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Antunes TPC, Jardim FG, de Oliveira Abreu CIP, de Abreu LC, Bezerra IMP. Chronic Pain Self-Management Strategies for Older Adults: An Integrative Review. Life (Basel) 2024; 14:707. [PMID: 38929690 PMCID: PMC11204825 DOI: 10.3390/life14060707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Due to the complex nature of chronic pain, especially in older adults, a biopsychosocial approach is more effective than an isolated approach for its management. Furthermore, when patients are actively engaged in their pain management, they are more likely to be successful than relying totally on others. OBJECTIVE To analyze the self-management strategies currently used by older adults with chronic pain. METHOD An integrative review was conducted through seven online databases, searching for scientific studies on this topic published in the last 10 years. RESULTS AND CONCLUSION Fifty-eight studies were included in the final sample. Research on chronic pain self-management for older adults has increased in recent years. Although a diversity of chronic physical painful conditions are being investigated, many conditions are still under-investigated. Online and in-person strategies are currently adopted, demonstrating similar results. Positive results are evidenced by strategies including health promotion, mind control, social participation and take-action fields. Major results come from a combination of strategies focusing on biopsychosocial aspects of pain management. Results include not only the reduction of pain itself, but increased self-efficacy, adoption of health behaviors and improvement of functionality, among others, i.e., improved QoL, despite pain.
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Affiliation(s)
- Thaiany Pedrozo Campos Antunes
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
| | - Fernanda Golçalves Jardim
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
| | | | - Luiz Carlos de Abreu
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
- Department of Preventive Medicine, Federal University of Espirito Santo, Vitória 29075-910, Espírito Santo, Brazil;
| | - Italla Maria Pinheiro Bezerra
- Public Policy and Local Development Department, Superior School of Sciences of the Santa Casa de Misericórdia de Vitória, Vitória 29045-402, Espirito Santo, Brazil; (T.P.C.A.); (F.G.J.); (L.C.d.A.)
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Jarman MP, Jin G, Chen A, Losina E, Weissman JS, Berry SD, Salim A. Short-term outcomes of prehospital opioid pain management for older adults with fall-related injury. J Am Geriatr Soc 2024; 72:1384-1395. [PMID: 38418369 PMCID: PMC11090711 DOI: 10.1111/jgs.18830] [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: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia. METHODS We linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall-related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay. RESULTS Of 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non-home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups. CONCLUSIONS Few older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall-related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.
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Affiliation(s)
- Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Annie Chen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elena Losina
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Salim
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Woemn's Hospital, Boston, Massachusetts, United States
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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.
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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
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Sayler MG, Domian Ommen CE, McKimmy BJ, Smith KA. Is it Feasible? A Quality Improvement Project to Integrate Complementary Therapy Into a Pain Management Program on a Transitional Care Unit. J Dr Nurs Pract 2022; 15:46-56. [DOI: 10.1891/jdnp-d-20-00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundThe cost of pain to society is high, not only in dollars but in physical and emotional suffering. Undertreated pain in the geriatric population can lead to functional impairments and diminished quality of life. A transitional care unit (TCU) described having higher levels of moderate to severe pain than state and national levels in like facilities.ObjectiveA team of university faculty and students, and staff members from the TCU developed a quality improvement project to examine the feasibility of integrating complementary therapies to treat pain into clinical practice.MethodsThe team integrated three evidence-based complementary therapies into staff workflow.ResultsThe nursing and therapy staff reported minimal to no interruption to their workflow when patients used the complementary therapies. Staff expressed satisfaction with an expanded menu of pain management options. Patients reported statistically significant lower (p = 0.002) pain levels after using the complementary therapies and benefits beyond pain relief, including relaxation, stress reduction, and improved sleep.ConclusionAdding complementary therapies to the pain management program was feasible and the patients had less pain along with other benefits when using the therapies with standard care.Implications for NursingHaving additional methods for managing pain is beneficial and vital.
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Towers AM, Smith N, Allan S, Vadean F, Collins G, Rand S, Bostock J, Ramsbottom H, Forder J, Lanza S, Cassell J. Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background
Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.
Objectives
The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.
Design
This was a mixed-methods study.
Setting
The setting was care homes for older adults in England.
Participants
Care home residents participated.
Results
Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.
Limitations
No care homes rated as inadequate were recruited to the study.
Conclusions
The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.
Future work
Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Florin Vadean
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Grace Collins
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | | | - Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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Medical-Surgical Patients' and Registered Nurses' Satisfaction and Comprehensiveness of Patient Assessment Using the Clinically Aligned Pain Assessment Tool. Pain Manag Nurs 2021; 23:293-300. [PMID: 34493438 DOI: 10.1016/j.pmn.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/01/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The pain experience is complex, and nurses are challenged to objectively assess and document patients' subjective reports of pain. There is a clear need for an assessment tool that is easy to use and provides meaningful, actionable information for patients and nurses. AIMS This study explored nurses' and patients' satisfaction with the Clinically Aligned Pain Assessment (CAPA) as well as nurses' charting. SETTING AND PARTICIPANTS A convenience sample of adult patients and nurses on four medical-surgical units in one community hospital. METHODS A quantitative, two-group comparison design between patients and nurses using questionnaires to determine satisfaction and a retrospective chart review to determine comprehensiveness of nurse charting. RESULTS No significant differences existed between patients' and nurses' responses to seven of eight satisfaction questions The median score for seven of eight questions was 5 (using a 6-point Likert scale with 1 = strongly disagree and 6 = strongly agree), which demonstrated more than 80% agreement (somewhat agree, agree, strongly agree) among both groups that CAPA was superior to the NRS, based on individual responses. The one significant difference (p = 0.03) revealed patients were more likely to respond "agree or strongly agree" compared to nurses regarding the nurse thoroughly addressing patients' needs using CAPA. Inter-rater reliability using CAPA was determined to be 89.5%, and a panel of clinical experts determined CAPA had strong content validity of 88.33%. In addition, 70.41% of nurses charted comprehensively using CAPA. CONCLUSION As a result, CAPA was determined to be convenient, accurate, and valuable in guiding intervention decisions.
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Rababa M, Ellis JL. Nurses' Autonomy and Perceived Barriers to Pain Management in Nursing Home Residents. J Gerontol Nurs 2021; 47:45-52. [PMID: 34309450 DOI: 10.3928/00989134-20210624-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nurses' autonomy is essential for optimal pain management in nursing home (NH) residents. However, little is known about nurses' autonomy and how it relates to the issue of unrelieved pain in NH residents in Jordan and beyond. The current descriptive comparative study aimed to compare the prevalence of barriers to pain assessment and management in NH residents, perceived by nurses according to their autonomy level. Participating nurses were found to have low levels of clinical autonomy. A significant difference in the prevalence of perceived barriers to pain assessment and management was found among nurses according to their autonomy level. Findings provide a better understanding of nurses' autonomy and their perceived barriers to pain assessment and management in NH residents. Findings also highlight the significance of nurses' autonomy for the assessment and management of pain in NH residents. [Journal of Gerontological Nursing, 47(8), 45-52.].
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Vitullo M, Holloway D, Tellson A, Nguyen H, Estimon K, Linthicum J, Viejo H, Coffee A, Huddleston P. ∗Surgical patients' and registered nurses' satisfaction and Perception of Using the Clinically Aligned Pain Assessment (CAPA©) Tool for Pain Assessment. JOURNAL OF VASCULAR NURSING 2020; 38:118-131. [PMID: 32950112 DOI: 10.1016/j.jvn.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/17/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
Pain management is a significant issue in all health care systems. Pain is often mismanaged because of lack of a comprehensive pain assessment. This often leads to inappropriate medication administration, inadequate pain relief, negative patient outcomes, and delayed discharges. There is an opportunity for developing a more comprehensive pain assessment. The Clinically Aligned Pain Assessment (CAPA©) pain tool was developed by the University of Utah.. It assesses 5 dimensions of pain: comfort, change in pain, pain control, functioning, and sleep. The purpose of the study was to determine if the patients and nurses were more satisfied discussing pain with CAPA© or the numeric rating scale (NRS) and words to describe pain, intensity, location, duration, and aggravating and/or alleviating factors (WILDA) tool. This study had a 2-group comparison design with mixed methods approach. One group comprised patients and the other group comprised nurses. There were 63 nurses and 95 patients enrolled in the study at two perioperative hospitals. The results demonstrated that the patients and nurses were more satisfied with using the CAPA© tool than the NRS/WILDA. The CAPA© tool allows for a more comprehensive way to assess pain which has the potential to create more effective treatments for pain, improve discharge time, and positive patient outcomes.
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Affiliation(s)
- Mary Vitullo
- Baylor Scott and White Research Institute, Dallas, TX.
| | | | | | - Hoa Nguyen
- Baylor Scott and White Research Institute, Dallas, TX
| | | | | | - Henry Viejo
- Baylor Scott and White Research Institute, Dallas, TX
| | - Amy Coffee
- Baylor Scott and White Research Institute, Dallas, TX
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Montesino-Goicolea S, Sinha P, Huo Z, Rani A, Foster TC, Cruz-Almeida Y. Enrichment of genomic pathways based on differential DNA methylation profiles associated with chronic musculoskeletal pain in older adults: An exploratory study. Mol Pain 2020; 16:1744806920966902. [PMID: 33073674 PMCID: PMC7711149 DOI: 10.1177/1744806920966902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
Our study aimed to identify differentially methylated CpGs/regions and their enriched genomic pathways associated with underlying chronic musculoskeletal pain in older individuals. We recruited cognitively healthy older adults with (n = 20) and without (n = 9) self-reported musculoskeletal pain and collected DNA from peripheral blood that was analyzed using MethylationEPIC arrays. We identified 31,739 hypermethylated CpG and 10,811 hypomethylated CpG probes (ps ≤ 0.05). All CpG probes were clustered into 5966 regions, among which 600 regions were differentially methylated at p ≤ 0.05 level, including 294 hypermethylated regions and 306 hypomethylated regions (differentially methylated regions). Ingenuity pathway enrichment analysis revealed that the pain-related differentially methylated regions were enriched across multiple pathways. The top 10 canonical pathways were linked to cellular signaling processes related to immune responses (i.e. antigen presentation, programed cell death 1 receptor/PD-1 ligand 1, interleukin-4, OX40 signaling, T cell exhaustion, and apoptosis) and gamma-aminobutyric acid receptor signaling. Further, Weighted Gene Correlation Network Analysis revealed a comethylation network module in the pain group that was not preserved in the control group, where the hub gene was the cyclic adenosine monophosphate-dependent transcription factor ATF-2. Our preliminary findings provide new epigenetic insights into the role of aberrant immune signaling in musculoskeletal pain in older adults while further supporting involvement of dysfunctional GABAergic signaling mechanisms in chronic pain. Our findings need to be urgently replicated in larger cohorts as they may serve as a basis for developing and targeting future interventions.
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Affiliation(s)
- Soamy Montesino-Goicolea
- Pain Research & Intervention Center of Excellence,
University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science,
College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Puja Sinha
- Department of Neuroscience, College of Medicine, University of
Florida, Gainesville, FL, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health &
Health Professions and College of Medicine, University of Florida, Gainesville,
FL, USA
| | - Asha Rani
- Department of Neuroscience, College of Medicine, University of
Florida, Gainesville, FL, USA
| | - Thomas C Foster
- Department of Neuroscience, College of Medicine, University of
Florida, Gainesville, FL, USA
- Genetics and Genomics Program, University of Florida,
Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL,
USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence,
University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science,
College of Dentistry, University of Florida, Gainesville, FL, USA
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Zheng K, Wang X. Publications on the Association Between Cognitive Function and Pain from 2000 to 2018: A Bibliometric Analysis Using CiteSpace. Med Sci Monit 2019; 25:8940-8951. [PMID: 31762442 PMCID: PMC6894366 DOI: 10.12659/msm.917742] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aimed to use CiteSpace software to conduct a bibliometric analysis of published studies on the association between pain and cognitive function from 2000 to 2018. The study also aimed to determine publication patterns and authorship and to identify recent trends for research in this field. MATERIAL AND METHODS Publications on the association between cognitive function and pain between 2000 and 2018 were identified from the Web of Science database. Bibliographic information, including authorship, country, citation frequency, changes in citation, and interactive visualization were generated using CiteSpace software. Co-citation, or frequency of two publications cited together by another publication, was also studied. RESULTS On 8th January 2019, 4,889 publications were identified. The United States (1132 publications) and the University of Washington (87 publications) were the most productive country and institution, respectively. The journal, Pain (182 publications) had the largest number of publications and was the most frequently cited journal (citation counts, 1569) with the highest centrality (0.62). Author A had the largest number of publications (21). Author B had the greatest co-citation count (223). Author C tied with Author D as the first co-cited author in terms of centrality (0.18). Author E in 2011 (co-citation count, 96) and Author F in 2008 (centrality: 0.11) had the highest co-citation counts and centrality, respectively. The keyword 'empathy' ranked first for research developments with the highest citation burst (10.045). CONCLUSIONS Bibliometric analysis of the association between pain and cognitive function might identify new directions for future research.
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Affiliation(s)
- Kangyong Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,The Fifth Clinical College, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China (mainland)
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Andrews SM, Dipnall JF, Tichawangana R, Hayes KJ, Fitzgerald JA, Siddall P, Poulos C, Cunningham C. An Exploration of Pain Documentation for People Living with Dementia in Aged Care Services. Pain Manag Nurs 2019; 20:475-481. [DOI: 10.1016/j.pmn.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/09/2018] [Accepted: 01/22/2019] [Indexed: 10/26/2022]
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Gregory J. Use of pain scales and observational pain assessment tools in hospital settings. Nurs Stand 2019; 34:e11308. [PMID: 31468952 DOI: 10.7748/ns.2019.e11308] [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] [Accepted: 03/12/2019] [Indexed: 11/09/2022]
Abstract
Pain is a personal, individual and subjective experience. The complex and dynamic nature of pain makes its assessment and management challenging for healthcare professionals. Various pain scales are available that can assist in identifying the patient's experience of pain; however, these tend to reduce this experience to a measure of pain intensity. The use of pain scales also requires patients to communicate and describe their pain; when this is not possible, it is necessary for healthcare professionals to observe patient behaviours that may indicate pain. Various observational pain assessment tools have been developed to assist in recognising and assessing pain. This article discusses the various pain scales and observational pain assessment tools that are available, and the evidence to support their use.
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Affiliation(s)
- Julie Gregory
- East Lancashire Hospitals NHS Trust, Blackburn, England
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Muñoz-Alvaredo L, López Vallecillo M, Jiménez Pérez JM, Martín-Gil B, Muñoz Moreno MF, Fernández-Castro M. Prevalence, pain management and registration in Internal Medicine units. ENFERMERIA CLINICA 2019; 30:275-281. [PMID: 30598350 DOI: 10.1016/j.enfcli.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/18/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalization units in a third level public hospital of the regional health service of Castilla y León. METHOD A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analyzed as recorded in the clinical records. RESULTS 83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale. CONCLUSIONS There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management.
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Affiliation(s)
- Laura Muñoz-Alvaredo
- Unidad de Medicina Interna y Enfermedades Infecciosas, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - María López Vallecillo
- Unidad de Gestión de Cuidados Gacela, Hospital Clínico Universitario de Valladolid, Valladolid, España; Facultad de Enfermería, Universidad de Valladolid, Valladolid, España
| | | | - Belén Martín-Gil
- Unidad de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Fe Muñoz Moreno
- Estadística, Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Mercedes Fernández-Castro
- Sección de Enfermería, Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España.
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Shahar I, Mendelson G, Gerbi S, Ben Natan M. Pain Assessment and Management by Nurses in a Geriatric Setting: Discrepancies between Guidelines and Documented Practice. Pain Manag Nurs 2018; 19:456-463. [DOI: 10.1016/j.pmn.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
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15
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Older adult's experience of chronic low back pain and its implications on their daily life: Study protocol of a systematic review of qualitative research. Syst Rev 2018; 7:81. [PMID: 29793522 PMCID: PMC5968538 DOI: 10.1186/s13643-018-0742-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Of various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more than 17 million older adults in the USA suffer from at least one episode of LBP annually, approximately six million of them experience chronic LBP that significantly affects their quality of life and physical function. Since many older adults with chronic LBP may also have comorbidities and are more sensitive to pain than younger counterparts, these older individuals may face unique age-related physical and psychosocial problems. While some qualitative research studies have investigated the life experiences of older adults with chronic LBP, no systematic review has integrated and synthesized the scientific knowledge regarding the influence of chronic LBP on the physical, psychological, and social aspects of lives in older adults. Without such information, it may result in unmet care needs and ineffective interventions for this vulnerable group. Therefore, the objective of this systematic review is to synthesize knowledge regarding older adults' experiences of living with chronic LBP and the implications on their daily lives. METHODS/DESIGN Candidate publications will be sought from databases: PubMed, CINAHL, and PsycINFO. Qualitative research studies will be included if they are related to the experiences of older adults with chronic LBP. Two independent reviewers will screen the titles, abstracts, and full-text articles for eligibility. The reference lists of the included studies will be checked for additional relevant studies. Forward citation tracking will be conducted. Meta-ethnography will be chosen to synthesize the data from the included studies. Specifically, the second-order concepts that are deemed to be translatable by two independent reviewers will be included and synthesized to capture the core of the idiomatic translations (i.e., a translation focusing on salient categories of meaning rather than the literal translation of words or phrases). DISCUSSION This systematic review of qualitative evidence will enable researchers to identify potential unmet care needs, as well as to facilitate the development of effective, appropriate, person-centered health care interventions targeting this group of individuals. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018: CRD42018091292.
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Schofield P. The Assessment of Pain in Older People: UK National Guidelines. Age Ageing 2018; 47:i1-i22. [PMID: 29579142 PMCID: PMC5888957 DOI: 10.1093/ageing/afx192] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pat Schofield
- Positive Ageing Research Institute Anglia Ruskin University Chelmsford, Cambridge
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Thakral M, Shi L, Foust JB, Patel KV, Shmerling RH, Bean JF, Leveille SG. Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain. Geriatr Nurs 2018; 39:450-456. [PMID: 29477646 DOI: 10.1016/j.gerinurse.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 02/06/2023]
Abstract
Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months. A count variable indicated number of persistent categories. Pain quality was highly persistent. Adjusted for baseline covariates, individuals endorsing 3 persistent categories were 2-2.5x more likely to experience more widespread pain at 18 months compared to fewer persistent categories. No associations were noted in changes in pain severity or interference. A comprehensive pain assessment that includes diverse pain quality descriptors may improve individualized pain management.
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Affiliation(s)
- Manu Thakral
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA.
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Janice B Foust
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Robert H Shmerling
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
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18
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Kaasalainen S, Zacharias R, Hill C, Wickson-Griffiths A, Hadjistavropoulos T, Herr K. Advancing the pain management in older adults agenda forward through the development of key research and education priorities: A Canadian perspective. Can J Pain 2017; 1:171-182. [PMID: 35005352 PMCID: PMC8730549 DOI: 10.1080/24740527.2017.1383139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 11/04/2022]
Abstract
Background: The undermanagement of pain in older adults has been identified as a problem worldwide. Aims: The purpose of this research is to identify priority areas in education and research for future development with the aim of improving pain management in older persons. In addition, barriers to addressing these priorities are identified. Methods: This mixed methods study, based on a modified Delphi approach, included three distinct components: (1) a qualitative component using focus groups with key informants or experts in the field of pain management in older adults (n = 17), (2) a scoping review of the literature, and (3) a survey of ranked responses completed by the same key informants who attended the focus groups. Thematic analysis was used to identify the initial list of issues and descriptive statistics were used for ranking them. Results: A number of concerns related to both education and research were frequently endorsed by participants. For education, they identified the need for more content in both undergraduate and continuing education programs related to documenting about pain; assessing pain, and learning about the complexities of pain. Research priorities included the need to explore successful practice models; costs of untreated pain; effects of mobility on pain; and patient preferences for pain management. Key barriers to addressing these barriers included lack of staff time and resources and unfamiliarity with pain assessment tools. Conclusion: These findings highlight priority issues related to pain management in older adults from a nationwide perspective.
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Affiliation(s)
- Sharon Kaasalainen
- Department of Family Medicine, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ramesh Zacharias
- Chronic Pain Management Unit, Chedoke Hospital & Village of Erin Meadows, Hamilton, Ontario, Canada
| | - Courtney Hill
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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19
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Kang Y, Demiris G. Self-report pain assessment tools for cognitively intact older adults: Integrative review. Int J Older People Nurs 2017; 13:e12170. [PMID: 28980440 DOI: 10.1111/opn.12170] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 08/21/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pain is common in older adults, but it is often underreported or undertreated partly because many consider pain to be a normal consequence of ageing. Among the plethora of available self-report pain assessment tools, there is no synthetised evidence which tools are indicated for use among cognitively intact older adults. PURPOSE OF THE STUDY To understand documented self-report pain assessment tools that have been used among cognitively intact older adults, and to describe their characteristics including overall performance as well as studies demonstrating their use. METHODS A systematic search of the indexed databases PubMed, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) was conducted to identify documented self-report pain assessment tools through peer-reviewed papers, including citations from January 1990 to December 2015. Thirty-five percentage of abstracts were independently evaluated by two raters according to specific criteria. RESULTS Among identified tools, the Iowa Pain Thermometer, the 6-point Verbal Descriptor Scale, the Numeric Rating Scale, the short form Brief Pain Inventory (BPI) and the Geriatric Pain Measure (GPM) may be suitable tools for self-reported pain by cognitively intact older adults based on the statement of the literature. Only two self-report tools (the GPM and the Geriatric Painful Events Inventory) were designed specifically for older adults. CONCLUSIONS More studies are needed to evaluate pain measures' psychometric performance across different settings, racial/ethnic groups and disease categories. Since 80% of older adults have at least one chronic disease, multidimensional tools such as the GPM may need to be used more often for accurate self-report of pain. IMPLICATIONS FOR PRACTICE Examining the psychometric properties of comprehensive self-report pain assessment tools informs recommendations for the selection of tools to be used in clinical practice.
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Affiliation(s)
- Youjeong Kang
- School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- School of Nursing & School of Medicine, University of Washington, Seattle, WA, USA
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20
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Mayahara M, Wilbur J, O'Mahony S, Breitenstein S. E-Pain Reporter: A Digital Pain and Analgesic Diary for Home Hospice Care. J Palliat Care 2017; 32:77-84. [PMID: 28868960 DOI: 10.1177/0825859717722466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Informal hospice caregivers play a key role in managing patients' pain at home, but lack of adherence to doctor-prescribed analgesic regimens and medication errors are significant barriers to truly effective pain management. A digital pain diary may improve caregiver management of pain at home; however, most digital pain tools available today were developed without input from patients or caregivers. Accordingly, the purpose of this study was to develop a digital pain application (1) for hospice caregivers to record patient pain and analgesic use and (2) for nurses to monitor administration of analgesics by caregivers. Using advisory group methods, nurse case managers (n = 6), and informal caregivers (n = 3) helped us to convert a paper-based pain and analgesic diary into a digital format-the e-PAIN Reporter-and to refine the application. The e-PAIN Reporter provides information on patient pain assessment and pain management and reports to nurses in real time. Further testing is now needed to determine (1) the feasibility of using the e-PAIN Reporter and (2) its effectiveness in improving pain management for hospice patients.
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Affiliation(s)
- Masako Mayahara
- 1 College of Nursing, Rush University, Chicago, Illinois, USA
| | - JoEllen Wilbur
- 1 College of Nursing, Rush University, Chicago, Illinois, USA
| | - Sean O'Mahony
- 1 College of Nursing, Rush University, Chicago, Illinois, USA.,2 Rush Medical College, Rush University, Chicago, Illinois, USA.,3 Palliative Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Lambing A, Nichols CD, Munn JE, Anderson TL, Tortella BJ, Witkop ML. Patient, caregiver, and provider perceptions of pain and pain management in adolescents and young adults with bleeding disorders. Haemophilia 2017; 23:852-860. [DOI: 10.1111/hae.13293] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Angela Lambing
- Henry Ford Hemophilia and Thrombosis Treatment Center; Detroit MI USA
| | | | - James E. Munn
- University of Michigan Hemophilia Treatment Center; Ann Arbor MI USA
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Jones J, Sim TF, Hughes J. Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management-A Narrative Review of Current Practices. PHARMACY 2017; 5:E30. [PMID: 28970442 PMCID: PMC5597155 DOI: 10.3390/pharmacy5020030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023] Open
Abstract
Elderly people are susceptible to both falls and cognitive impairment making them a particularly vulnerable group of patients when it comes to pain assessment and management in the emergency department (ED). Pain assessment is often difficult in patients who present to the ED with a cognitive impairment as they are frequently unable to self-report their level of pain, which can have a negative impact on pain management. This paper aims to review how cognitive impairment influences pain assessment in elderly adults who present to the ED with an injury due to a fall. A literature search of EMBASE, ProQuest, PubMed, Science Direct, SciFinder and the Curtin University Library database was conducted using keyword searches to generate lists of articles which were then screened for relevance by title and then abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. The literature reports that ED staff commonly use visual or verbal analogue scales to assess pain, but resort to their own intuition or physiological parameters rather than using standardised observational pain assessment tools when self-report of pain is not attainable due to cognitive impairment. While studies have found that the use of pain assessment tools improves the recognition and management of pain, pain scores are often not recorded for elderly patients with a cognitive impairment in the ED, leading to poorer pain management in this patient group in terms of time to analgesic administration and the use of strong opioids. All healthcare professionals involved in the care of such patients, including pharmacists, need to be aware of this and strive to ensure analgesic use is guided by appropriate and accurate pain assessment in the ED.
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Affiliation(s)
- Joshua Jones
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Tin Fei Sim
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Jeff Hughes
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
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23
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McGuire DB, Kaiser KS, Haisfield-Wolfe ME, Iyamu F. Pain Assessment in Noncommunicative Adult Palliative Care Patients. Nurs Clin North Am 2017; 51:397-431. [PMID: 27497016 DOI: 10.1016/j.cnur.2016.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients.
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Affiliation(s)
- Deborah B McGuire
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, PO Box 980567, Richmond, VA 23298, USA.
| | - Karen Snow Kaiser
- Clinical Quality and Safety, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Mary Ellen Haisfield-Wolfe
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Florence Iyamu
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
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Wong AYL, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:14. [PMID: 28435906 PMCID: PMC5395891 DOI: 10.1186/s13013-017-0121-3] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/04/2017] [Indexed: 12/12/2022]
Abstract
Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.
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Affiliation(s)
- Arnold YL Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR China
| | - Jaro Karppinen
- Medical Research Center Oulu, Department of Physical and Rehabilitation Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR China
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25
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Liu JYW, Lai CKY. Implementation of Observational Pain Management Protocol for Residents With Dementia: A Cluster-RCT. J Am Geriatr Soc 2017; 65:e56-e63. [DOI: 10.1111/jgs.14763] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Justina Y. W. Liu
- Centre for Gerontological Nursing; School of Nursing; The Hong Kong Polytechnic University; Hong Kong
| | - Claudia K. Y. Lai
- Centre for Gerontological Nursing; School of Nursing; The Hong Kong Polytechnic University; Hong Kong
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26
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Gorawara-Bhat R, Wong A, Dale W, Hogan T. Nurses' perceptions of pain management for older-patients in the Emergency Department: A qualitative study. PATIENT EDUCATION AND COUNSELING 2017; 100:231-241. [PMID: 27591825 DOI: 10.1016/j.pec.2016.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES 1) Identify themes arising from nurses' perceptions of assessing older-patients' pain; 2) use themes to guide development of optimal interventions to improve quality of pain assessment in the emergency department (ED). METHODS Nurse interviews (n=20) were conducted until theme saturation. They were transcribed, coded, and analyzed using qualitative methodology. RESULTS Two major themes-nurse 'challenges' and 'strategies' to overcome challenges, and their subthemes - classified as 'patient-related' or 'system-related,' were salient in nurses' perceptions. Strategies nurses reported for managing challenges were based in their own professional lived experiences. DISCUSSION AND CONCLUSION A 2×2 framework was developed to conceptualize challenges, strategies, subthemes and their classifications, yielding 4 typologies comprising challenge types matched with appropriate strategy types. While emergent challenges and strategies are corroborated in the literature, the present study is the first to develop a scheme of typologies beneficial for guiding the development of optimal interventions to improve the quality of assessing pain in older-patients. PRACTICE IMPLICATIONS The typology framework can guide the development of pain assessment tools and the needed combinations for assessing multidimensional pain in older-patients. Using the present findings, a new clinical intervention was shown to significantly improve pain management for older-patients in the ED.
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Affiliation(s)
| | - Alexandra Wong
- Section of Geriatrics and Palliative Medicine, Chicago, IL, USA
| | - William Dale
- Section of Geriatrics and Palliative Medicine, Chicago, IL, USA
| | - Teresita Hogan
- Section of Geriatrics and Palliative Medicine, Chicago, IL, USA; Section of Emergency Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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27
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Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Pain in older people. Australas J Ageing 2016; 35:293. [PMID: 27061131 DOI: 10.1111/ajag.12262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gregory J. Initial testing of a behavioural pain assessment tool within trauma units. Int J Orthop Trauma Nurs 2016; 24:3-11. [PMID: 27919714 DOI: 10.1016/j.ijotn.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/18/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
Pain is common in trauma patients who may be older and also may have cognitive impairment leading to reduced communication about their pain. A number of observational pain assessment tools are available and have been found to have limited clinical usefulness. The Bolton Pain Assessment Tool (BPAT) was developed following a trial of three established tools and includes a section to involve family and/or close carers in the pain assessment process. The aim of this paper is to present the findings of initial testing of BPAT. BPAT was used and evaluated by clinical staff in four trauma units in the UK. Forty-six staff evaluations were completed and 98% indicated it was easy to use; it took between one and two minutes to complete by 69.5% and led to pain management interventions by 93.5% of the respondents. It was rated highly by the clinical staff, but the involvement of families and close carers in the assessment process was different at each unit, with one unit not involving the family/close carer. There remains the need for a simple and practical way of assessing pain. This initial testing of the clinical feasibility of BPAT suggests that it is easy to use and helps to identify pain, but further testing of its reliability and validity is required.
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Affiliation(s)
- Julie Gregory
- School of Nursing, Midwifery and Social Work, University of Manchester, Jean MacFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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29
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Muntinga ME, Jansen APD, Schellevis FG, Nijpels G. Expanding access to pain care for frail, older people in primary care: a cross-sectional study. BMC Nurs 2016; 15:26. [PMID: 27110220 PMCID: PMC4842300 DOI: 10.1186/s12912-016-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/16/2016] [Indexed: 12/15/2022] Open
Abstract
Background Although untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care. Practice nurse-led, comprehensive geriatric assessments (CGAs) may increase access to tailored pain care for frail, older people who live at home. To explore this, we investigated whether new pain cases were identified by practice nurses during CGAs administered as part of an intervention with the Geriatric Care Model, a comprehensive care model based on the Chronic Care Model, and whether the intervention led to tailored pain action plans in care plans of frail, older people. Methods We used cross-sectional data from the older Adults: Care in Transition (ACT) study, a 2-year clinical trial carried out in two regions of the Netherlands. Practice nurses proactively visited older people at home and administered an in-home CGA that included an assessment of pain. Pain care-related agreements and actions (pain action plans) based on CGA results were described in a tailored care plan. We analyzed care plans of 781 older people who received a first-time CGA by a practice nurse for the presence of pain, pain location and cause, new pain cases, and pain action plans. We used descriptive statistics to analyze our data. Results We found that 315 (40.3 %) older people experienced any type of pain. Practice nurses identified 20 (10.6 %) new pain cases, and 188 (59.7 %) older people with pain formulated at least one therapeutic or non-therapeutic pain action plan together with a practice nurse. More than half of the older people whose pain had already been identified by a primary care physician wanted a pain action plan. Most pain action plans consisted of actions or agreements related to continuity of care. Discussion and conclusion Practice nurses in primary care can contribute to expanding older people's access to tailored pain care. Future researchers should continue to direct their focus at ways to overcome the barriers that restrict older people’s access to pain care.
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Affiliation(s)
- M E Muntinga
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schellevis
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands ; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation. Pain Res Manag 2016; 2016:6493463. [PMID: 27445619 PMCID: PMC4904616 DOI: 10.1155/2016/6493463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.
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Williams BA, Ahalt C, Stijacic-Cenzer I, Smith AK, Goldenson J, Ritchie CS. Pain behind bars: the epidemiology of pain in older jail inmates in a county jail. J Palliat Med 2015; 17:1336-43. [PMID: 25265035 DOI: 10.1089/jpm.2014.0160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The number of older jail inmates in poor health is increasing rapidly. Among older adults, pain is common and leads to greater acute care use. In jail, pain management is complicated by concerns about misuse and diversion. A lack of data about the prevalence and management of pain in older jail inmates limits our ability to develop optimal palliative care strategies for this population. OBJECTIVE To describe the prevalence of and factors associated with pain and analgesic use in a population of older jail inmates. DESIGN Cross-sectional study. χ(2) tests assessed association between characteristics, pain, and analgesic use. SETTING/SUBJECTS Two hundred ten jail inmates age 55 or older. MEASUREMENTS "Severe frequent pain" defined as "severe or very severe" pain experienced "frequently or constantly" using the validated Memorial Symptom Assessment Scale. Medical conditions, substance use, and analgesic treatment determined through self-report and jail medical records. RESULTS Participants' mean age was 59 years; 69% had multimorbidity; 75% reported any pain; 39% reported severe frequent pain. Report of severe frequent pain was associated with multimorbidity, functional impairment, and pre-jail acute care use (p<0.05), but not with substance use (57% versus 56%, p=0.89). Within a week of their interview, most participants with severe frequent pain had received an analgesic (87%) and many received an opioid (70%). CONCLUSION High rates of pain in a rapidly growing population of older jail inmates with multimorbidity and functional impairment suggest that jails are an important site for assessing symptom burden and developing appropriate palliative care interventions.
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Affiliation(s)
- Brie A Williams
- 1 Division of Geriatrics, University of California , San Francisco, San Francisco, California
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Ware LJ, Herr KA, Booker SS, Dotson K, Key J, Poindexter N, Pyles G, Siler B, Packard A. Psychometric Evaluation of the Revised Iowa Pain Thermometer (IPT-R) in a Sample of Diverse Cognitively Intact and Impaired Older Adults: A Pilot Study. Pain Manag Nurs 2015; 16:475-82. [DOI: 10.1016/j.pmn.2014.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/04/2014] [Indexed: 10/23/2022]
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Pain Assessment and Management in Nursing Education Using Computer-based Simulations. Pain Manag Nurs 2015; 16:609-16. [DOI: 10.1016/j.pmn.2014.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022]
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Shega JW, Tiedt AD, Grant K, Dale W. Pain measurement in the National Social Life, Health, and Aging Project: presence, intensity, and location. J Gerontol B Psychol Sci Soc Sci 2015; 69 Suppl 2:S191-7. [PMID: 25360020 DOI: 10.1093/geronb/gbu101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe the rationale for the pain presence, location, and intensity measures in the National Social Life, Health and Aging Project (NSHAP). METHOD Responses to the pain presence, location (pain map), and intensity (verbal descriptor scale) items were analyzed by gender and age (62-69, 70-79, and 80-91). Pain intensity was dichotomized (none to mild vs moderate or higher) and compared by demographics, physical function, mood, and self-rated health. All analyses used Wald tests to compare sample means. RESULTS Participants completed the pain presence (n = 2,430/2,799), location (n = 2,558/2,799), and intensity (n = 2,589/2,799) items. Pain items varied by gender with women reporting more head, arm, hip/buttock, leg, and foot pain compared to men, (p < .05) at each individual site. Women also reported more intense pain compared to men-2.13 versus 1.94, respectively (p < .05). Pain items demonstrated remarkable similarity among age cohorts. Health indicators were significant and in the expected direction (p < .001). An increase in comorbidity, ADL and IADL dependence, worse self-rated health, and more depressive symptoms were each significantly more common among participants who reported moderate or greater pain compared to none to mild pain. DISCUSSION Pain presence, location, and intensity measures were successfully integrated into NSHAP Wave 2 and exhibit construct and external validity.
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Affiliation(s)
| | - Andrew D Tiedt
- Department of Justice, Bureau of Justice Statistics, Washington, District of Columbia
| | - Kaelin Grant
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - William Dale
- Department of Medicine, University of Chicago, Chicago, Illinois
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Liu JYW, Lai C. Implementation of observational pain management protocol to improve pain management for long-term institutionalized older care residents with dementia: study protocol for a cluster-randomized controlled trial. Trials 2014; 15:78. [PMID: 24625010 PMCID: PMC3995611 DOI: 10.1186/1745-6215-15-78] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/05/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Systematic use of observational pain tools has been advocated as a means to improve pain management for care home residents with dementia. Pain experts suggest that any observational tool should be used as part of a comprehensive pain management protocol, which should include score interpretation and verification with appropriately suggested treatments. The Observational Pain Management Protocol (Protocol) was therefore developed. This study aims to investigate the extent to which the implementation of this Protocol can improve pain management in care home residents with dementia. METHODS/DESIGN In this two-group, single-blinded, cluster-randomized controlled trial, 122 care home residents with dementia and pain-related diagnoses will be recruited from eight care homes (that is 15 to 16 residents from each care home). Invitations will be sent to all local care homes who meet the home selection criteria. The eight care homes will be randomly selected from all care homes that agree to join this trial. They will then be randomized to either the control or experimental conditions. Participants from each care home will be placed into their home's corresponding group to avoid 'contamination' effects across participants. Each intervention cycle will take 16 weeks (that is, baseline assessment and care home staff training for 4 weeks and Protocol implementation for 12 weeks). The Protocol will guide the pain management of the participants in the experimental care homes. Meanwhile, the control care homes will continue their usual pain management strategies. Intervention effects will be measured weekly during the protocol implementation period and compared with the baseline measurements, as well as between the experimental and control conditions. DISCUSSION Although similar pain protocols have been suggested previously, the recommendations were based on experts' opinions rather than evaluation of research studies. The feasibility and effectiveness of this kind of pain management protocol, tailored to older people with dementia, remains unknown. The findings of this trial will offer strong evidence that better strategies for pain management should be used in the care home daily routine. TRIAL REGISTRATION The Chinese University of Hong Kong, Centre for Clinical Trials: CUHK-CCT00367.
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Affiliation(s)
- Justina Yat Wa Liu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Claudia Lai
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Apinis C, Tousignant M, Arcand M, Tousignant-Laflamme Y. Can Adding a Standardized Observational Tool to Interdisciplinary Evaluation Enhance the Detection of Pain in Older Adults with Cognitive Impairments? PAIN MEDICINE 2014; 15:32-41. [DOI: 10.1111/pme.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Byma EA, Given BA, Given CW. Longitudinal differences in pain among older adult Home and Community Based Waiver Program participants in relation to diagnosis of cancer. Home Health Care Serv Q 2014; 32:249-66. [PMID: 24372477 DOI: 10.1080/01621424.2013.851051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Generalized estimating equation analyses models were used to examine the longitudinal association between pain and diagnosis of cancer among older adult, Home and Community Based Waiver Program participants. Daily pain was reported by over half, with 29% experiencing daily pain that was unusually intense. Diagnosis of cancer was a significant predictor of daily pain only as an interaction term with cognitive impairment. Being female, having a medical diagnosis of depression, or increasing measure of comorbid conditions significantly increased the likelihood of daily pain. In comparison, increasing age, being of African American, Hispanic, or "other" race resulted in a significantly decreased likelihood of daily pain.
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Ripamonti CI, Sichetti DAP, Fanizza C, Romero M. Is pain reporting to health care professionals age-related? A cross sectional multicenter study in a hospital setting. Expert Opin Pharmacother 2013; 14:2011-7. [DOI: 10.1517/14656566.2013.829041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Prevalence of Pain Among Residents in Japanese Nursing Homes: A Descriptive Study. Pain Manag Nurs 2013; 14:e1-9. [DOI: 10.1016/j.pmn.2011.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 01/26/2011] [Accepted: 01/26/2011] [Indexed: 11/23/2022]
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Tse MM, Ho SS. Pain Management for Older Persons Living in Nursing Homes: A Pilot Study. Pain Manag Nurs 2013; 14:e10-21. [DOI: 10.1016/j.pmn.2011.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 01/04/2011] [Accepted: 01/12/2011] [Indexed: 11/24/2022]
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Educational needs of health care providers working in long-term care facilities with regard to pain management. Pain Res Manag 2012; 17:341-6. [PMID: 23061085 DOI: 10.1155/2012/506352] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF), with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs). OBJECTIVE To identify the educational needs of HCPs working in LTCF with regard to pain management. METHODS A qualitative research design using the nominal group technique was undertaken. Seventy-two HCPs (21 physicians⁄pharmacists, 15 occupational⁄physical therapists, 24 nurses and 21 orderlies) were recruited from three LTCF in Quebec. Each participant was asked to provide and prioritize a list of the most important topics to be addressed within a continuing education program on chronic pain management in LTCF. RESULTS Forty topics were generated across all groups, and six specific topics were common to at least three out of the four HCP groups. Educational need in pain assessment was ranked the highest by all groups. Other highly rated topics included pharmacological treatment of pain, pain neurophysiology, nonpharmacological treatments and how to distinguish pain expression from other behaviours. CONCLUSION The present study showed that despite an average of more than 10 years of work experience in LTCF, HCPs have significant educational needs in pain management, especially pain assessment. These results will help in the development of a comprehensive pain management educational program for HCPs in LTCF.
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Löckenhoff CE, Laucks SS, Port AD, Tung J, Wethington E, Reid MC. Temporal horizons in pain management: understanding the perspectives of physicians, physical therapists, and their middle-aged and older adult patients. THE GERONTOLOGIST 2012; 53:850-60. [PMID: 23103522 DOI: 10.1093/geront/gns136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The management of chronic noncancer pain (CNCP) involves trade-offs between immediate and delayed consequences of various treatments. Temporal trade-offs may be particularly salient for older adults because of age-related differences in prognosis and perceptions of future time. This study examined how perceptions of time influence the management of CNCP among patients and providers with particular emphasis on age differences. DESIGN AND METHODS Focus groups were conducted with 28 CNCP patients (5 groups), 21 physicians (4 groups), and 23 physical therapists (3 groups). Audiotapes were transcribed and analyzed using standard qualitative methods. RESULTS Analyses identified multiple aspects of time perceptions that are relevant to the management of CNCP: the long-term prognosis, the time horizon used for concrete treatment planning, and concerns about future side effects. Although there was some overlap, these aspects showed divergent patterns across age groups and between patients and providers. Patients and providers agreed that pain is more stable and chronic in older adults. Time horizons in treatment planning differed between patients who were present-focused and providers who were focused on longer term effects, but treatment horizons did not differ by patient age. Finally, although providers were more concerned about future side effects in older people, patients' concerns did not differ by age. IMPLICATIONS Time horizons have practical implications for the quality of the patient-provider relationship and self-management of CNCP. A better understanding of the underlying mechanisms could inform interventions to reduce age disparities in pain care.
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Affiliation(s)
- Corinna E Löckenhoff
- Address correspondence to Corinna E. Löckenhoff, Department of Human Ecology, Cornell University, Martha van Rensselaer Hall, Ithaca, NY 14853. E-mail:
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Liu JYW, Pang PCP, Lo SKL. Development and implementation of an observational pain assessment protocol in a nursing home. J Clin Nurs 2012; 21:1789-93. [PMID: 22594390 DOI: 10.1111/j.1365-2702.2012.04152.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Justina Y W Liu
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
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Herr K, Titler M, Fine PG, Sanders S, Cavanaugh JE, Swegle J, Tang X, Forcucci C. The effect of a translating research into practice (TRIP)--cancer intervention on cancer pain management in older adults in hospice. PAIN MEDICINE (MALDEN, MASS.) 2012; 13:1004-17. [PMID: 22758921 PMCID: PMC3422373 DOI: 10.1111/j.1526-4637.2012.01405.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and who have some of the most unique pain challenges. One of the priorities of hospice is to provide a pain-free death, and while outcomes are better in hospice, patients still die with poorly controlled pain. OBJECTIVE This article reports on the results of a Translating Research into Practice intervention designed to promote the adoption of evidence-based pain practices for older adults with cancer in community-based hospices. SETTING This Institutional Human Subjects Review Board-approved study was a cluster randomized controlled trial implemented in 16 Midwestern hospices. METHODS Retrospective medical records from newly admitted patients were used to determine the intervention effect. Additionally, survey and focus group data gathered from hospice staff at the completion of the intervention phase were analyzed. RESULTS Improvement on the Cancer Pain Practice Index, an overall composite outcome measure of evidence-based practices for the experimental sites, was not significantly greater than control sites. Decrease in patient pain severity from baseline to post-intervention in the experimental group was greater; however, the result was not statistically significant (P = 0.1032). CONCLUSIONS Findings indicate a number of factors that may impact implementation of multicomponent interventions, including unique characteristics and culture of the setting, the level of involvement with the change processes, competing priorities and confounding factors, and complexity of the innovation (practice change). Our results suggest that future study is needed on specific factors to target when implementing a community-based hospice intervention, including determining and measuring intervention fidelity prospectively.
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Affiliation(s)
- Keela Herr
- University of Iowa, College of Nursing, Iowa City, IA 52242, USA.
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Gagliese L, Katz L, Gibson M, Clark AJ, Lussier D, Gordon A, Salter MW. A brief educational intervention about pain and aging for older members of the community and health care workers. THE JOURNAL OF PAIN 2012; 13:849-56. [PMID: 22841472 DOI: 10.1016/j.jpain.2012.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 04/17/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Developing educational interventions about pain may lead to improved pain management for older people. A public group educational session, entitled "Pain in the Older Person," was presented in 7 cities across Canada (Vancouver, Calgary, London, Toronto, Ottawa, Montreal, and Halifax). The presentation lasted approximately 90 minutes and was followed by a question and answer period of at least 20 minutes. Prior to the educational session, participants provided demographic data and completed measures of pain intensity, frequency, interference, and treatment; of subjective health; and of knowledge about pain. Following the session, participants completed the same knowledge items again as well as items assessing satisfaction. Data were provided by 54 health care workers (HCW) and 54 older community members (66.3 ± 10.2 years old). Prior to the educational session, knowledge gaps were evident among the older community members, especially about analgesic use. Among the HCW, knowledge gaps were found about addiction and the relationship between pain and aging. Comparison of knowledge scores before and after the educational session revealed that both groups demonstrated significant knowledge gains. Satisfaction scores were very high, with no significant difference between HCW and older community members. This is the first study to show that a brief educational intervention is associated with gains in knowledge about pain and aging among both older community members and HCW. These results suggest that a brief public educational session is a promising method of pain education that may reduce barriers to pain management in older people. PERSPECTIVE This article describes the results of a brief public educational session about pain and aging attended by older members of the community and health care workers. This intervention could potentially improve pain management for older people.
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Affiliation(s)
- Lucia Gagliese
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
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Hadjistavropoulos T. Self-Management of Pain in Older Persons: Helping People Help Themselves. PAIN MEDICINE 2012; 13 Suppl 2:S67-71. [DOI: 10.1111/j.1526-4637.2011.01272.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The presentation and management of pain in older adults with dementia are highly complicated. This article addresses assessment challenges and nonpharmacological and pharmacological management strategies related to pain in those with dementia. Vigilant monitoring of comfort level and the effective use of multidimensional pain management strategies could substantially increase quality of life for older adults with dementia.
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Affiliation(s)
- Der Fa Lu
- The University of Iowa College of Nursing, Iowa City, IA, USA
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Christo PJ, Li S, Gibson SJ, Fine P, Hameed H. Effective treatments for pain in the older patient. Curr Pain Headache Rep 2011; 15:22-34. [PMID: 21128021 DOI: 10.1007/s11916-010-0164-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
By 2050, the number of older persons across the globe will exceed the number of younger people for the first time in history. Chronic conditions, especially pain, will rise in prevalence as the population ages. Controlling pain in this unique subset of the population demands careful attention to pharmacokinetic and pharmacodynamic factors and their specific impact on pharmacotherapies, relevant complementary and alternative medicine therapies, and interventional strategies.
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Affiliation(s)
- Paul J Christo
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD 21205, USA.
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Abstract
AIMS To explore the care needs of older patients in the intensive care units. Background. As the numbers of older patients admitted to the intensive care units are growing, care quality of critically ill older patients has become an important issue. However, there are few studies directly investigating perceived care needs of hospitalised older patients and the studies on care needs of older patients in the intensive care units are even fewer. The identification of care needs from older patients' perspective will help develop qualified nursing practice. DESIGN A qualitative exploratory design. METHODS Purposive sampling was performed to recruit 35 older patients from three hospitals in Taiwan. The interview transcripts were analysed by qualitative content analysis. RESULTS The results revealed that care needs of older patients in the intensive care units are multidimensional, including physical, informational and psychosocial dimensions. Older patients' needs of the physical dimension included relieving pain and discomfort, starting oral intake as soon as possible and having continuous sleep. Informational needs included adequate explanations about their disease progression and prognosis and information on recovery-promoting activity. Psychosocial needs included caring behaviour of intensive care units staff, flexible visiting hours, increase in control ability and maintenance of good communication with intensive care units staff. CONCLUSION The findings can assist nurses in understanding the interventions necessary to meet care needs of critically ill older patients. The critically ill older adults need more than medical-technical care. They need more holistic care. The psychosocial and informational needs must be considered commensurate with the presenting physical needs. RELEVANCE TO CLINICAL PRACTICE Nurses have an important role in meeting intensive care units older patients' care needs. Intensive care units nurses should conduct comprehensive assessment regarding older patients' needs at the beginning and at various points in their intensive care units stay and match these needs with appropriate nursing interventions.
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Affiliation(s)
- Ching-Wen Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
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