Pain prevalence, experiences and management strategies among the elderly in taiwanese nursing homes

Pain Experiences and Coping Strategies in Rural Older Adults With Chronic Musculoskeletal Pain in Mountainous Areas of Taiwan

BACKGROUND

Although rural communities are home to a higher proportion of older residents, they provide fewer healthcare services than do urban core communities. Chronic musculoskeletal (MSK) pain is often associated with reduced daily activity and quality of life in older adults, particularly those in rural areas.

AIMS

This study investigated the pain experiences and coping strategies in rural older adults with MSK pain in Taiwan.

METHODS

A structured questionnaire was used to collect data from rural older adults with chronic MSK pain in mountainous areas of Taiwan.

RESULTS

In total, 55 rural older adults were enrolled in this study. The most common pain sites were the low back and knees. The main cause of pain was osteoarthritis. Three quarters of the participants suffered from moderate to severe chronic MSK pain on average. The results revealed that behavioral strategies were used more often than cognitive strategies. Regarding behavioral strategies, the most common non-pharmacologic and pharmacologic pain coping strategies were to rest and to take Chinese medicine, respectively. The most common cognitive strategy for pain coping was to talk to others.

CONCLUSIONS

The findings suggested that pain management for chronic MSK pain in rural older adults was inadequate in mountainous areas of Taiwan. Most rural older adults used multiple coping strategies to deal with their pain, and behavioral strategies were favored over cognitive strategies.

Long-term mortality in older adults with chronic pain: a nationwide population-based study in Taiwan

PURPOSE

This study was conducted to clarify the long-term mortality in the older population with chronic pain (CP), which is still unclear.

METHODS

We identified 17,568 older participants (aged ≥ 65 years) with CP and an identical number of comparison cohort without CP matched 1:1 by age and sex between 1996 and 2000 from the Taiwan National Health Insurance Research Database. Causes of CP, underlying comorbidities, living areas, and mortality were collected for analyses. The long-term mortality and the causes of mortality were compared between the two cohorts through follow-up since 2000 until 2015.

RESULTS

The mean age (± standard deviation) was 73.5 ± 5.7 years, and female participants comprised 55.1% in both cohorts. The most common causes of CP were osteoarthritis (24.2%), spinal disorders (22.4%), peripheral vascular diseases (14.0%), and osteoporosis (9.5%). Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP (adjusted hazard ratio [AHR]: 1.18; 95% confidence interval [CI] 1.14-1.21). The increased mortality rate was observed even after the follow-up of 6 years (AHR 1.15; 95% CI 1.10-1.20). No significant difference was observed in the causes of mortality between the two cohorts. The most common cause of mortality was malignancy, followed by cardiovascular and cerebrovascular diseases.

CONCLUSIONS

Chronic pain was associated with an increased rate of long-term mortality in the older population. Early detection and intervention for treating CP are suggested for this population.

Pain perception of older adults in nursing home and home care settings: evidence from China

Background

In the past decade, the number of long-term care (LTC) services for older adults in China has grown annually by an average of 10%. Older adults, their family members, and policymakers in China are concerned about patient outcomes in different care settings because older adults who have a similar functional status and LTC needs may choose either nursing home care or home care. The aim of this study was to compare pain perception in nursing home care and home care settings for physically dependent older adults in China.

Methods

Multi-stage sampling method was used to recruit respondents aged 65 and older from Yichang City, China, in 2015. The researchers employed a two-step analytical strategy—zero-inflated ordered probit regression followed by propensity score matching method—to model the effect of contrasting residence types on pain perception.

Results

Zero-inflated ordered probit regression analysis with participants unmatched (n = 484) showed that compared with older adults who received home care, those who received nursing home care did not have more severe pain (β = 0.088, SE = 0.196, p = 0.655). After propensity-score matching, the research found that older adults in the home care group perceived less pain compared with the nursing home group (β = 0.489, SE = 0.169, p = 0.004).

Conclusions

The older adults who received home care perceived significantly less pain than the nursing home residents. The pain of older adults may differ based on the type of LTC services and therapy intensity they received, and home care might lead to less pain and better comfort than nursing home care.

Overview of Pain Management in Older Adults

Epidemiological data suggests that the prevalence of musculoskeletal and neuropathic pain increases with age until at least late mid-life, though the pattern is somewhat unclear beyond this point. And though the prevalence of some types of pain may peak in late midlife, pain is still a substantial and common complaint even in the oldest age groups. This article provides an overview of later-life pain and includes a brief review of its epidemiology, describes commonly encountered barriers to its management, and discusses guidelines and recommended approaches to its assessment and management.

The prevalence, impact and management of musculoskeletal disorders in older people living in care homes: a systematic review

The aim was to systematically review the literature describing the prevalence, impact and current management of musculoskeletal pain in older people living in care homes. Published literature (AMED, CINAHL, EMBASE, psycINFO, MEDLINE, Cochrane Library) and unpublished literature (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials, UK National Research Register Archive) were searched on 1 March 2015. All studies assessing the prevalence, impact and management of musculoskeletal disorders in older people living in care homes were included. Literature was appraised using the CASP cohort and qualitative critical appraisal tools. Data were analysed using descriptive statistical approaches, meta-analysis and meta-ethnography techniques. Twenty-four papers reporting the results of 263,775 care home residents in 12 countries were identified. The evidence base was moderate in quality. Prevalence of musculoskeletal pain for people in care homes was 30.2 % (95 % confidence intervals 29.9-30.5 %; n = 105,463). Care home residents reported that musculoskeletal pain had a significant impact on their perceived independence and overall ability to participate in everyday activities of daily living. Three papers which presented data on interventions demonstrated that whilst multi-component assessment and management packages did not significantly change clinical outcomes, these empowered care home staff to feel more confident in managing these patients. Musculoskeletal pain is a common problem in care homes worldwide, and residents report significant impact on their lives. However, there is uncertainty regarding how to assess and manage such pain. PROSPERO Registration Number: CRD42014009824.

Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record

OBJECTIVE

To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used.

METHODS

We included patients 65 years and older who received NSAIDs between 2005 and 2010. Prescription data were extracted from EMR systems of GP practices participating in the Dutch NIVEL Primary Care Database. We calculated the proportion of NSAID prescriptions with co-prescription of gastroprotective medication for each GP practice at intervals of three months. Association between proportion of gastroprotection, brand of electronic medical record (EMR), and type of GP practice were explored. Temporal trends in proportion of gastroprotection between electronic medical records systems were analyzed using a random effects linear regression model.

RESULTS

We included 91,521 patient visits with NSAID prescriptions from 77 general practices between 2005 and 2010. Overall proportion of NSAID prescriptions to the elderly with co-prescription of gastroprotective medication was 43%. Mean proportion of gastroprotection increased from 27% (CI 25-29%) in the first quarter of 2005 with a rate of 1.2% every 3 months to 55%(CI 52-58%) at the end of 2010. Brand of EMR and type of GP practice were independently associated with co-prescription of gastroprotection.

CONCLUSION

Although prescription of gastroprotective medications to elderly patients who receive NSAIDs increased in The Netherlands, they are not co-prescribed in about half of the indicated cases. Brand of EMR system is associated with differences in prescription of gastroprotective medication. Optimal design and utilization of EMRs is a potential area of intervention to improve quality of prescription.

Photoplethysmography variability as an alternative approach to obtain heart rate variability information in chronic pain patient

Heart rate variability (HRV) is a well-known method for the assessment of autonomic nervous function of the heart. Previous study suggested that pulse rate variability (PRV) determined by photoplethysmography could be used instead of HRV to more simply assess autonomic nervous function. However, most research studies included healthy subjects. Thus, the aim of this study was to investigate the feasibility for PRV as a surrogate index for patients with chronic pain. This study investigated the correlation coefficient (by Pearson correlation) and agreement (by Bland-Altman analysis) between PRV and HRV in chronic pain patients in the clinical setting. The results showed high significant correlations (p < 0.001, r > 0.86) between all the HRV and PRV parameters and good agreements (ratio < 0.1) between the parameters in terms of HR, mean RR, VLF, LF, nLF, nHF, and SD1/SD2. Our study suggests that HRV can also be reliably estimated using the photoplethysmography-based PP interval in elderly patients with chronic pain.

The pain experience of inpatients in a teaching hospital: revisiting a strategic priority

For hospital executives and clinicians to improve pain management, organizations must examine the current pain experience of in-patients beyond simply measuring patient satisfaction. The aim of this study was to quantify the prevalence of pain among adult in-patients and the degree of interference pain had on daily activities. A descriptive, cross-sectional study was undertaken in a 530 bed tertiary care, teaching hospital in central Canada. A convenience sample (N = 88) of adult medical-surgical patients completed the Short Form-Brief Pain Inventory survey. Pain prevalence was 70.4%. The mean pain severity score was 3.76 (standard deviation, SD = 2.88) and mean pain interference score on daily activities was 4.56 (SD = 3.93). The most frequently identified site of pain was the lower extremities (n = 15, 28%). Women had higher mean scores on pain "right now" compared to men (p < 0.05). The sample majority (n = 81) indicated hospital staff asked about the presence of pain. Seventy-nine percent (n = 57) reported hospital staff "always" did everything they could to help manage pain. Eighty-four percent (n = 61) selected "always" or "usually" to describe their ability to be involved in deciding pain treatments. The mean pain relief score from treatments was 61% (SD = 34.79). Significant positive correlations were found between pain intensity ratings and pain interference on all daily activities (p < 0.001). Pain prevalence remains high with a significant relationship between pain and activities of daily living. The study provides baseline data to direct future initiatives at improving pain management.

Guidance on the management of pain in older people

This guidance document reviews the epidemiology and management of pain in older people via a literature review of published research. The aim of this document is to inform health professionals in any care setting who work with older adults on best practice for the management of pain and to identify where there are gaps in the evidence that require further research. The assessment of pain in older people has not been covered within this guidance and can be found in a separate document (http://www.britishpainsociety.org/pub_professional.htm#assessmentpop). Substantial differences in the population, methods and definitions used in published research makes it difficult to compare across studies and impossible to determine the definitive prevalence of pain in older people. There are inconsistencies within the literature as to whether or not pain increases or decreases in this age group, and whether this is influenced by gender. There is, however, some evidence that the prevalence of pain is higher within residential care settings. The three most common sites of pain in older people are the back; leg/knee or hip and 'other' joints. In common with the working-age population, the attitudes and beliefs of older people influence all aspects of their pain experience. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile. There are few absolute contraindications and relative cautions to prescribing paracetamol. It is, however, important that the maximum daily dose (4 g/24 h) is not exceeded. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in older people after other safer treatments have not provided sufficient pain relief. The lowest dose should be provided, for the shortest duration. For older adults, an NSAID or cyclooxygenase-2 (COX-2) selective inhibitor should be co-prescribed with a proton pump inhibitor (PPI), and the one with the lowest acquisition cost should be chosen. All older people taking NSAIDs should be routinely monitored for gastrointestinal, renal and cardiovascular side effects, and drug–drug and drug–disease interactions. Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life. However, this must be individualised and carefully monitored. Opioid side effects including nausea and vomiting should be anticipated and suitable prophylaxis considered. Appropriate laxative therapy, such as the combination of a stool softener and a stimulant laxative, should be prescribed throughout treatment for all older people who are prescribed opioid therapy. Tricyclic antidepressants and anti-epileptic drugs have demonstrated efficacy in several types of neuropathic pain. But, tolerability and adverse effects limit their use in an older population. Intra-articular corticosteroid injections in osteoarthritis of the knee are effective in relieving pain in the short term, with little risk of complications and/or joint damage. Intra-articular hyaluronic acid is effective and free of systemic adverse effects. It should be considered in patients who are intolerant to systemic therapy. Intra-articular hyaluronic acid appears to have a slower onset of action than intra-articular steroids, but the effects seem to last longer. The current evidence for the use of epidural steroid injections in the management of sciatica is conflicting and, until further larger studies become available, no firm recommendations can be made. There is, however, a limited body of evidence to support the use of epidural injections in spinal stenosis. The literature review suggests that assistive devices are widely used and that the ownership of devices increases with age. Such devices enable older people with chronic pain to live in the community. However, they do not necessarily reduce pain and can increase pain if used incorrectly. Increasing activity by way of exercise should be considered. This should involve strengthening, flexibility, endurance and balance, along with a programme of education. Patient preference should be given serious consideration. A number of complementary therapies have been found to have some efficacy among the older population, including acupuncture, transcutaneous electrical nerve stimulation (TENS) and massage. Such approaches can affect pain and anxiety and are worth further investigation. Some psychological approaches have been found to be useful for the older population, including guided imagery, biofeedback training and relaxation. There is also some evidence supporting the use of cognitive behavioural therapy (CBT) among nursing home populations, but of course these approaches require training and time. There are many areas that require further research, including pharmacological management where approaches are often tested in younger populations and then translated across. Prevalence studies need consistency in terms of age, diagnosis and terminology, and further work needs to be done on evaluating non-pharmacological approaches.

Self-care management and risk factors for depressive symptoms among elderly outpatients in Taiwan

BACKGROUND

Early detection and appropriate treatment interventions for depressive symptoms in the elderly are important issues for healthcare systems. However, few studies to date have focused on understanding self-care strategies to manage depressive symptoms among elderly people worldwide. The purpose of this study was to explore self-care management strategies and risk factors for depressive symptoms among elderly outpatients in Taiwan.

METHODS

A convenience sample of elderly persons (≥65 years old; N = 1054) was recruited from outpatient clinics of two hospitals in northern Taiwan.

RESULTS

In our sample, the prevalence of depressive tendency was 16.3%. The majority of participants (70.1%) managed depressive symptoms with self-care strategies. The strategy most often used to relieve depressive symptoms was "take a walk." The main information source for self-care strategies was self-learning. Depressive tendency in this sample was shown by logistic regression analysis to be significantly predicted by gender, marital status, perceived income adequacy, perceived health condition, stroke, and cancer.

CONCLUSION

Elderly people need to be made more aware of strategies to self-manage depressive symptoms. Healthcare providers can decrease/prevent the first risk factor for depressive symptoms (poor perceived health status) by improving elders' perceived health and promoting their actual health. The second risk factor (poor perceived income adequacy) can be decreased/prevented by carefully assessing patients' financial situation during clinic visits and providing suitable referral for further assistance.

Pain in older adults: A prevalence study in the Mediterranean region of Catalonia

Although information is available about the prevalence of pain in older adults in Anglo-Saxon and Scandinavian countries, very little is known about older adults in other parts of the world. This study reports the prevalence of pain in a randomly selected sample of older adults living in the Mediterranean region of Catalonia. Besides studying the existence of pain at the time of interview, the authors investigated several characteristics of the participants' pain experience: pain onset, number and location of pain sites, intensity of pain, number of days in pain, severity of pain, the extent to which pain interfered with daily life, and expressed needs in relation to pain. A cross-sectional survey was conducted of adults aged 65 years and over living in Catalonia. A total of 592 individuals participated in the study, and data was collected through personal interviews with participants. The prevalence of any pain was 73.5%, and similar across age groups but higher in females than in males. Among individuals suffering from pain, 94.2 were experiencing chronic pain (i.e., pain of three months' duration or more). The mean number of painful areas (out of 10) was 4.48. No clear pattern of the prevalence of regional pain was observed, although joints were the most frequently reported painful place. Pain interfered in the life of a considerable number of participants (35.5%), but no differences in the level of expressed needs was detected between those that were affected and those that were not. This study provides new evidence that pain is an important problem for the older adult, one that severely impacts on their health status, causing disability and reduced ability to function, particularly in older women.

Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan: a nationwide survey

This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required.

Predictors of pain in nursing home residents with dementia: a cross-sectional study

AIM

The aim of this study was to investigate the association between care activities and pain and restraint and pain in residents with dementia.

BACKGROUND

If pain in people with dementia is not identified or alleviated in a timely manner, it could lead to an adverse effect on their physical, mental, social health and quality of life. Care activities and restraint might cause pain, but little is known as to whether they are true risk-factors of pain in people with dementia.

DESIGN

A cross-sectional research design was employed.

METHODS

One hundred and twelve people with dementia were chosen from two nursing homes located in northern Taiwan. The demographic and clinical data collected included diagnoses, analgesics, restraints, recent falls, etc. The severity of dementia was assessed using the Clinical Dementia Rating Scale. The researchers observed every participant immediately following instances of routine care and then recorded the level of pain using the Chinese version of the Pain Assessment in Advanced Dementia scale.

RESULTS

About 36·6% of the participants had a Chinese version of the Pain Assessment in Advanced Dementia scale score above two points and an overall mean score of 1·50 (SD 1·81) with a range from 0-8. Only one resident with dementia received regular analgesic. Pain level in residents with dementia that needed assisted care was higher than in residents who were able to move about freely. It showed a positive correlation between level of pain and the severity of dementia among residents. The major predictors for pain in residents with dementia included restraint, assisted bathing and assisted transfer.

CONCLUSION

The findings confirm the association between care activities and pain and between restraint and pain in residents with dementia.

RELEVANCE TO CLINICAL PRACTICE

Formal caregivers need to minimise the triggering of pain when they assist residents' daily activities and avoid unnecessary restraints, while offering personalised, conventional nursing care to residents with late-stage dementia.

Pain prevalence, experiences, and self-care management strategies among the community-dwelling elderly in Taiwan

The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among community-dwelling elderly in Taiwan. A convenience sample of elderly persons (n=1054) was recruited from outpatient clinics of two hospitals in northern Taiwan. Participants' pain prevalence was 50.0%, and the average number of pain sites was 3.9 (standard deviation [SD]=5.8). Knees were the most commonly described pain site, but the most painful site was the spinal cord area. The mean pain intensity was 3.1 (SD=1.8) and pain interference was 2.8 (SD=2.1). Most participants took prescribed medications to deal with pain; doctors were the main information source for this self-care strategy. Although participants reported using various self-care pain management strategies, most still reported moderate-to-severe worst pain. Moreover, our participants identified far fewer self-care strategies than U.S. elders with chronic pain. These findings suggest that community-dwelling elders in Taiwan know little about managing pain symptoms or ascribe a different meaning to pain than their U.S. counterparts. Because health care providers play an important role in helping the elderly to manage pain, the authors recommend training health care providers about Taiwanese elders' perceptions of pain, to perform regular pain assessments, and provide current knowledge about pain assessment and pain management strategies.

Use, perceived effectiveness, and gender differences of pain relief strategies among the community-dwelling elderly in Taiwan

Pain is a common problem among the elderly. The entire scope of chronic pain relief strategies used by community elderly is still unclear. A limited number of studies have investigated this issue from diverse culture perspectives. In the present study, we investigated the use and perceived effectiveness of pain relief strategies adopted by the elderly; gender differences between frequently used relief strategies were also explored. Two hundred nineteen participants living in Taiwan City, Taiwan, were recruited by a random sampling method and interviewed face to face. The prevalence of chronic pain among the elderly was 42.0% (n = 92). The elderly tended to adopt multiple strategies (mean ± SD = 9.08 ± 3.56; range = 2-18) to relieve their chronic pain. In three domains of pain relief strategies, conventional medicine was used more frequently than complementary and alternative medicine and psychologic approaches. Most pain relief strategies were ineffective. Among the 22 strategies used, no strategy was reported as "much improved" by a majority of users. The top five pain relief strategies used by men and women were the same. Elderly women tended to adopt more psychologic approaches, such as acceptance and ignoring to relieve pain, than men. The findings suggest that nurses should pay more attention to the issue of chronic pain relief and provide the elderly with more effective pain relief strategies.

Pain and health-care utilization among older men in a veterans care home

Pain is a common health-care issue, and the prevalence increases with advancing age. Although it is often assumed that people with chronic pain are associated with a higher consumption of health care, evidence supporting this assertion is insufficient. Data from the Longitudinal Older VEterans (LOVE) study were stratified to explore the prevalence of pain and its relationship with health-care utilization. In total, data from 574 residents (mean age: 80.9+/-5.4 years, all male) were obtained. Among them, 92.8% were physically independent and 20.2% of them had mild to moderate cognitive impairment. Overall, 153 (26.3%) subjects reported pain; 114 (74.5%) subjects with mild pain and the remaining 39 (25.5%) subjects with moderate pain. The most commonly reported pain was lower back pain (40.5%, 62/153), which was followed by joint pain (29.4%, 45/153). Subjects with pain were more likely to have higher scores on the Geriatric Depression Scale (2.4+/-2.4 vs. 1.8+/-2.2, p = 0.023) and care-complexity problems (4.7+/-2.0 vs. 3.9+/-1.9, p < 0.001), despite being similar in age (81.3+/-5.0 vs. 80.8+/-5.5, p = 0.271), cognitive status and physical independence. Compared with pain-free subjects, subjects with pain were more likely to be hospitalized in the 12-month study period (0.71+/-1.20 vs. 0.46+/-1.00, p = 0.010), but the utilization of emergency department treatment (1.74+/-1.23 vs. 1.88+/-1.63, p = 0.560) was not statistically significant. In conclusion, the prevalence of pain among residents in a Taiwanese veterans care home was 26.3%; subjects with pain having more depressive symptoms, higher clinical-care complexity, and more likely to be hospitalized during the 12-month follow-up.

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

AIMS

To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary.

BACKGROUND

Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role.

METHODS

A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100.

RESULTS

Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident.

CONCLUSION

The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.

Self-care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes

AIMS

To explore self-care management strategies for sleep disturbances and risk factors for poor sleep among older residents of nursing homes in Taiwan.

BACKGROUND

With the deterioration of health that accompanies ageing, sleep quality becomes poorer, making it a significant issue in geriatric care. However, little is known about self-care strategies for management of sleep disturbances among elders worldwide.

DESIGN

A cross-sectional design was used.

METHODS

Residents (n = 196) were recruited from nine nursing homes chosen by stratified sampling across Taiwan. The Pittsburgh Sleep Quality Index, a self-care management of sleep disturbance questionnaire and a demographic form were used to collect data.

RESULTS

The prevalence of poor sleep in these older nursing home residents was 46.4%. Only 48.5% of participants used self-care strategies to manage sleep disturbances. The most frequently used strategy was 'take prescribed medicines'. Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that having no spouse and a low educational level significantly predicted poor sleep.

CONCLUSIONS

This study revealed a high prevalence of poor sleep quality among older residents of nursing homes in Taiwan. Older residents' inability to get relief from sleep disturbances may have been because of their limited use of strategies to manage sleep disturbances.

RELEVANCE TO CLINICAL PRACTICE

As health care providers play an important role in helping older people to manage sleep disturbances in nursing homes, it is crucial to train nursing home staff to perform sleep assessments and provide current knowledge about sleep disturbance management. It is also necessary to pay more attention to the sleep problems of elders without spouses and with little education.

Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults

The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52+/-8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p<0.001). Knee, low back, and hip pain were most common in both groups. The elderly people reported more frequency of falls than the middle-aged adults. The score of the FRT was higher among men (20.67+/-7.16cm) than among women (18.77+/-6.59cm). In both groups; the women had a higher VAS score than those of matched the men. Although the middle-aged adults had higher and better scores than the elderly people, the data showed that the middle-aged adults are also at risk and should be prepared properly for healthy aging.

A survey of Chinese nurses? current knowledge of pain in older people

AIM

To investigate the current level of Chinese nurses' knowledge of pain and pain management in older people.

BACKGROUND

Most research about nurses' knowledge regarding pain has taken place in developed countries; however, limited research in this area has taken place in developing countries and particularly in China.

METHODS

Registered Nurses (n = 621) in three different hospitals were surveyed with the questionnaire about pain and pain management with respect to older people.

RESULTS

The finding showed that a significant knowledge deficit in this area exists. There were no significant differences among nurses in terms of education background, position and whether or not there was attendance in an educational session on pain management. However, there were statistically significant differences based on age; hospital of employment and clinical area in which employed.

CONCLUSION

This survey suggested that nurses' knowledge of pain in older people should be improved. Basic and continuing education of nurses in this area should be enhanced and their active participation in pain management should be encouraged.

RELEVANCE TO CLINICAL PRACTICE

The findings in this survey highlight a significant pain management knowledge deficit among the nurses in the clinical practice. The findings may help the nurses realize their knowledge deficit in this area and may also suggest curriculum changes for the nurses to improve pain management knowledge.

Self-care management and risk factors for depressive symptoms among Taiwanese institutionalized older persons

BACKGROUND

Depression in the elderly has become a serious healthcare issue worldwide, but studies of self-care strategies and risk factors for depressive symptoms are limited.

OBJECTIVES

To determine the self-care strategies and risk factors for depressive symptoms among residents of public elder care homes in Taiwan.

METHODS

A cross-sectional design was used. Two of 18 public elder care homes were chosen by random sampling throughout Taiwan. Residents (N = 200) of these two care homes who were 65 years old or above and without severe cognitive deficit participated in this study.

RESULTS

Nearly half of the participants (49%) were identified by the Geriatric Depression Scale as depressed. Most participants (93%) used self-care strategies to manage their depressive symptoms. The most frequently used strategy was "take a walk." Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that cognitive function, perceived health status, and osteoarthritis were significant predictors of depression in this sample.

CONCLUSIONS

Because older persons tended to engage in activities and to interact with others to manage their depressive symptoms, healthcare providers in public elder care homes may consider arranging enough activities and people contacts for residents. Due to the limited number of healthcare providers in these homes, the author recommends increasing the knowledge of both providers and residents about depression and self-care management strategies.

Self-care management and risk factors for depressive symptoms among elderly nursing home residents in Taiwan

The purpose of this study was to explore self-care management strategies and risk factors for depressive symptoms among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n = 220). In these elderly nursing home residents, the prevalence of depressive tendency was 55.0%. Although only 42% of participants used self-care strategies to manage depressive symptoms, the most frequently used strategy was "take a walk." Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that satisfaction with living situation and perceived health status significantly predicted depressive symptoms. Since elders tended to engage in activities and interact with others to manage their depressive symptoms, health care providers in nursing homes should consider improving access to activities and interpersonal contacts for elderly residents. Elders' awareness of strategies to self-manage depressive symptoms also needs to be increased. The risk factors for depressive symptoms may be addressed by providing a pleasant and comfortable living environment, discouraging poor perceived health status, and promoting the health of elderly residents of nursing homes in Taiwan.

Reliability and validity of the Faces Pain Scale with older adults

BACKGROUND

The Faces Pain Scale (FPS) is effective with older adults in clinical assessment of pain intensity. The 0-10 numerical rating scale (NRS) has universally adapted for assessment of pain intensity. The commonly used versions of the FPS have six, seven or nine faces.

OBJECTIVES

We proposed an 11 face modified version of the McGrath nine face FPS to compare with the 0-10 NRS without the mathematical translation. The psychometric properties of the proposed version were also investigated in a sample of Korean older adults.

DESIGN

This study employed methodological research design.

SETTINGS AND PARTICIPANTS

A sample of 31 older adults was recruited through local senior citizen centers to examine the construct validity and the test-retest reliability. For the concurrent validity testing, a sample of 85 older adults with chronic pain was recruited through a general hospital and an oriental medical hospital.

METHODS

The construct validity was examined by determining if the subjects perceive the FPS as representing pain and they agree on the rank of each face. The test-retest reliability was examined at a 2-week interval. The concurrent validity was examined by using the NRS and the Visual Analogue Scale (VAS).

RESULTS

Subjects perceived the 11 FPS as a pain measure, and the subjects' agreements in the rank ordering of the faces were almost perfect (Kendall's W = .93, p < .001). Cohen's kappa of .61 (p < .001) for test-retest reliability was acceptable in the cognitively intact subjects. Concurrent validity measured by the correlation between the FPS and the NRS (r = .73, p < .001) and the VAS (r = .73, p < .001) was supported.

CONCLUSIONS

These results supported the appropriateness of the 11 FPS for use with the older adults in clinical practice to measure pain intensity. Additionally, this study provided cross-cultural evidence to evaluate usefulness of the FPS.

Depressive symptoms, pain experiences, and pain management strategies among residents of taiwanese public elder care homes

The purpose of this study was to explore depressive symptoms, pain experiences, and pain self-care management strategies among residents of public elder care homes in Taiwan. Random sampling was used to recruit participants (n=200). In this sample, the prevalence of depressive symptoms was 49.0%. Pain prevalence was significantly higher in the depressed group (59.2%) than in the non-depressed group (43.1%). Depressed participants tended to report more severe pain intensity, worst pain, average pain, and more interference with walking than the non-depressed group. Most participants (60.0%) took prescribed medications for dealing with pain. Self was the main information source for pain management strategies. Participants reported severe bouts of pain but used limited self-care pain management strategies. Due to the limited number of health care providers in elder care homes, the authors recommend increasing knowledge about depression, pain, and pain management strategies of both institutional health care staff and residents.