ROC-analyses were performed to identify cut-off values for medium and intense pain for each score. Effectiveness was calculated using percentage agreement. In total, 126 patients were included into analysis. RESULTS The BPS-NI showed substantial congruence in interrater-reliability (Cohens-Kappa 0.71), whereas the PAINAD-G showed moderate congruence (Kappa 0.48). Based on ROC-analyses, for medium pain levels a cut-off 4 (BPS-NI) or 2 (PAINAD-G) and for severe pain levels cut-off 5 (BPS-NI) and 3 (PAINAD-G) would result in good accordance with self-reported NRS for pain. CONCLUSION The BPS-NI shows a good validity in measuring pain intensity in patients on general wards and may possibly be used for patients unable to communicate. Using defined cut-off values for BPS-NI and PAINAD-G, clinically relevant pain intensities in patients can reliably be detected. SIGNIFICANCE Measuring the pain intensity in patients unable to communicate is a common challenge on general wards. This study assessed reliability and applicability BPS-NI and the PAINAD-G in a general ward setting. Furthermore, it provides cut-off values in order to estimate pain intensity and support analgesic response.
Collapse
Affiliation(s)
- Jan D Wandrey
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Niklas Behnel
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Elisa Weidner
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrike Dummin
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Falk von Dincklage
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Anesthesia, Critical Care, Emergency and Pain Medicine, Ferdinand-Sauerbruch-Strasse, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Sascha Tafelski
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
11
|
Singh SP, Guindon J, Mody PH, Ashworth G, Kopel J, Chilakapati S, Adogwa O, Neugebauer V, Burton MD. Pain and aging: A unique challenge in neuroinflammation and behavior. Mol Pain 2023; 19:17448069231203090. [PMID: 37684099 PMCID: PMC10552461 DOI: 10.1177/17448069231203090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic pain is one of the most common, costly, and potentially debilitating health issues facing older adults, with attributable costs exceeding $600 billion annually. The prevalence of pain in humans increases with advancing age. Yet, the contributions of sex differences, age-related chronic inflammation, and changes in neuroplasticity to the overall experience of pain are less clear, given that opposing processes in aging interact. This review article examines and summarizes pre-clinical research and clinical data on chronic pain among older adults to identify knowledge gaps and provide the base for future research and clinical practice. We provide evidence to suggest that neurodegenerative conditions engender a loss of neural plasticity involved in pain response, whereas low-grade inflammation in aging increases CNS sensitization but decreases PNS sensitivity. Insights from preclinical studies are needed to answer mechanistic questions. However, the selection of appropriate aging models presents a challenge that has resulted in conflicting data regarding pain processing and behavioral outcomes that are difficult to translate to humans.
Collapse
Affiliation(s)
- Shishu Pal Singh
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Josee Guindon
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Prapti H Mody
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Gabriela Ashworth
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jonathan Kopel
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sai Chilakapati
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Volker Neugebauer
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michael D Burton
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| |
Collapse
|
12
|
Santos KVGD, Rocha MA, Dantas JKDS, Araújo SCMD, Dantas DV, Dantas RAN. Non-pharmacological analgesia strategies in adult and elderly endovascular procedures: a scoping review. Rev Bras Enferm 2022; 75:e20210741. [PMID: 35946724 DOI: 10.1590/0034-7167-2021-0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To identify the main non-pharmacological analgesia strategies used in clinical practice in adult and elderly endovascular procedures. METHODS scoping review, undertaken in July 2021, on 12 national and international data sources. The recommendations of the JBI and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist were followed. Thirteen studies were selected to compose the sample, with no time or language cut-off. RESULTS the main non-pharmacological strategies found were cold compress, use of music, and reflexology. The most prevalent procedures were coronary angiography, peripheral venous catheterization, and femoral catheter removal. Pain measurement by Visual Numeric Scale and Visual Analog Scale described pain reduction in adults and elderly. CONCLUSIONS the main non-pharmacological strategies found were cold compress, use of music, and reflexology, which reduce pain in adults and the elderly.
Collapse
Affiliation(s)
| | - Mayara Araujo Rocha
- Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil
| | | | | | | | | |
Collapse
|
13
|
Santos KVGD, Rocha MA, Dantas JKDS, Araújo SCMD, Dantas DV, Dantas RAN. Estratégias não farmacológicas na analgesia de adultos e idosos em procedimentos endovasculares: revisão de escopo. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0741pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: identificar as principais estratégias não farmacológicas utilizadas na prática clínica na analgesia de adultos e idosos em procedimentos endovasculares. Métodos: é uma revisão de escopo, realizada em julho de 2021, em 12 fontes de dados nacionais e internacionais. Seguiram-se as recomendações do JBI e do checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Foram selecionados 13 estudos para compor a amostra, sem recorte temporal ou de idioma. Resultados: as principais estratégias não farmacológicas encontradas foram: compressa com gelo, uso da música e reflexologia. Os procedimentos mais prevalentes foram: angiografia coronariana, cateterismo venoso periférico e retirada de cateter femoral. A mensuração da dor pela Escala Visual Numérica e Escala Visual Analógica descreveram redução da dor de adultos e idosos. Conclusões: as principais estratégias não farmacológicas encontradas foram compressa com gelo, uso da música e reflexologia, que reduzem a dor de adultos e idosos.
Collapse
|
14
|
Johnson A, Booker SQ. Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults. Pain Manag Nurs 2021; 22:694-701. [PMID: 33972196 PMCID: PMC11198878 DOI: 10.1016/j.pmn.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/14/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Alisa Johnson
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida.
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| |
Collapse
|
15
|
Weir S, Koritsas S. Pain and distress in people with severe or profound
ID
in Victoria, Australia: Utility of behavioural assessment tools. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Influence of Cognitive Orientation and Attentional Focus on Pain Perception. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137176. [PMID: 34281112 PMCID: PMC8297099 DOI: 10.3390/ijerph18137176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022]
Abstract
Background. Recently, a growing interest has emerged in the role of attention and hypervigilance in the experience of pain. Shifting attention away from pain seems likely to reduce the perception of pain itself. Objectives. The present study has been designed to test the following overall hypotheses: (1) disposition to catastrophize, self-efficacy perceived in pain resistance (task self-efficacy), previous experiences concerning the tolerance of physical pain, and degree of impulsiveness are significant predictors of the decision to abandon a painful test such as the cold pressor test (CPT); (2) the manipulation of the attentive focus (internal or external) can influence the level of perceived pain. Methods. Effects of the manipulation of attentional focus (internal and external) on pain perception and response of trial abandonment were evaluated in a sample of university students (n = 246) subjected to the cold pressor test. Results. A significant effect (p < 0.05) was found through a test–retest comparison on the final level of perceived pain among subjects who had received instruction to externalize the focus of their attention (mixed factorial analysis of variance), but no significance was observed with respect to the decision to abandon the experiment. A general explanatory model of the abandonment behavior demonstrating overall good fit measurements was tested too. Conclusion. The abandonment of tests has been shown to be predicted mainly by catastrophic attitude. Attentive impulsiveness showed a further positive effect on catastrophic attitude. Perceived self-efficacy in the tolerance of pain limited learned helplessness, which in turn positively influenced catastrophizing.
Collapse
|
17
|
Gilmartin-Thomas JFM, Forbes A, Liew D, McNeil JJ, Cicuttini FM, Owen AJ, Ernst ME, Nelson MR, Lockery J, Ward SA, Busija L. Evaluation of the Pain Impact Index for Community-Dwelling Older Adults Through the Application of Rasch Modelling. Pain Pract 2021; 21:501-512. [PMID: 33295122 PMCID: PMC8187294 DOI: 10.1111/papr.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the Pain Impact Index, a simple, brief, easy-to-use, and novel tool to assess the impact of chronic pain in community-dwelling older adults. METHODS A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert-type items that comprised the Index. The Index was evaluated for ordering of category thresholds, unidimensionality, overall fit to the Rasch model, measurement bias (Differential Item Functioning, DIF), targeting, and construct validity. RESULTS The four-item Pain Impact Index was self-completed by 6454 community-dwelling Australians who were aged at least 70 years and experienced pain on most days. Two items showed evidence of threshold disordering, and this was resolved by collapsing response categories (from 5 to 3) for all items. The rescored Index conformed to the unidimensionality assumption and had satisfactory fit with the Rasch model (analyses conducted on a reduced sample size to mitigate the potential for overpowering: n = 377, P > 0.0125, power > 77%). When considering uniform DIF, the most frequent sources of measurement bias were age, knee pain, and upper back pain. When considering nonuniform DIF, the most frequent source of measurement bias was knee pain. The Index had good ability to differentiate between respondents with different levels of pain impact and had highest measurement precision for respondents located around the average level of pain impact in the study sample. Both convergent and discriminant validity of the Index were supported. CONCLUSION The Pain Impact Index showed evidence of unidimensionality, was able to successfully differentiate between levels of pain impact, and had good evidence of construct validity.
Collapse
Affiliation(s)
- Julia F-M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alice J Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, U.S.A
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, U.S.A
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Samper-Ternent R, Gonzalez-Gonzalez C, Zazueta JD, Wong R. Factors associated with pain at the end-of-life among older adults in Mexico. Public Health 2021; 191:68-77. [PMID: 33540186 DOI: 10.1016/j.puhe.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The goal of care at the end-of-life has changed in recent years to encompass not only the relief of suffering but also improve the quality of death. Palliative care offers a coordinated and multidisciplinary approach to improving the quality of life and quality of care of individuals and their families facing illness at the end-of-life. This manuscript examines the end-of-life of older adults in Mexico and the factors associated with pain in this period of their life. STUDY DESIGN We used data from the Mexican Health and Aging Study (MHAS), a longitudinal panel study of adults 50 years and older in Mexico that is nationally representative of urban and rural areas and includes a next-of-kin questionnaire that captures the conditions during the last year of life of those who died. We used all four waves of data to construct a group of deceased individuals between 2001 and 2015, including information in the wave immediately before death and a complete next-of-kin questionnaire. We studied factors associated with pain at the end-of-life in this group. METHODS The dependent variable was pain reported over time among deceased individuals. We constructed pain categories based on whether the pain was reported in one or two waves (occasional and persistent), and the pain intensity reported (mild, moderate, or severe). We included independent variables previously reported to be related to pain, including sociodemographic, functional, and health characteristics. We used descriptive statistics and a multinomial regression model to examine the factors associated with pain in this group. RESULTS Pain was reported by 71.5% of older adults who died between 2001 and 2015. The prevalence of pain differed significantly by sociodemographic characteristics. Women had 1.69 higher odds of reporting severe pain than men. Compared to those with zero years of education, the odds of reporting severe pain were 0.72 for those with 1-6 years of education (P < 0.05) and 0.55 for those with more than 7 years (P < 0.001). Poor self-reported health, arthritis, taking more medications, depression, and functional limitations in the wave prior to death were associated with higher odds of persistent pain at the end-of-life (P < 0.05). Conversely, older age, more years of education, and diabetes were associated with lower odds of persistent pain (P < 0.001). CONCLUSIONS The prevalence of pain among older Mexican adults is high at the end-of-life. Sociodemographic factors, some chronic diseases, number of medications, psychosocial factors, and functional status impact the odds of reporting pain in this group at the end-of-life. Providing education to families on psychosocial interventions to improve the quality of care at the end-of-life is a pressing need in Mexico. These findings provide information to help policymakers and healthcare providers in Mexico improve the quality of care at the end-of-life.
Collapse
Affiliation(s)
- R Samper-Ternent
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
| | | | - J D Zazueta
- Netherlands Interdisciplinary Demographic Institute, The Hague, Netherlands
| | - R Wong
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
19
|
Booker SQ, Herr KA, Horgas AL. A Paradigm Shift for Movement-based Pain Assessment in Older Adults: Practice, Policy and Regulatory Drivers. Pain Manag Nurs 2021; 22:21-27. [PMID: 32948452 PMCID: PMC7886935 DOI: 10.1016/j.pmn.2020.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The profession of nursing has been on the front line of pain assessment and management in older adults for several decades. Self-report has traditionally been the most reliable pain assessment method, and it remains a priority best practice in identifying the presence and intensity of pain. Although advances in technology, biomarkers, and facial cue recognition now complement self-report, it is still important to maximize self-report of pain and to gather understanding of the total pain experience directly from patients. Practices in pain assessment in older adults have evolved over the past 25 years, and current research and quality improvement studies seek not only to detect the presence of pain, but also to determine the best protocol for assessment and most important pain characteristics to assess. Increasing data are now supporting two emerging practices: (1) consistently assessing the impact of pain on function, and (2) measuring pain during movement-based activities rather than at rest. OBJECTIVE The purpose of this article is thus to discuss the shifting paradigm for movement-based pain assessment in older adults, as well as the practice, policy, and regulatory drivers that support this practice change.
Collapse
Affiliation(s)
- Staja Q Booker
- College of Nursing, University of Florida, Gainesville, Florida.
| | - Keela A Herr
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Ann L Horgas
- College of Nursing, University of Florida, Gainesville, Florida
| |
Collapse
|
20
|
Cesari M, Cherubini A, Guralnik JM, Beresniak A, Rodriguez-Mañas L, Inzitari M, Walston J. Early detection of accelerated aging and cellular decline (AACD): A consensus statement. Exp Gerontol 2021; 146:111242. [PMID: 33484892 DOI: 10.1016/j.exger.2021.111242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
The cellular hallmarks of accelerated aging and their clinical expression may be grouped using the terms 'accelerated aging and cellular decline' (AACD) and/or 'age-associated cellular decline'. This construct is designed to capture the biological background predisposing the development of age-related conditions. By classifying risk factors, early indicators, and clinical differentiators of AACD through expert consensus, this study aimed to identify the signs, symptoms, and markers indicative of AACD. In doing so, this work paves the way for future implementation of the AACD concept in the clinical and research settings. An interdisciplinary panel of experts with clinical and research expertise was selected to participate in a virtual workshop to discuss AACD. A modified nominal group technique was used to establish consensus among the group. An extended group of international experts critically reviewed an early draft of the manuscript, and their feedback was then incorporated into the model. Experts identified 13 factors predisposing to or clinically manifesting AACD. Among these, chronic diseases, obesity, and unfavorable genetic background were considered as the most important. There was a consensus that a gradual and nonspecific development often characterizes AACD, making its clinical detection potentially challenging. In addition, signs and symptoms might have multifactorial causes and overlapping origins, such as genetic and epigenetic predispositions. As a result, an initial checklist was outlined, listing clinical factors of special relevance (e.g., fatigue, low quality of sleep, and low mood) to represent early manifestations of the organism's exhaustion, which are also frequently neglected in the clinical setting. Differentiating AACD from other conditions is essential. The use of a combination of biomarkers was proposed as a viable method in a two-step process of differentiation: 1) identification of early AACD clinical indicators, followed by 2) symptom and biomarker confirmation with a focus on system domains (to be potentially targeted by future specific interventions). Although the AACD construct is not yet ready for routine use in clinical practice, its operationalization may support the early identification of age-related conditions (when this might still be amenable to reversion) and also encourage preventative interventions. Further investigation is needed to establish specific biomarkers that confirm independent risk factors for AACD and provide a more definitive structure to the concept of AACD (and age-associated cellular decline).
Collapse
Affiliation(s)
- Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Via Camaldoli 64, 20100 Milano, Italy.
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, POR, Ancona, IRCCS INRCA, via della Montagnola 81, 60100, Ancona, Italy.
| | - Jack M Guralnik
- University of Maryland School of Medicine, Howard Hall, 660 W. Redwood Street, HH 132A, Baltimore, MD 21201, USA.
| | - Ariel Beresniak
- Data Mining International, International SA, World Trade Centre II CP856, 29 Route de Pre-Bois, CH-1215, Geneva 15, Switzerland.
| | - Leocadio Rodriguez-Mañas
- Geriatrics Department, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12,500, 28905, Getafe, Madrid, Spain.
| | - Marco Inzitari
- REFiT Bcn research group, Parc Sanitari Pere Virgili and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Jeremy Walston
- Department of Medicine, Division of Geriatric Medicine and Gerontology, John Hopkins University, 5501 Hopkins Bayview Circle, Suite 1A, 62, Baltimore, MD, 21224, USA.
| |
Collapse
|
21
|
Silva AG, De Francesco S, Rodrigues M, Queirós A, Cerqueira M. Test-Retest Reliability of Pain Measures in Institutionalized Older Adults: Number of Painful Body Sites, Pain Intensity, and Pain Extent. Pain Pract 2020; 21:270-276. [PMID: 32967059 DOI: 10.1111/papr.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The reliability of pain assessment in frail and older adults has seldom been assessed. This study aims to assess the test-retest reliability of (1) the number of painful body sites, (2) pain intensity, and (3) pain extent in institutionalized older adults. METHODS Seventy-four older adults who were institutionalized were assessed in 2 separate sessions, 2 days to 1 week apart, for pain intensity, number of painful body sites, and pain extent (in pixels) using a vertical pain numeric scale (0 to 10), a body chart divided into 50 body regions, and ImageJ, respectively. Intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable differences (MDDs) were calculated. RESULTS In session 1, the mean values (± standard deviation) were 5.54 ± 2.12 points for pain intensity, 4.47 ± 3.27 for number of painful body sites, and 2,726.00 ± 2,322.09 for pain extent. ICCs were 0.82 (95% confidence interval [CI] = 0.72 to 0.89) for pain intensity, 0.89 (95% CI = 0.83 to 0.93) for number of painful body sites, and 0.74 (95% CI = -0.07 to 0.91) for pain area. The MDDs were 2.46 for pain intensity, 3.14 for number of painful body sites, and 4,997.60 for pain extent. CONCLUSIONS The vertical pain rating scale and the body chart seem reliable to assess pain intensity and number of pain sites, respectively. The wide CI for the ICC found for pain area and the high measurement error compromise its potential clinical relevance.
Collapse
Affiliation(s)
- Anabela G Silva
- School of Health Sciences, Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
| | - Silvia De Francesco
- School of Health Sciences, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | - Milton Rodrigues
- School of Health Sciences, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | - Alexandra Queirós
- School of Health Sciences, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | - Margarida Cerqueira
- School of Health Sciences, Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
| |
Collapse
|
22
|
MacEntee MI, Brondani M, Avivi-Arber L, Bartlett D, Donnelly L, Duyck J, Hori K, Karve A, Persson GR, Kettratad-Pruksapong M, Schimmel M, Hon-Ching So F, Thomson WM, Yoon MN, Wyatt C. Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium. Gerodontology 2020; 38:5-16. [PMID: 33009707 DOI: 10.1111/ger.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs. METHODS Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence. RESULTS Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP). CONCLUSIONS The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Avanti Karve
- University of Sydney, Camperdown, NSW, Australia
| | | | | | | | | | | | | | - Chris Wyatt
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
23
|
[Pain and pain management in old age: special features and recommendations]. Z Gerontol Geriatr 2020; 54:507-512. [PMID: 32676737 DOI: 10.1007/s00391-020-01765-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pain is highly prevalent in older persons and has a variety of causes. In geriatric patients, especially in patients with dementia, pain is often not sufficiently recognized and therefore frequently remains untreated. For the affected patient group this can have far-reaching consequences for their functional and cognitive abilities and may consequently lead to loss of autonomy. OBJECTIVE Existing deficits of pain assessment for geriatric patients are described, with a primary focus on those patients suffering from cognitive impairments and pain. In addition, the influence of multimorbidity on pain management in old age is considered in detail. METHODS The diagnostics and measurement of pain in older individuals are described based on recent literature and corresponding instruments used in the assessment of pain are outloned. The authors pay special attention to the possibilities of pain measurement in patients with higher grade cognitive impairments and non-communicative patients. CONCLUSION A standardized pain assessment should be an integral component in the care and treatment of geriatric patients and individuals suffering from dementia. Validated instruments for pain measurement exist for both groups and should be integrated into daily clinical practice.
Collapse
|
24
|
Booker SQ, Tripp-Reimer T, Herr KA. "Bearing the Pain": The Experience of Aging African Americans With Osteoarthritis Pain. Glob Qual Nurs Res 2020; 7:2333393620925793. [PMID: 32548212 PMCID: PMC7271276 DOI: 10.1177/2333393620925793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022] Open
Abstract
Studies document that osteoarthritis-related joint pain is more severe in
African American older adults, but research on the personal experience
of osteoarthritis pain self-management in this population is limited.
Using a qualitative descriptive design, our objective was to extend
our understanding of the experience of life with osteoarthritis pain.
Eighteen African Americans (50 years and older) were recruited from
Louisiana to participate in a single semi-structured, in-depth
interview. A conventional content analysis revealed that “Bearing the
pain” characterized how older African Americans dealt with
osteoarthritis. Bearing the pain comprised three actions: adjusting to
pain, sharing pain with others, and trusting God as healer. We
discovered that a metapersonal experience subsumes the complex
biopsychosocial-cultural patterns and the intricate interaction of
self, others, and God in living with and managing osteoarthritis pain.
Study findings have implications for application of more inclusive
self-management frameworks and interventions.
Collapse
|
25
|
Ketamine infusion for pain control in elderly patients with multiple rib fractures: Results of a randomized controlled trial. J Trauma Acute Care Surg 2020; 87:1181-1188. [PMID: 31425468 DOI: 10.1097/ta.0000000000002479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rib fractures are associated with increased mortality, particularly in the elderly. While opiate-based pain regimens remain the cornerstone of rib fracture management, issues related to opioids have driven research into alternative analgesics. Adjunctive ketamine use in lieu of opioids continues to increase but little evidence exists to support its efficacy or safety within the elderly trauma population. METHODS A prospective, randomized, double-blind placebo-controlled trial of elderly patients (age, ≥65 years) with three or more rib fractures admitted to a Level I trauma center was conducted. Exclusion criteria included Glasgow Coma Scale score less than 14, and chronic opiate use. Groups were randomized to either low-dose ketamine (LDK) at 2 μg·kg·min or an equivalent rate of 0.9% normal saline. The primary outcome was reduction in numeric pain scores (NPS). Secondary outcomes included oral morphine equivalent (OME) utilization, epidural rates, pulmonary complications, and adverse events. RESULTS Thirty (50.8%) of 59 were randomized to the experimental arm. Groups were similar in makeup. Low-dose ketamine failed to reduce 24-hour NPS or OME totals. Subgroup analysis of 24 patients with Injury Severity Score greater than 15 demonstrated that LDK was associated with a reduction in OME utilization the first 24-hours (25.6 mg vs. 42.6 mg, p = 0.04) but at no other time points. No difference in other secondary outcomes or adverse events was noted. CONCLUSION Low-dose ketamine failed to affect NPS or OME within the overall cohort, but a decrease in OME was observed in those with an Injury Severity Score greater than 15. Additional studies are necessary to confirm whether LDK benefits severely injured elderly patients. LEVEL OF EVIDENCE Therapeutic, level I.
Collapse
|
26
|
Roseen EJ, Ward RE, Keysor JJ, Atlas SJ, Leveille SG, Bean JF. The Association of Pain Phenotype with Neuromuscular Impairments and Mobility Limitations Among Older Primary Care Patients: A Secondary Analysis of the Boston Rehabilitative Impairment Study of the Elderly. PM R 2020; 12:743-753. [PMID: 31994830 DOI: 10.1002/pmrj.12336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/05/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Clarifying the relationship between pain phenotypes and physical function in older adults may enhance screening and treatment for functional decline in primary care settings. OBJECTIVE To investigate the association of more severe pain phenotypes with neuromuscular impairments or mobility limitations among older community-dwelling primary care patients. DESIGN Cross-sectional analysis. SETTING The Boston Rehabilitative Impairment Study of the Elderly. PARTICIPANTS Adults aged 65 years or older. METHODS We counted the number of musculoskeletal pain locations (none, single site, multisite, or widespread) using the McGill Pain Questionnaire and identified pain intensity tertiles using the Brief Pain Inventory. Neuromuscular attributes (trunk extensor muscle endurance, and leg speed, strength, strength asymmetry, and range of motion) and mobility (Short Physical Performance Battery [SPPB]) were assessed with performance-based measures. Additionally, self-reported mobility was measured on the Late Life Function and Disability Instrument (LLFDI). For neuromuscular attributes and LLFDI, scores in the lowest tertile indicated neuromuscular impairment or mobility limitations, respectively. For SPPB, a score <7 (of 12) indicated severe mobility limitations. RESULTS Among 430 participants (mean age = 77) most were female (68%), white (83%), and had either multisite (50%) or widespread (14%) pain. After adjusting for baseline characteristics, widespread pain (compared to none) was associated with slow leg speed (adjusted odds ratio, 95% confidence interval: aOR = 2.33, 1.03-5.27), limited ankle range of motion (aOR = 2.15, 1.03-4.47) and mobility limitations on LLFDI (aOR = 3.85, 1.81-8.19). Being in the highest pain intensity tertile, versus lowest tertile, was associated with poor trunk extensor muscle endurance (aOR = 2.49, 1.41-4.39), limited ankle range of motion (aOR = 2.15, 1.25-3.71), and mobility limitations on SPPB (aOR = 2.56, 1.45-4.52), and LLFDI (aOR = 4.70, 2.63-8.40). CONCLUSIONS Among ambulatory, older primary care patients, more severe pain phenotypes are associated with neuromuscular impairments identified on physical testing and mobility limitations on validated measures.
Collapse
Affiliation(s)
- Eric J Roseen
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA.,PhD Program in Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA.,New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA
| | - Rachel E Ward
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Julie J Keysor
- PhD Program in Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA.,Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA
| | - Steven J Atlas
- Department of Medicine, Harvard Medical School, Boston, MA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Cambridge, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| |
Collapse
|
27
|
Miró J, Sánchez-Rodríguez E, Brijaldo S, Jensen MP. The Silhouettes Fatigue Scale: comprehensibility and validity in older individuals. Disabil Rehabil 2019; 42:1906-1911. [PMID: 30672341 DOI: 10.1080/09638288.2018.1539129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Fatigue has been shown to be one of the key factors that interfere in the quality of life of elderly individuals. In order to understand its impact and evaluate the efficacy of treatments that target fatigue, researchers and clinicians need psychometrically sound and easy to use assessment instruments. The aim of this work was to address this need by evaluating the comprehensibility and validity of the Silhouettes Fatigue Scale (SFS) in a sample of older individuals.Methods: A total of 70 older individuals participated in the study. Participants were interviewed individually and asked to rate their level of fatigue during the week before the interview using the SFS and the FACIT-Fatigue Scale (to help evaluate convergent validity), and respond to the Pain Catastrophizing Scale (to help evaluate discriminant validity).Results: The results indicate that the SFS is understandable and that the scores have an adequate convergent validity and discriminant validity when used with older adults.Conclusions: The SFS is a valid measure of fatigue that can be used with older adults. It fills the need for a brief and easy to administer and score measure, which can be used in situations where assessment burden is a significant issue.Implications for rehabilitationFatigue is a significant problem among the elderly resulting in significant disability, and psychometrically sound and easy to use questionnaires are needed.The Silhouettes Fatigue Scale (SFS) is a new single-item self-report fatigue rating scale.Results show that the SFS is understandable, and that the scores have discriminant and convergent validity when used with older adults.As it does not use written items, it may be more easily understood by people who have basic or even no literacy level, thus making it easier to use for a wider audience.
Collapse
Affiliation(s)
- Jordi Miró
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
| | - Solángel Brijaldo
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
28
|
Booker S“S, Booker RD. Shifting Paradigms: Advance Care Planning for Pain Management in Older Adults With Dementia. THE GERONTOLOGIST 2018; 58:420-427. [PMID: 28958054 PMCID: PMC5946942 DOI: 10.1093/geront/gnx025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Indexed: 12/11/2022] Open
Abstract
Ensuring effective pain management is an important quality of life (and death) issue for older adults with dementia, particularly since they are more vulnerable to under-assessment and under-treatment of pain. Yet, pain management decisions are often made by health care providers and caregivers with little to no input on the older adult's with dementia values for pain management. The Institute of Medicine (IOM) has recognized the revolutionary imperative to change the manner in which pain care is planned and coordinated. Implementing advance care planning (ACP) prior to advanced stages of dementia may assist in developing a person-centered pain management plan and improve pain care for this population throughout the dementia trajectory. This forum overviews the current state of pain management in dementia, discusses the significance of ACP in a pain management context, and offers practical solutions for common challenges in ACP. Dementia in this article is an umbrella term referring to the many forms of dementiathat cause cognitive impairment.
Collapse
|
29
|
|
30
|
Arnstein P, Herr KA, Butcher HK. Evidence-Based Practice Guideline: Persistent Pain Management in Older Adults. J Gerontol Nurs 2017. [DOI: 10.3928/00989134-20170419-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|