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

Frailty, pain and psychological variables among older adults living in Hong Kong nursing homes: can we do better to address multimorbidities?

WHAT IS KNOWN ON THE SUBJECT?: Frailty and multimorbidity are common in later life. A higher level of frailty is associated with a higher risk of adverse physical and psychological health situations. Older adults with pain have been reported to be lonelier and more depressed, as well as less happy and less satisfied with their life as compared to those without pain. In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Frailty index is positively correlated with the presence of pain, and associated with gender, functional mobility and loneliness. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. All nurses are advised to improve the management of pain in older people in order to lower the levels of pain, frailty and psychological distress among this population. Nursing care should address the loneliness level especially the problem of social loneliness among older adults particularly those living in nursing homes.

ABSTRACT

Introduction In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. Aim To examine the levels of frailty, pain and psychological parameters among older adults living in Hong Kong nursing homes, and the cross-sectional relationships among these items. Methods A cross-sectional study was conducted among 178 residents from six nursing homes. Frailty, pain, mobility, happiness, loneliness and life satisfaction of participants were assessed using validated questionnaires. Results A multiple linear regression (R(2)  = 0.338, P < 0.05) showed that the frailty index was associated with loneliness, functional mobility and gender. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. Discussion It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. Findings suggest that apart from improving mobility and reducing pain, loneliness could be a target of psychosocial interventions to reduce frailty and improve quality of life. Implications for practice It is advised that nursing care should address loneliness, especially the problem of social loneliness among older adults particularly those living in nursing homes.

A community-based walk-in screening of depression in Taiwan

Depression is a crucial public health problem because of its relatively high association with suicidal attempts, prolonged social isolation, poor physical health, and dementia. However, the available data and study on the prevalence of depression in Taiwan were mostly completed within the previous 1 to 2 decades, and these studies were limited to certain areas or populations. Little is known regarding the current status of depression in Taiwan. We used a brief tool, the Center for Epidemiological Studies Depression Scale (CES-D), to screen depression in 4 areas among the general and aged population. The results showed a higher CES-D score in the southern area among general (mean ± SD: 7.8 ± 8.4) or aged participants (mean ± SD: 7.2 ± 8.0) compared with other areas. The ratio of suspected depression patients was 16.4% of all recruited participants and 13.3% of aged participants. These results may provide information for this public health issue.

Aromatherapy: does it help to relieve pain, depression, anxiety, and stress in community-dwelling older persons?

To examine the effectiveness of an aromatherapy programme for older persons with chronic pain. The community-dwelling elderly people who participated in this study underwent a four-week aromatherapy programme or were assigned to the control group, which did not receive any interventions. Their levels of pain, depression, anxiety, and stress were collected at the baseline and at the postintervention assessment after the conclusion of the four-week programme. Eighty-two participants took part in the study. Forty-four participants (37 females, 7 males) were in the intervention group and 38 participants (30 females, 8 males) were in the control group. The pain scores were 4.75 (SD 2.32) on a 10-point scale for the intervention group and 5.24 (SD 2.14) for the control group before the programme. There was a slight reduction in the pain score of the intervention group. No significant differences were found in the same-group and between-group comparisons for the baseline and postintervention assessments. The depression, anxiety, and stress scores for the intervention group before the programme were 11.18 (SD 6.18), 9.64 (SD 7.05), and 12.91 (SD 7.70), respectively. A significant reduction in negative emotions was found in the intervention group (P<0.05). The aromatherapy programme can be an effective tool to reduce pain, depression, anxiety, and stress levels among community-dwelling older adults.

Aromatherapy hand massage for older adults with chronic pain living in long-term care

PURPOSE

Older adults living in long-term care experience high rates of chronic pain. Concerns with pharmacologic management have spurred alternative approaches. The purpose of this study was to examine a nursing intervention for older adults with chronic pain.

DESIGN

This prospective, randomized control trial compared the effect of aromatherapy M technique hand massage, M technique without aromatherapy, and nurse presence on chronic pain. Chronic pain was measured with the Geriatric Multidimensional Pain and Illness Inventory factors, pain and suffering, life interference, and emotional distress and the Iowa Pain Thermometer, a pain intensity scale.

METHOD

Three groups of 39 to 40 participants recruited from seven long-term care facilities participated twice weekly for 4 weeks. Analysis included multivariate analysis of variance and analysis of variance.

FINDINGS

Participants experienced decreased levels of chronic pain intensity. Group membership had a significant effect on the Geriatric Multidimensional Pain Inventory Pain and Suffering scores; Iowa Pain Thermometer scores differed significantly within groups.

CONCLUSIONS

M technique hand massage with or without aromatherapy significantly decreased chronic pain intensity compared to nurse presence visits. M technique hand massage is a safe, simple, but effective intervention. Caregivers using it could improve chronic pain management in this population.

Access to mental health care among older adults

Many older adults experience common mental health problems that can have a negative impact on physiological health, functional status, and quality of life. Lack of access to mental health care for community-dwelling older adults is a significant problem. Busy primary care practices, few mental health professionals, inadequate problem recognition, and flaws in the health care system all contribute to restricted access to mental health care. As the population of adults 65 and older continues to grow, the need for mental health care for this group will increase. Strategies to improve access to mental health care must be targeted at the individual level, the provider level, and the system level.

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.

Comparisons of catastrophizing, pain attitudes, and cold-pressor pain experience between Chinese and European Canadian young adults

Experimental pain research indicates ethnic differences in pain experience. Most of the cross-cultural pain research studied African Americans and Hispanics with little data available for Asian groups. This study examined differences in pain catastrophizing, pain attitudes, and pain responses between Chinese and European Canadian young adults. Prior to completing a cold-pressor (CP) task, 80 Chinese and 80 European Canadian undergraduate students were administered measures of pain catastrophizing and pain attitudes, including stoicism and cautiousness. Pain threshold, pain tolerance, and pain intensity were measured during the CP task. The Short Form-McGill Pain Questionnaire was administered immediately postimmersion to measure sensory and affective pain. While there was no group difference in pain threshold and pain intensity, Chinese participants displayed lower pain tolerance and reported higher SF-MPQ-Affective than European Canadians. Regarding psychological variables, there was no difference in stoicism and cautiousness between groups, but Chinese participants reported greater pain catastrophizing. Mediational analysis indicated that pain catastrophizing mediated the group differences in SF-MPQ-Affective score. The implications of the findings and future research were discussed.

PERSPECTIVE

The study found ethnic differences in cold-pressor responses, in which Chinese undergraduates reported higher levels of pain compared to their Euro-Canadian counterparts. The finding that pain catastrophizing mediated the ethnic difference in SF-MPQ-Affective scores indicated the importance of examining the role of catastrophizing in pain reports from Chinese and Euro-Canadian patients.

A collaborative model for the treatment of depression in homebound elders

Depression is a serious mental health problem for older adults. This study examined the effectiveness of an Advanced Practice Psychiatric Nurse (APPN)-Primary Care Physician (PCP) collaborative model to provide care to homebound elders with depressive symptoms. One hundred seventy nine individuals were screened for depression revealing an incidence of 46%. Of these, 83 (46%) were invited to participate in the study based on their depression scores; 41 (49%) agreed to participate in the study. Significant improvement in depression scores occurred for those who received treatment. Treatment included pharmacological and psychosocial interventions. As the population over the age of 65 continues to grow, many more older adults will need mental health treatment, and creative methods to provide services to homebound individuals must be explored.

Gender differences in pain and depressive tendency among Chinese elders with knee osteoarthritis

The purpose of this study was to explore gender differences in pain experiences, pain control beliefs, pain coping strategies, and depressive tendency among Chinese elderly with knee osteoarthritis (OA). Participants (N=199) were drawn from a previous convenience sample of outpatients with OA in Taiwan. Results indicated female elders tended to report higher scores on least pain, current pain and overall pain intensity than male elders (all p<0.01). Female elders also reported significantly greater pain disturbance than males across each item and for the overall score, except for walking. Males and females did not differ significantly in scores for pain control beliefs or for either pharmacological or non-pharmacological coping strategies. In addition, female elders tended to have greater depressive tendency than males. Results of regression analyses suggest that depressive tendency was a mediator of gender in predicting overall pain intensity and pain disturbance. In summary, this sample of elders showed gender differences in depressive tendency and some pain experiences but not in pain control beliefs and coping strategies. These results suggest that health care providers should be cautious about using gender differences to explain pain experiences among Chinese elders. In addition, health care providers may decrease these female patients' pain intensity and pain disturbance by treating depressive symptoms.

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.