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Ohta R, Sano C. Factors affecting the duration of initial medical care seeking among older rural patients diagnosed with rheumatoid arthritis: a retrospective cohort study. BMC Rheumatol 2024; 8:23. [PMID: 38840174 PMCID: PMC11155024 DOI: 10.1186/s41927-024-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Early diagnosis and treatment of rheumatoid arthritis (RA) are essential to prevent progressive joint destruction and improve the quality of life (QOL) of patients. This study aimed to identify the factors associated with the duration from symptom onset to seeking initial medical care among older rural patients diagnosed with RA. METHODS This retrospective cohort study was conducted in Unnan City, Japan, using electronic patient records. Data from patients aged > 65 years, who were admitted to the Unnan City Hospital between April 2016 and March 2021, were analyzed. The primary outcome was the duration from symptom onset to the initial visit to the medical institution. Demographic factors, laboratory data, and data on symptoms were collected and analyzed using statistical tests and regression models. RESULTS In total, 221 participants were included in this study. The longer duration from symptom onset to medical care usage was significantly associated with age (adjusted odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.03-1.15), isolated conditions (adjusted OR: 4.45, 95% CI: 1.85-10.70), and wrist symptoms (adjusted OR: 3.22, 95% CI: 1.44-7.17). Higher education level and alcohol consumption were also associated with the duration from symptom onset to medical care usage. CONCLUSIONS Older age, isolated conditions, and specific joint symptoms were significant factors influencing delays in seeking medical care among older rural patients with RA. Interventions to improve health literacy, increase social support, and raise awareness of RA symptoms are essential for expediting diagnosis and improving patient QOL. Further research is needed to explore additional psychosocial factors and beliefs that affect health-seeking behaviors in patients with RA.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, Unnan, 699-1221, Japan.
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo, 690-0823, Japan
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Murphy DJ, Porter MM, Mackenzie CS, Chipperfield JG. Development, feasibility, and acceptability of a process based intervention to decrease internalized ageism. GERONTOLOGY & GERIATRICS EDUCATION 2024:1-16. [PMID: 38825865 DOI: 10.1080/02701960.2024.2360395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
A lifetime of exposure to ageism may be internalized in older adults, and these ageist beliefs that are directed inwards can have severe consequences. However, research on reducing internalized ageism is scarce. To address this, we designed and implemented a six-week online process-based intervention to reduce internalized ageism and to assess its feasibility. The intervention utilized a process-based therapy approach targeting psychological, behavioral, and physiological pathways through which internalized ageism negatively impacts health, as specified by stereotype embodiment theory. Intervention components included education, acceptance and commitment therapy techniques, and attributional retraining. A total of 81 older adult participants participated in the feasibility study. Most participants rated each session and the overall program as very useful after each session (average program usefulness rating of 4.54/5). Participants also attributed a wide range of novel behaviors to this intervention and stated that they felt it changed their perspectives on ageism and/or internalized ageism. Results from this study provide a promising foundation from which to advance research on interventions that address internalized ageism - a problem that has severe consequences on the health and well-being of growing numbers of older adults globally.
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Affiliation(s)
- Dallas J Murphy
- Clinical Psychology MA student, University of Manitoba, Winnipeg, Canada
| | - Michelle M Porter
- Director, Centre on Aging, Professor, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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Boring BL, Walsh KT, Ng BW, Schlegel RJ, Mathur VA. Experiencing Pain Invalidation is Associated with Under-Reporting of Pain: A Social Psychological Perspective on Acute Pain Communication. THE JOURNAL OF PAIN 2024; 25:104428. [PMID: 37984509 DOI: 10.1016/j.jpain.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
Pain invalidation involves the dismissal or lack of understanding of another's pain, undermining their subjective experience. Frequent exposure to invalidation negatively impacts mental and physical health as well as pain-related behaviors, potentially leading people to conceal their pain from others in the future and/or withdraw from potential sources of support. It is therefore possible that experiencing pain invalidation may also impact pain-reporting behavior in clinical settings. Across 2 separate samples of emerging adults, we examined whether exposure to invalidation of one's pain was associated with cognizant modulation of one's subjective acute pain ratings within routine medical and dental settings. Drawing upon social psychological theories of impression management and self-presentation, we hypothesized that exposure to pain invalidation would be associated with the under-rating of one's pain. In Study 1, previous experiences of invalidation were associated with under-rating of one's pain when visiting the doctor and the dentist. Study 2 found that invalidation from family and medical professionals-but not from friends-was associated with under-rating pain in both settings. Findings provide further evidence for the harmful effects of pain invalidation, particularly for emerging adults, as the dismissal of one's subjective experience may sow self-doubt while reinforcing cultural stigmas against pain, leading to alterations in pain communication that ultimately creates barriers to efficacious clinical treatment and care and increase pain-related suffering. PERSPECTIVE: Pain invalidation imparts harm to those who already suffer from pain, be it mentally, physically, and/or behaviorally. We show that people who have encountered invalidation are more likely to under-rate their pain when seeking care, impeding assessment and treatment, and further highlighting the importance of clinical validation of pain experiences.
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Affiliation(s)
- Brandon L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Kaitlyn T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Brandon W Ng
- Department of Psychology, University of Richmond, Richmond, Virginia
| | - Rebecca J Schlegel
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Texas A&M Institute for Neuroscience, College Station, Texas
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Mattenklodt P, Ingenhorst A, Flatau B, Becker K, Grießinger N. [Interdisciplinary pain therapy in the elderly]. Schmerz 2024; 38:89-98. [PMID: 37266908 DOI: 10.1007/s00482-023-00721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 06/03/2023]
Abstract
Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.
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Affiliation(s)
- Peter Mattenklodt
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - Anne Ingenhorst
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Brigitta Flatau
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Kristina Becker
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Norbert Grießinger
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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5
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Mattenklodt P, Ingenhorst A, Flatau B, Becker K, Grießinger N. [Interdisciplinary pain therapy in the elderly]. DIE ANAESTHESIOLOGIE 2024; 73:147-155. [PMID: 38376754 DOI: 10.1007/s00101-024-01392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.
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Affiliation(s)
- Peter Mattenklodt
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - Anne Ingenhorst
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Brigitta Flatau
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Kristina Becker
- medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland
| | - Norbert Grießinger
- Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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6
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Ames H, Hestevik CH, Briggs AM. Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis. BMC Geriatr 2024; 24:24. [PMID: 38182977 PMCID: PMC10768085 DOI: 10.1186/s12877-023-04608-4] [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: 03/29/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Chronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers. METHODS We searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual. RESULTS All 22 included studies represented older people's experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible. CONCLUSIONS These findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.
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Affiliation(s)
- Heather Ames
- The Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway.
| | | | - Andrew M Briggs
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
- Faculty of Health Sciences, Curtin University, PO Box U1987, Perth, 6845, Western Australia
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Allen JO, Sikora N. Aging Stigma and the Health of US Adults Over 65: What Do We Know? Clin Interv Aging 2023; 18:2093-2116. [PMID: 38116457 PMCID: PMC10729833 DOI: 10.2147/cia.s396833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
This narrative review assessed the current state of research on aging stigma and health relevant to US adults ages 65 and older. We adopted a stigma framework to highlight aging stigma as a meaningful social construct and the complex ways in which it may be harmful for health. We identified 29 studies of various types (experimental, intervention, cross-sectional quantitative, longitudinal quantitative, and qualitative) published between 2010 and 2023 that investigated relationships between concepts related to aging stigma and health. Aging stigma was associated with poor short- and long-term health outcomes spanning cognition, psychological wellbeing, physical health, and hospitalizations. The premise that aging stigma is harmful to health was moderately well supported, while evidence that health influenced aging stigma was weak. Collectively, studies provided insight into several mechanisms through which aging stigma may affect the health of older US adults, while also highlighting areas for future research. Potential strategies for addressing aging stigma as a public health hazard were discussed.
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Affiliation(s)
- Julie Ober Allen
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Nadine Sikora
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
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8
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Langmann E, Weßel M. Leaving no one behind: successful ageing at the intersection of ageism and ableism. Philos Ethics Humanit Med 2023; 18:22. [PMID: 38001533 PMCID: PMC10668457 DOI: 10.1186/s13010-023-00150-8] [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: 03/31/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens. METHOD A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health. RESULTS We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia. DISCUSSION We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities. CONCLUSION Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.
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Affiliation(s)
- Elisabeth Langmann
- Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, Tübingen, 72074, Germany.
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Turner SG, Brooker H, Ballard C, Corbett A, Hampshire A, Sabatini S. The Role of Awareness of Age-Related Change in the Longitudinal Association between Pain and Physical Activity. Int J Aging Hum Dev 2023:914150231208686. [PMID: 37899713 PMCID: PMC11058115 DOI: 10.1177/00914150231208686] [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] [Indexed: 10/31/2023]
Abstract
We examined how physical pain impacts the developmental construct of Awareness of Age-Related Change (AARC-gains and AARC-losses) and, in turn, how AARC mediates and moderates the association between pain and subsequent physical activity. We used longitudinal data from 434 participants of the UK PROTECT Study (mean age = 65.5 years; SD = 6.94 years). We found that pain in 2019 predicted higher AARC-losses (β = .07; p = .036) and less physical activity (β = -.13; p-value = .001) in 2020. Additionally, we found that AARC-losses partially mediated, but did not moderate, the association of pain in 2019 and physical activity in 2020. AARC-losses may explain physical inactivity in middle-aged and older adults experiencing pain. Incorporating developmental constructs such as AARC into theories and empirical studies on pain and pain management may be necessary to more fully capture people's responses to pain.
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Affiliation(s)
- Shelbie G. Turner
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, NY, USA
| | | | | | | | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
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10
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Hammouri A, Taani MH, Ellis J. Ageism in the Nursing Care of Older Adults: A Concept Analysis. ANS Adv Nurs Sci 2023; 46:441-454. [PMID: 36728753 DOI: 10.1097/ans.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite the high prevalence of ageism worldwide, it is still underestimated and unrecognized by many nurses. Concept clarification is required to delineate the meaning of the word "ageism" in nursing. The purpose of this concept analysis is to clearly define the concept of ageism relative to nursing discipline using the Walker and Avant method. Defining the concept of ageism will provide nurses with a better understanding of its causes and consequences. It will aid policy makers in developing policies and interventions to help decrease ageism in health care environments.
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11
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Cummings S, Scime NV, Brennand EA. Age and postoperative opioid use in women undergoing pelvic organ prolapse surgery. Acta Obstet Gynecol Scand 2023; 102:1371-1377. [PMID: 37587619 PMCID: PMC10540930 DOI: 10.1111/aogs.14638] [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: 04/12/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Our objective was to explore the relation between patient age and postoperative opioid use up to 24 hours following pelvic organ prolapse (POP) surgery. MATERIAL AND METHODS We conducted a prospective cohort study following 335 women ranging in age from 26 to 82 years who underwent surgery for multi-compartment POP at a tertiary center in Alberta, Canada. Patient characteristics were measured using baseline questionnaires. Perioperative data were collected from medical chart review during and up to 24 hours following surgery. We used logistic regression to analyze the odds of being opioid-free and linear regression to analyze mean differences in opioid dose, measured as total morphine equivalent daily dose, exploring for a potential non-linear effect of age. Adjusted models controlled for preoperative pain, surgical characteristics and patient health factors. RESULTS Overall, age was positively associated with greater odds of being opioid-free in the first 24 hours after surgery (adjusted odds ratio per increasing year of age = 1.07, 95% confidence interval [CI] 1.04-1.09, n = 332 women). Among opioid users, age was inversely associated with total opioid dose (adjusted mean difference per increasing year of age = 0.71 mg morphine equivalent daily dose, 95% CI -0.99 to -0.44, n = 204 women). There was no evidence of a non-linear relation between age and postoperative opioid use or dose. CONCLUSIONS In the context of POP surgery, we found that younger women were more likely to use opioids after surgery and to use a higher dose in the first 24 hours when compared with older women. These findings support physicians to consider age when counseling POP patients regarding pain management after surgery, and to direct resources aimed at opioid-free pain control towards younger patients.
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Affiliation(s)
- Shannon Cummings
- Department of Obstetrics and Gynecology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Natalie V. Scime
- Department of Health and SocietyUniversity of Toronto ScarboroughScarboroughOntarioCanada
| | - Erin A. Brennand
- Department of Obstetrics and Gynecology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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12
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Shackleton DA, Castillo LIR, Hampton AJD, Volodin A, Hadjistavropoulos T. Age Differences in Thermal Pain Responses: A Direct Laboratory Comparison. J Gerontol B Psychol Sci Soc Sci 2023; 78:1521-1525. [PMID: 37104120 DOI: 10.1093/geronb/gbad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVES According to a widely cited assertion, older adults are less likely than younger individuals to express pain complaints. Age-related differences in pain responses have been discussed in the literature despite a paucity of research involving direct comparisons of younger and older adults' pain reactions (i.e., verbal, nonverbal) in the context of a single experimental investigation. Our goal was to test the hypothesis that older adults are more stoic than younger adults in their expression of pain. METHODS We measured trait stoicism as well as multiple responses to thermal pain. RESULTS In contrast to suggestions in the literature, equivalence testing indicated that older and younger adults displayed similar verbal and nonverbal pain responses. Our results suggest that older adults are no more stoic about their pain than are younger persons. DISCUSSION This is the first attempt to explore a wide array of age differences in pain expression within the context of a single experimental study.
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Affiliation(s)
| | - Louise I R Castillo
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Amy J D Hampton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Andrei Volodin
- Department of Mathematics and Statistics, University of Regina, Regina, Saskatchewan, Canada
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13
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Hanson ER, Quist HE, Mintert JS, Arshad M, Friedman BL, Pleasant A, Monico-Cristales NS, Tillman R, Mehelis M, Karnik A, Sonder A, Mardian AS. Program Evaluation: exploring health disparities that impact chronic pain referrals within a VA Health Care System. FRONTIERS IN PAIN RESEARCH 2023; 4:1110554. [PMID: 37228808 PMCID: PMC10204586 DOI: 10.3389/fpain.2023.1110554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction The present Program Evaluation study examines sociodemographic characteristics of Veterans in the Phoenix VA Health Care System who have back pain, and specifically the likelihood of those characteristics being associated with a referral to the Chronic Pain Wellness Center (CPWC) in the year 2021. We examined the following characteristics: Race/ethnicity, gender, age, mental health diagnosis, substance use disorder diagnosis, and service-connected diagnosis. Methods Our study used cross sectional data from the Corporate Data Warehouse for 2021. 13624 records had complete data for the variables of interest. Univariate and multivariate logistic regression was used to determine the likelihood of patients' being referred to the Chronic Pain Wellness Center. Results The multivariate model found under-referral to be significant for younger adults and for patients who identified as Hispanic/Latinx, Black/African American, or Native American/Alaskan. Those with depressive disorders and opioid use disorders, on the other hand, were found to be more likely to be referred to the pain clinic. Other sociodemographic characteristics were not found to be significant. Discussion Study limitations include the use of cross-sectional data, which cannot determine causality, and the inclusion of patients only if the ICD-10 codes of interest were recorded for an encounter in 2021 (i.e., a prior history of a particular diagnosis was not captured). In future efforts, we plan to examine, implement, and track the impact of interventions designed to mitigate these identified disparities in access to chronic pain specialty care.
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Affiliation(s)
- Eric R. Hanson
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
- Department of Psychiatry, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
| | - Heidi E. Quist
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Jeffrey S. Mintert
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Mahreen Arshad
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Brittany L. Friedman
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Alexandra Pleasant
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | | | - Rhonda Tillman
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Mark Mehelis
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Anita Karnik
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Anais Sonder
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Aram S. Mardian
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
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14
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Levy BR, Pietrzak RH, Slade MD. Societal impact on older persons' chronic pain: Roles of age stereotypes, age attribution, and age discrimination. Soc Sci Med 2023; 323:115772. [PMID: 36965204 PMCID: PMC10763575 DOI: 10.1016/j.socscimed.2023.115772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/12/2023]
Abstract
RATIONALE In view of the severity and prevalence of chronic pain, combined with the limited success of long-term treatments, there is the need for a more expansive understanding of its etiology. We therefore investigated over time three societal-based potential determinants of chronic pain that were previously unexamined in this connection: negative age stereotypes, age attribution, and age discrimination. METHODS The cohort consisted of 1373 Americans aged 55 and older, who participated in four waves of the National Health and Resilience in Veterans Study, spanning seven years. RESULTS Consistent with the hypotheses, negative age stereotypes as well as age discrimination predicted chronic pain, and age attribution acted as a mediator between the negative age stereotypes and chronic pain. In a subset of participants who were free of chronic pain at baseline, those who had assimilated negative age stereotypes were 32% more likely to develop chronic pain in the next seven years than those who had assimilated positive age stereotypes. CONCLUSION Our finding that the three societal-based and modifiable predictors contributed to chronic pain refutes the widely held belief that chronic pain experienced in later life is entirely and inevitably a consequence of aging.
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Affiliation(s)
- Becca R Levy
- Social and Behavioral Science Department, Yale School of Public Health, USA; Psychology Department, Yale University, USA.
| | - Robert H Pietrzak
- Social and Behavioral Science Department, Yale School of Public Health, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, USA; Department of Psychiatry, Yale School of Medicine, USA
| | - Martin D Slade
- Department of Internal Medicine, Yale School of Medicine, USA
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The implementation of a community-centered first aid education program for older adults-community health workers perceived barriers. BMC Health Serv Res 2023; 23:128. [PMID: 36755241 PMCID: PMC9905768 DOI: 10.1186/s12913-023-09142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Older adults are a high-risk group for accidental injuries, and strengthening training in first aid for older adults can improve their first aid capabilities and minimize their post-accident mortality. Community health workers are the greatest option to equip older adults with first aid instruction and training. However, the development of first aid education for the public by community health workers fails to take into account the elderly population. In view of this, this study aims to explore the barriers and challenges of first aid training for older adults from the perspective of community health workers and to provide a basis for better first-aid training for older adults in the community. METHODS This study adopted a qualitative research design. A total of 18 community health workers were recruited from two community health service centers in Qujing and one community health service center in Guangzhou from May to July 2022 to participate in the study. Participants were interviewed face-to-face using semi-structured in-depth interviews. The interview data were analyzed using Krippendorff's thematic clustering technique. RESULTS The results of the study identified community health workers' perceived challenges and barriers to providing first aid training to older adults in the community as older adults-level barriers, community health workers-level barriers, management systems-level barriers, and society-level barriers. CONCLUSIONS Community health workers are highly aware of multiple barriers and challenges in providing first aid training to community-based elderly populations. In particular, lack of professional training, heavy workloads, and limited resources and financial support. Therefore, supportive training, policies, and government funding are crucial for community health workers to conduct first aid training for older adults.
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Podhorecka M, Husejko J, Woźniewicz A, Pyszora A, Kȩdziora-Kornatowska K. Who will treat older patients? Should medical education focus more on activities aimed at displaying positive attitudes toward older people? The prevalence of ageism among students of medical and health sciences. Front Public Health 2022; 10:1032487. [PMID: 36530671 PMCID: PMC9752869 DOI: 10.3389/fpubh.2022.1032487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
In the conditions of an aging society, a justification is found to explain the issue of the attitude of future health care workers, who are to care for elderly people in the future, toward these people, which will make it possible to predict in advance what problems related to the care of seniors may soon arise. After clarifying this issue, it will be important to distinguish the individual factors influencing this attitude in order to determine which social phenomena will require special attention. Eight hundred and three medical and health sciences students participated in the research from various fields of medical studies. A Survgo system was used, where an online questionnaire was placed and then posted in social media. Only students of medicine and healthcare facilities participated in the study. The first questionnaire contained socio-demographic questions. Then, the KOAP questionnaire and Welch's t-test were used, and finally the proprietary questionnaire on contact with seniors. Analyses were conducted using the R Statistical language. Scores on the KAOP questionnaire ranged from 122.4 to 134.57. The highest scores were shown for physiotherapy students and the lowest for pharmacy students. The highest level of attitude toward elderly was reported in students of 1st to 3rd year of study. For 4th-5th year or supplementary level students, attitude levels were decreasing. Welch's t-test showed that the level of attitude toward old people in men was significantly higher than in women. There was no significant correlation between the age factor on the quotient scale and the KOAP score. Married individuals had significantly higher KAOP scores compared to singles and those in an informal relationship. No significant differences between the study stage factor and KAOP score have been found. Those who live and/or have regular contact with the elderly were characterized by higher KAOP questionnaire scores. The attitude toward the elderly depends on many factors, such as the chosen field of study, stage of education, contact with the elderly, gender or marital status. In order to develop proper contact with seniors, the solution may be to influence modifiable factors, especially the correct education of future health care workers.
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Affiliation(s)
- Marta Podhorecka
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland,*Correspondence: Marta Podhorecka
| | - Jakub Husejko
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Agnieszka Woźniewicz
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Anna Pyszora
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Kornelia Kȩdziora-Kornatowska
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Sanchez-Santos MT, Williamson E, Nicolson PJA, Bruce J, Collins GS, Mallen CD, Griffiths F, Garret A, Morris A, Slark M, Lamb SE. Development and validation of a prediction model for self-reported mobility decline in community-dwelling older adults. J Clin Epidemiol 2022; 152:70-79. [PMID: 36108957 DOI: 10.1016/j.jclinepi.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study is to develop and validate two models to predict 2-year risk of self-reported mobility decline among community-dwelling older adults. STUDY DESIGN AND SETTING We used data from a prospective cohort study of people aged 65 years and over in England. Mobility status was assessed using the EQ-5D-5L mobility question. The models were based on the outcome: Model 1, any mobility decline at 2 years; Model 2, new onset of persistent mobility problems over 2 years. Least absolute shrinkage and selection operator logistic regression was used to select predictors. Model performance was assessed using C-statistics, calibration plot, Brier scores, and decision curve analyses. Models were internally validated using bootstrapping. RESULTS Over 18% of participants who could walk reported mobility decline at year 2 (Model 1), and 7.1% with no mobility problems at baseline, reported new onset of mobility problems after 2 years (Model 2). Thirteen and 6 out of 31 variables were selected as predictors in Models 1 and 2, respectively. Models 1 and 2 had a C-statistic of 0.740 and 0.765 (optimism < 0.013), and Brier score = 0.136 and 0.069, respectively. CONCLUSION Two prediction models for mobility decline were developed and internally validated. They are based on self-reported variables and could serve as simple assessments in primary care after external validation.
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Affiliation(s)
- Maria T Sanchez-Santos
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK; College of Medicine and Health, University of Exeter, UK
| | - Philippa J A Nicolson
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Angela Garret
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alana Morris
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mandy Slark
- Centre for Rehabilitation Research, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, UK
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Maiers M, Salsbury SA. "Like Peanut Butter and Jelly": A Qualitative Study of Chiropractic Care and Home Exercise Among Older Adults With Spinal Disability. Arthritis Care Res (Hoboken) 2022; 74:1933-1941. [PMID: 33973398 DOI: 10.1002/acr.24636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE A mixed-methods, randomized controlled trial comparing short- and long-term chiropractic care and exercise therapy for spinal disability in older adults found no between-group differences in the primary outcome. However, those who received long-term management reported greater improvement in neck pain, self-efficacy, function, and balance. This nested qualitative study explored participants' perceptions of the benefits and drawbacks of chiropractic care and exercise for spine-related outcomes, with an emphasis on understanding what makes treatment for spine-related problems worthwhile. METHODS Of 171 individual interviews conducted after completing study treatment, 50 participants (25 per treatment group) were randomly selected for this analysis. Qualitative descriptive analysis included dual coding of verbatim transcripts by 2 investigators (MM and SAS), which was further distilled into a consensus-derived codebook of themes and organized using NVIVO software. RESULTS Participants described trial interventions as complementary to one another for spine-related disability. Chiropractic care was viewed as improving spinal pain and controlling symptoms, while exercise therapy was noted for its long-term impact on self-efficacy and self-management. These older adults considered changes in pain, global sense of improvement, and improved biomechanical function as making treatment worthwhile. CONCLUSION Older adults valued nonpharmacologic treatment options that aided them in controlling spine-related symptoms, while empowering them to maintain clinical benefit gained after a course of chiropractic spinal manipulation and exercise. The complementary nature of provider-delivered and active care modalities may be an important consideration when developing care plans. This study underscores the importance of understanding participants' values and experiences when interpreting study results and applying them to practice.
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Affiliation(s)
- Michele Maiers
- Northwestern Health Sciences University, Bloomington, Minnesota
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Mayo DM, Meuser TM, Robnett RH, Webster ME, Woolard CE. Cross-Generational Understandings of Ageism and Its Perceived Impacts on Personal-Public Health. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:711-727. [PMID: 34968170 DOI: 10.1080/01634372.2021.2019865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
In 2016, the World Health Organization (WHO) launched a global campaign to combat ageism, emphasizing its potential harm to personal and public health. This qualitative focus group study explored generational differences in understanding the WHO's definition and impact of ageism among baby boomers (ages 60-72; n = 17) and silent generation members (ages 78-85; n = 10). Verbatim transcripts were analyzed via a grounded theory approach, and representative themes and quotations were extracted by consensus. Members of both age groups initially downplayed personal impacts of ageism in favor of a broader discussion of age-related discrimination on a societal level. As each discussion progressed, however, participants acknowledged economic, social, and health impacts linked with ageism, but primarily for others. Both groups noted ageist actors in places of employment, healthcare settings, restaurants, retirement communities, and within family networks. Interestingly, each group rated risk of harm by ageism as greater for the other group. Our findings highlight challenges associated with the translation of a broad public health campaign to engage specific stakeholder subgroups. We discuss future research, education, and training initiatives across all ages to address the detrimental impacts of ageism.
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Affiliation(s)
- Diana M Mayo
- Student Access Center, Division of Student Support, University of New England, Portland, Maine, USA
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Patient and Spine Surgeon Perceptions on Shared Decision-Making in the Treatment of Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity. Spine (Phila Pa 1976) 2022; 47:730-736. [PMID: 34652306 DOI: 10.1097/brs.0000000000004257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE To understand patients' and spine surgeons' perspectives about decision-making around surgery for adult spinal deformity. SUMMARY OF BACKGROUND DATA Surgery for correction of adult spinal deformity is often beneficial; however, in over 20% of older adults (≥ 65 yrs of age), outcomes from surgery are less desirable. MATERIALS AND METHODS We conducted semistructured, in-depth interviews with six patients and five spine surgeons. Two investigators independently coded the transcripts using constant comparative method, as well as an integrative, team-based approach to identify themes. RESULTS Patients themes: 1) patients felt surgery was their only choice because they were running out of time to undergo invasive procedures; 2) patients mentally committed to surgery prior to the initial encounter with their surgeon and contextualized the desired benefits while minimizing the potential risks; 3) patients felt that the current decision support tools were ineffective in preparing them for surgery; and 4) patients felt that pain management was the most difficult part of recovery from surgery. Surgeons themes: 1) surgeons varied substantially in their interpretations of shared decision-making; 2) surgeons did not consider patients' chronological age as a major contraindication to undergoing surgery; 3) there is a goal mismatch between patients and surgeons in the desired outcomes from surgery, where patients prioritize complete pain relief whereas surgeons prioritize concrete functional improvement; and 4) surgeons felt that patient expectations from surgery were often established prior to their initial surgery visit, and frequently required recalibration. CONCLUSION Older adult patients viewed the decision to have surgery as time-sensitive, whereas spine surgeons expressed the need for recalibrating patient expectations and balancing the risks and benefits when considering surgery. These findings highlight the need for improved understanding of both sides of shared decision-making which should involve the needs and priorities of older adults to help convey patient-specific risks and choice awareness. LEVEL OF EVIDENCE 3.
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Merminod G, Weber O, Semlali I, Terrier A, Decosterd I, Rubli Truchard E, Singy P. Talking about chronic pain in family settings: a glimpse of older persons’ everyday realities. BMC Geriatr 2022; 22:358. [PMID: 35461217 PMCID: PMC9034600 DOI: 10.1186/s12877-022-03058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The expression of chronic pain remains a delicate matter for those older persons who suffer from this condition. If many studies highlight the difficulties of putting pain into words, scarce are those that take into account how given social networks can facilitate or prevent its expression. Based on a qualitative study that explores the communication about chronic pain in older persons’ social network, this article reports on this key issue of talking about health in later life within family settings and provides clinicians with information about the way older persons with chronic conditions perceive their everyday realities and social relations.
Methods
A multidisciplinary research team (medicine, linguistics and psychology) interviewed 49 persons with chronic pain, all from the French-speaking part of Switzerland, aged 75 and older, without any major cognitive or auditory impairments. After transcription, the interviews were analyzed by combining content and discourse analysis with social network theories.
Results
Communication about chronic pain depends significantly on the position of the interlocutors within the family structure, with a preference for direct relatives or individuals with similar difficulties. In social networks, the ability to communicate about chronic pain is both a resource (by allowing older persons to get help or by strengthening interpersonal relations) and a challenge (by threatening their autonomy, social relations or self-esteem).
Conclusions
The study shows the predominance of the nuclear family (partner, children) in communication relating specifically to the everyday management of chronic pain. This state of affairs is, nevertheless, balanced by issues of (loss of) autonomy. These findings, in line with current trends in geriatrics, could benefit future reflections on the scope and limits of including relatives in the care of older patients with chronic conditions.
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Decisional Regret Among Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity: A Single Institutional Study. Spine (Phila Pa 1976) 2022; 47:E337-E346. [PMID: 34812198 DOI: 10.1097/brs.0000000000004287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE To investigate the prevalence of decisional regret among older adults undergoing surgery for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA Among older adults (≥65 years old), ASD is a leading cause of disability, with a population prevalence of 60% to 70%. While surgery is beneficial and results in functional improvement, in over 20% of older adults outcomes from surgery are less desirable. METHODS Older adults with ASD who underwent spinal surgery at a quaternary medical center from January 1, 2016 to March 1, 2019, were enrolled in this study. Patients were categorized into medium/high or low-decisional regret cohorts based on their responses to the Ottawa decision regret questionnaire. Decisional regret assessments were completed 24 months after surgery. The primary outcome measure was prevalence of decisional regret after surgery. Factors associated with high decisional regret were analyzed by multivariate logistic regression. RESULTS A total of 155 patients (mean age, 69.5 yrs) met the study inclusion criteria. Overall, 80% agreed that having surgery was the right decision for them, and 77% would make the same choice in future. A total of 21% regretted the choice that they made, and 21% responded that surgery caused them harm. Comparing patient cohorts reporting medium/high- versus low-decisional regret, there were no differences in baseline demographics, comorbidities, invasiveness of surgery, length of stay, discharge disposition, or extent of functional improvement 12-months after surgery. After adjusting for sex, American Society of Anesthesiologists score, invasiveness of surgery, and presence of a postoperative complication, older adults with preoperative depression had a 4.0 fold increased odds of high-decisional regret (P = 0.04). Change in health related quality of life measures were similar between all groups at 12-months after surgery. CONCLUSION While the majority of older adults were appropriately counseled and satisfied with their decision, one-in-five older adults regret their decision to undergo surgery. Preoperative depression was associated with medium/high decisional regret on multivariate analysis.Level of Evidence: 4.
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Perez E, Donovan EK, Rybarczyk BD, Dzierzewski JM. Insomnia Treatment Preferences Among Primary Care Patients. Clin Ther 2022; 44:630-637. [PMID: 35361532 PMCID: PMC9133067 DOI: 10.1016/j.clinthera.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/04/2022] [Accepted: 03/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Sleep disturbance is common in primary care. The main treatment options include medication and cognitive behavioral therapy for insomnia. Best practice guidelines recommend a collaborative decision-making approach to treatment. This study examined differences in insomnia treatment preferences based on demographic and clinical characteristics among primary care patients. METHODS A total of 200 patients (mean [SD] age, 54.92 [12.48] years) at a university medical center and community health clinic participated in brief screenings for insomnia, depression, anxiety, and insomnia treatment preference. Insomnia symptoms were measured with the Insomnia Severity Index, whereas depressive and anxiety symptoms were measured with the Patient Health Questionnaire 2 and Generalized Anxiety Disorder 2. χ2 analyses were performed to detect significant differences in preference between groups. FINDINGS A total of 46.5% of participants preferred medication and 56.0% preferred behavioral treatment (ratings not exclusionary). Preference for behavioral treatment was highest among severe insomnia presentations (15.2% preferred to 4.5% disliked; P = 0.002). Medication preference was higher among patients with elevated anxiety (57.3% preferred to 42.7% disliked; P = 0.017). Preference for behavioral treatment (66.7% preferred to 33.3% disliked; P = 0.012) and medication (56.8% preferred to 43.2% disliked; P = 0.016) was highest among those with elevated depression. Treatment preference only differed by age for behavioral treatment (P = 0.008). Preference was highest among patients ≤51 years of age (67.2% preferred to 32.8% disliked). IMPLICATIONS Primary care patients preferred behavioral and medication strategies for insomnia treatment. In addition, as mental health and sleep worsen, patients were more likely to prefer behavioral treatment. Knowledge of patient treatment preference may facilitate shared decision making, which increases patient satisfaction with care and engagement with treatment.
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Teo K, Churchill R, Riadi I, Kervin L, Wister AV, Cosco TD. Help-Seeking Behaviors Among Older Adults: A Scoping Review. J Appl Gerontol 2022; 41:1500-1510. [PMID: 35156428 PMCID: PMC9024019 DOI: 10.1177/07334648211067710] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults’ help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.
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Affiliation(s)
- Kelly Teo
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Ryan Churchill
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Indira Riadi
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Lucy Kervin
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Andrew V Wister
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada.,Gerontology Research Centre, 416185Simon Fraser University, Vancouver, BC, Canada
| | - Theodore D Cosco
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada.,Oxford Institute of Population Ageing, 416185University of Oxford, Oxford, UK
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Associations between pain and physical activity among older adults. PLoS One 2022; 17:e0263356. [PMID: 35089966 PMCID: PMC8797193 DOI: 10.1371/journal.pone.0263356] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Chronic pain is a significant societal problem and pain complaints are one of the main causes of work absenteeism and emergency room visits. Physical activity has been associated with reduced risk of suffering from musculoskeletal pain complaints, but the exact relationship in an older adult sample is not known. Methods Participants self-reported their physical activity level and whether they were often troubled by bone, joint, or muscle pain. Logistic regression analyses revealed the nature of the relationship between musculoskeletal pain and physical activity cross-sectionally and longitudinally over the course of 10 years. Data were taken from the English Longitudinal Study of Ageing, comprising of 5802 individuals residing in England aged 50 or older. Results Only high levels of physical activity were associated with a reduced risk of suffering from musculoskeletal pain compared to a sedentary lifestyle longitudinally. In addition, having low wealth, being female, and being overweight or obese were found to be risk factors for suffering from musculoskeletal pain. Conclusions The development of interventions aimed at alleviating and preventing musculoskeletal pain complaints might benefit from incorporating physical activity programs, weight loss, and aspects addressing wealth inequality to maximise their efficacy.
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College Students’ Attitudes Toward the Elderly: an Exploratory Study in Turkey. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-020-09393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Heleno E, Andias R, Silva AG. What do community-dwelling older adults with chronic pain value in a program of combined pain neuroscience education plus exercise? PATIENT EDUCATION AND COUNSELING 2021; 104:3072-3078. [PMID: 33958256 DOI: 10.1016/j.pec.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/31/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the experience of older adults after a pain neuroscience education (PNE) and exercise intervention. METHODS Focus group interviews were conducted with 14 older adults after receiving 8-weekly sessions of PNE and exercise and encompassed older adults' perceptions of the intervention and its impact. Interviews were transcribed verbatim and analyzed by 3 researchers using thematic analysis in a five-step approach (compiling, disassembling, reassembling, interpreting, and concluding). RESULTS Three themes emerged: pain reconceptualization, motivational factors, and perceived improvements. Pain reconceptualization was illustrated by participants' ability to use language that related to PNE concepts (n = 12), increased self-efficacy (n = 5), and adjusted emotions (n = 2) and behaviors (n = 6). Motivational factors were the group-administered intervention (n = 6) and the physical therapists' communication skills (n = 10). The intervention was perceived as having a positive impact on sleep (n = 3), well-being (n = 6), and activity/ability to perform activities (n = 8). CONCLUSION Older adults understand PNE concepts and reconceptualize pain. PNE and exercise were perceived as having a positive impact on day-to-day life. PRACTICE IMPLICATIONS Mode of administration, communication skills, and rapport are aspects of the intervention that are valued by older adults. Also, PNE might be used as a strategy to increase older adults' adherence to physical activity.
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Affiliation(s)
- Emanuel Heleno
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
| | - Rosa Andias
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal; Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
| | - Anabela G Silva
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal; Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
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Salsbury SA, Maiers M. Qualitative Analysis of Illness Representations and Coping Perceptions Among Older Adults With Chronic Spinal Disability: “A Thought in the Back of My Mind”. J Manipulative Physiol Ther 2021; 44:652-662. [DOI: 10.1016/j.jmpt.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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Schönstein A, Dallmeier D, Denkinger M, Rothenbacher D, Klenk J, Bahrmann A, Wahl HW. Health and Subjective Views on Aging: Longitudinal Findings From the ActiFE Ulm Study. J Gerontol B Psychol Sci Soc Sci 2021; 76:1349-1359. [PMID: 33528511 PMCID: PMC8363042 DOI: 10.1093/geronb/gbab023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Previous research supports that subjective views on aging (VoA), such as older subjective age (SA) and negative attitudes toward own aging (ATOA), go along with negative outcomes. A differentiated treatment of health and disease as antecedents of VoA is largely lacking. Therefore, our objective was to estimate the relationship between generally framed physical, affective, and cognitive health as well as specific diseases and VoA, operationalized both as SA and ATOA. Methods Data were drawn from the ActiFE Ulm study for which a representative sample of community-dwelling older people (65–90 years) was recruited at baseline. Follow-ups were conducted 7.7 years (median) after recruitment (N = 526). Health- and disease-related data at baseline, based on established assessment procedures for epidemiological studies, were regressed on VoA (1-item SA indicator, 5-item ATOA scale) measures at follow-up. Results Reported severity of affective health problems such as depression was the strongest general risk factor for both older SA and negative ATOA. Also, some but not all major diseases considered were associated with VoA. Notably, back pain predicted negative ATOA, while cancer was associated with older SA. Rheumatism was linked with more negative ATOA along with higher SA. Throughout analyses, explained variance in ATOA was considerably higher than in SA. Discussion Affective health problems, such as depression, should be regarded as a major correlate of subjective aging views. Interestingly, diseases do not have to be life-threatening to be associated with older SA or negative ATOA.
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Affiliation(s)
| | - Dhayana Dallmeier
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Germany.,Department of Epidemiology, Boston University School of Public Health, Massachusetts, USA
| | - Michael Denkinger
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Germany
| | | | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Anke Bahrmann
- Network Aging Research (NAR), Heidelberg University, Germany.,Heidelberg University Hospital, Germany
| | - Hans-Werner Wahl
- Network Aging Research (NAR), Heidelberg University, Germany.,Institute of Psychology, Heidelberg University, Germany
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Krajewska-Kułak E, Cybulski M, Aniśko P, Popławska M. Age Differences in Attitudes towards Older People in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136869. [PMID: 34206817 PMCID: PMC8297323 DOI: 10.3390/ijerph18136869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The attitudes towards older people is essential. Society's perception of older adults is often unpleasant. Inappropriate treatment of older people in society causes a decrease in self-esteem, a sense of control over one's own life, a decrease in the quality of life, an increase in anxiety, depression, anger, and sadness. The aim of this study was to compare the attitudes of young people and seniors towards older people in relation to their satisfaction with life and self-esteem. MATERIALS AND METHODS The study was conducted online in groups of young adults under 35 years of age (Group I) and over 65 years of age (group II), with 177 people each. METHOD The study used the following questionnaires: Satisfaction with Life Scale (SWLS), Self-Assessment of Own Person (SOP), and Kogan's Attitude Towards Old People Scale (KATOPS). RESULTS The satisfaction of life in both groups was average. The mean value of self-esteem was significantly (p < 0.001) lower in the group of seniors. Both groups of respondents had negative attitudes towards seniors in the KATOPS. There was a statistically significant correlation between life satisfaction and self-esteem in seniors. Gender, age, education, or place of residence of respondents had no impact on negative attitudes in both groups. CONCLUSIONS Both groups showed negative attitudes towards seniors. No significant correlation was found between the groups and gender of the respondents, and the influence of the respondent's age, education, marital status, or place of residence. There was a correlation between the respondents' attitudes in the subscale of negative attitudes and their satisfaction with life. No correlation between self-esteem and age and marital status were found with no dependence on gender, education, or place of residence.
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Affiliation(s)
- Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Medical University of Białystok, 15-096 Białystok, Poland; (M.C.); (P.A.)
- Correspondence:
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Medical University of Białystok, 15-096 Białystok, Poland; (M.C.); (P.A.)
| | - Paulina Aniśko
- Department of Integrated Medical Care, Medical University of Białystok, 15-096 Białystok, Poland; (M.C.); (P.A.)
- Doctoral School, Medical University of Białystok, 15-089 Białystok, Poland
| | - Magda Popławska
- Students’ Scientific Society, Department of Integrated Medical Care, Medical University of Białystok, 15-096 Białystok, Poland;
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Shalev A, Henderson CR, Gutierrez I, Mullen E, Reid MC. The Prevalence and Potential Role of Pain Beliefs When Managing Later-Life Pain. Clin J Pain 2021; 37:251-258. [PMID: 33323790 PMCID: PMC8686205 DOI: 10.1097/ajp.0000000000000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this study of 154 community-dwelling older adults with chronic noncancer pain, we sought to assess participants' beliefs about pain as well as pain management treatments and to determine the influence of those beliefs on participants' willingness to undertake 3 physician-recommended pain treatments, that is, a pharmacologic, physical, and psychological therapy. MATERIALS AND METHODS A 16-item questionnaire was employed to ascertain participants' pain beliefs, divided into 4 subscales representing: (1) negative beliefs about pharmacological treatments, (2) positive beliefs about physical treatment approaches, for example, exercise, (3) positive beliefs about psychological treatments, and (4) fatalistic beliefs about pain. Participants were asked to rate their willingness to undertake a pharmacologic, physical, or psychological therapy if their physician recommended that they do so. Agreement with each belief was measured, and we examined willingness to undertake each treatment as a function of pain belief subscale scores after controlling for relevant covariates. RESULTS Positive beliefs about physical treatments (eg, benefits of exercise) were the most strongly endorsed items on the pain beliefs questionnaire. All 3 treatment-focused pain beliefs subscales were significantly associated with willingness to undertake that form of treatment (eg, negative beliefs about pain medication use were associated with decreased willingness to take pain medication). Fatalistic attitudes were significantly associated with a decreased willingness to undertake physical treatments. DISCUSSION These results support the notion that patients' beliefs about pain and pain treatments can have important effects on treatment engagement and, if assessed, can help guide clinical management of chronic pain in older adults.
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Alsbrook KE, Harpel CK, Scott PW, Hayden AD, Dunwoody CJ, Wesmiller SW. Older Women and Opioid Analgesia after Breast Cancer Surgery. Pain Manag Nurs 2021; 22:327-335. [PMID: 33674240 DOI: 10.1016/j.pmn.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore which factors influence opioid analgesia use in older women during the 48-hour period after hospital discharge following initial breast cancer surgery. DESIGN This cross-sectional, descriptive study involved a cohort (n = 57) of older women recruited for a larger study of breast cancer patients. METHODS We gathered patient-reported data pertinent to perioperative and post-discharge pain control. Data were analyzed using linear regression to explore those characteristics that had the greatest influence on the amount of post-discharge opioid analgesia required. RESULTS After hospital discharge, 29 older women (51%) with breast cancer avoided opioid analgesia for various reasons. The number of prescribed opioid tablets each woman self-administered determined the total dosage of analgesia required 48 hours post-discharge. CONCLUSIONS The majority of this sample of older women with early-stage breast cancer experienced adequate pain relief after surgery and required little or no postoperative or postdischarge opioid analgesia. Optimization of the pain control experience for older women with breast cancer requires thorough pain assessment from diagnosis through survivorship through the end of life. This can be achieved by equipping women in this population to advocate for their pain control needs in real time. Future studies that elucidate preferences, beliefs, and current pain control practices before, during, and after breast cancer surgery will improve safety and efficacy of pain control for this fast-growing population.
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Affiliation(s)
- Karen E Alsbrook
- University of Pittsburgh School of Nursing, Department of Health Promotion and Development, Pittsburgh, Pennsylvania.
| | - Caroline K Harpel
- University of Pittsburgh School of Nursing, Department of Health Promotion and Development, Pittsburgh, Pennsylvania
| | - Paul W Scott
- University of Pittsburgh School of Nursing, Department of Health Promotion and Development, Pittsburgh, Pennsylvania; University of Pittsburgh School of Nursing, Department of Health and Community Systems, Pittsburgh, Pennsylvania
| | | | - Colleen J Dunwoody
- University of Pittsburgh School of Nursing, Department of Health Promotion and Development, Pittsburgh, Pennsylvania
| | - Susan W Wesmiller
- University of Pittsburgh School of Nursing, Department of Health Promotion and Development, Pittsburgh, Pennsylvania
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Gillsjö C, Nässén K, Berglund M. Suffering in silence: a qualitative study of older adults' experiences of living with long-term musculoskeletal pain at home. Eur J Ageing 2021; 18:55-63. [PMID: 33746681 PMCID: PMC7925717 DOI: 10.1007/s10433-020-00566-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Long-term musculoskeletal pain is a major, disabling, and often undertreated health problem among the increasing number of older adults worldwide. However, there is limited knowledge of community-dwelling older adults' experiences of living with this type of pain. The aim of the study was to deepen the understanding of the phenomenon: how older adults experience living with long-term musculoskeletal pain at home. The study design was an inductive qualitative Reflective Lifeworld Research approach grounded in phenomenological epistemology. Data were obtained from 20 community-dwelling older adults, aged 72-97 years. Data were collected through open-ended interviews and analyzed to understand the meanings of the phenomenon. The essence of the phenomenon entailed suffering in silence and encompassed the following constituents: loneliness and restrictions in daily living; ways to endure and distract from pain; not being taken seriously; fear of the future; and valuing joy and meaning in life. Living with long-term musculoskeletal pain restricts access to the world and leads to a suffering in silence. Finding ways to endure and distract from pain and to focus on issues that give joy and meaning in life is predominant in efforts to balance restraints from pain in life. Suffering is reinforced by loneliness, a sense of not being taken seriously by health care providers and fear of an uncertain future. It is necessary to foster increased attentiveness and sensitivity in meeting the needs of each older adult and provide a care that alleviates suffering and preserves and promotes health and well-being.
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Affiliation(s)
- Catharina Gillsjö
- School of Health Sciences, University of Skövde, P.O. Box 408, 541 28 Skövde, Sweden
- College of Nursing, University of Rhode Island, Kingston, USA
| | - Kristina Nässén
- Academy of Care, Working Life and Social Welfare, University of Borås, Borås, Sweden
| | - Mia Berglund
- School of Health Sciences, University of Skövde, P.O. Box 408, 541 28 Skövde, Sweden
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Kalavar M, Watane A, Cavuoto KM, Vanner EA, Sridhar J. Demographic Variations in Patient Populations and Regional Distributions Between Male and Female Ophthalmologists in the United States: Cross-Sectional Analysis. Semin Ophthalmol 2021; 36:633-640. [PMID: 33616481 DOI: 10.1080/08820538.2021.1891264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To determine if patient demographics differ by ophthalmologist gender.Methods: Demographic data on U.S. ophthalmologists were collected from the 2017 Medicare Physician and Other Supplier National Provider Identifier Aggregate Report.Results: Of the 17,230 ophthalmologists included, female ophthalmologists (23.7%) provided care for a smaller proportion of White patients (77.4% ± 24.9% female, 81.0% ± 22.1% male; p < .001), had younger beneficiaries (73.8 ± 3.2 years old females, 74.8 ± 2.9 years old males; p < .001) and had a higher proportion of female beneficiaries per provider (61.1% ± 4.6% females, 59.6% ± 4.0% males; p < .001). Average age of beneficiaries and number of beneficiaries were correlated with years since medical school (rho = 0.283, rho = 0.148; both p < .001). The number of Medicare beneficiaries, proportion of female beneficiaries, years since medical school and group practice size were independently associated with physician gender (p < .001).Conclusion: Female ophthalmologists saw a larger proportion of ethnically diverse, younger, female patients.
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Affiliation(s)
- Meghana Kalavar
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Arjun Watane
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Kara M Cavuoto
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
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Ng R, Chow TYJ. Aging Narratives over 210 years (1810-2019). J Gerontol B Psychol Sci Soc Sci 2020; 76:1799-1807. [PMID: 33300996 PMCID: PMC7798532 DOI: 10.1093/geronb/gbaa222] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives The World Health Organization launched a recent global campaign to combat ageism, citing its ubiquity and insidious threat to health. The historical context that promoted this pernicious threat is understudied, and such studies lay the critical foundation for designing societal-level campaigns to combat it. We analyzed the trend and content of aging narratives over 210 years across multiple genres—newspaper, magazines, fiction, nonfiction books—and modeled the predictors of the observed trend. Method A 600-million-word dataset was created from the Corpus of Historical American English and the Corpus of Contemporary American English to form the largest structured historical corpus with over 150,000 texts from multiple genres. Computational linguistics and statistical techniques were applied to study the trend, content, and predictors of aging narratives. Results Aging narratives have become more negative, in a linear fashion (p = .003), over 210 years. There are distinct shifts: From uplifting narratives of heroism and kinship in the 1800s to darker tones of illness, death, and burden in the 1900s across newspapers, magazines, and nonfiction books. Fiction defied this trend by portraying older adults positively through romantic courtship and war heroism. Significant predictors of ageism over 210 years are the medicalization of aging, loss of status, warmth, competence, and social ostracism. Discussion Though it is unrealistic to reverse the course of ageism, its declining trajectory can be ameliorated. Our unprecedented study lay the groundwork for a societal-level campaign to tackle ageism. The need to act is more pressing given the Covid-19 pandemic where older adults are constantly portrayed as vulnerable.
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Affiliation(s)
- Reuben Ng
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore.,Lloyd's Register Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Innovation 4.0, 3 Research Link, Singapore
| | - Ting Yu Joanne Chow
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
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Schofield P, Dunham M, Martin D, Bellamy G, Francis SA, Sookhoo D, Bonacaro A, Hamid E, Chandler R, Abdulla A, Cumberbatch M, Knaggs R. Evidence-based clinical practice guidelines on the management of pain in older people – a summary report. Br J Pain 2020; 16:6-13. [PMID: 35111309 PMCID: PMC8801690 DOI: 10.1177/2049463720976155] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people. Design: Review of evidence since 2010 using a systematic and consensus approach is performed. Results: Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines. Conclusion: Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions.
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Vale MT, Stanley JT, Houston ML, Villalba AA, Turner JR. Ageism and Behavior Change During a Health Pandemic: A Preregistered Study. Front Psychol 2020; 11:587911. [PMID: 33329247 PMCID: PMC7710520 DOI: 10.3389/fpsyg.2020.587911] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023] Open
Abstract
The COVID-19 pandemic has led to a suspected surge of ageism in America and has imposed critical health and safety behavior modifications for people of all ages (Ayalon et al., 2020; Lichtenstein, 2020). Given that older adults are a high-risk group, maintaining their safety has been paramount in implementing preventive measures (i.e., more handwashing, social distancing); however, making such behavior modifications might be contingent on how one views older adults (i.e., ageist stereotypes). Therefore, the goal of the current pre-registered study was to explore if hostile and benevolent ageism relate to pandemic-related fear and behavior change. An online survey assessing responses to the pandemic was taken by 164 younger and 171 older adults. Higher hostile ageism predicted lower pandemic-related behavior modification. Those high in benevolent ageism reported lower behavior change, but also reported higher pandemic-related fear; however, when pandemic-related fear was considered a mediator between the two, the directionality between benevolent ageism and behavior change switched, indicating a suppression effect. These findings highlight that ageist attitudes do predict responses to the pandemic and that hostile and benevolent ageism are distinct facets that have unique implications during a health pandemic.
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Affiliation(s)
- Michael T. Vale
- Department of Psychology, University of Akron, Akron, OH, United States
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‘I've never given it a thought’: older men's experiences with and perceptions of ageism during interactions with physicians. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe subjective experience of ageism among older men has received little research attention. This study examines older Canadian men's experiences with and perceptions of ageism during interactions with physicians. In-depth, face-to-face interviews were conducted with 21 men aged 55 years and over. The findings indicate a seeming lack of awareness of ageism among many, and many did not believe ageism was likely to occur during patient–physician interaction. Negative stereotyping of older patients was common. A large majority of the participants reported that they had not personally experienced ageism during a medical encounter, nor were they concerned about it. Numerous rationales were proffered as explanations of why a particular participant had not experienced ageism and who was more likely to be a target.
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Wells BM, Salsbury SA, Nightingale LM, Derby DC, Lawrence DJ, Goertz CM. Improper Communication Makes for Squat: A Qualitative Study of the Health-Care Processes Experienced By Older Adults in a Clinical Trial for Back Pain. J Patient Exp 2020; 7:507-515. [PMID: 33062871 PMCID: PMC7534140 DOI: 10.1177/2374373519860347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The study focused on perceptions of older adults toward the healthcare processes they experienced during a clinical trial for back pain that involved family medicine residents and licensed chiropractors. Methods: Individual semi-structured interviews were conducted with 115 older adults after a 12-week, 3-arm, randomized controlled trial. Two researchers conducted thematic analysis with inductive coding using qualitative software to identify participants’ salient experiences of the doctor–patient relationship, healthcare process, and collaboration between study providers. Investigators categorized thematic codes within an existing framework of clinical excellence in primary care. Results: Participants emphasized provider communication and interpersonal relationships, professionalism and passion for patient care, clinical and diagnostic acumen, and skillful negotiation of the health-care system. Older adults also described the importance of interdisciplinary collaboration and their preferences for receiving hands-on treatments for musculoskeletal conditions. Conclusion: These older adults valued doctors who communicated clearly and spent time listening to their concerns. Many participants appreciated clinicians who supported an active role for patients in their health-care and who provided touch-based care for musculoskeletal conditions.
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Affiliation(s)
- Breanne M Wells
- Technique Department, Palmer College of Chiropractic, Davenport, IA, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Lia M Nightingale
- Life Sciences Department, Palmer College of Chiropractic, Davenport, IA, USA
| | - Dustin C Derby
- College Administration, Palmer College of Chiropractic, Davenport, IA, USA
| | - Dana J Lawrence
- Parker Research Institute, Parker University, Dallas, TX, USA
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Abstract
Aim: The review aimed to identify factors influencing opioid prescribing as regular pain-management medication for older people. Background: Chronic pain occurs in 45%–85% of older people, but appears to be under-recognised and under-treated. However, strong opiate prescribing is more prevalent in older people, increasing at the fastest rate in this age group. Methods: This review included all study types, published 1990–2017, which focused on opioid prescribing for pain management among older adults. Arksey and O’Malley’s framework was used to scope the literature. PubMed, EBSCO Host, the UK Drug Database, and Google Scholar were searched. Data extraction, carried out by two researchers, included factors explaining opioid prescribing patterns and prescribing trends. Findings: A total of 613 papers were identified and 53 were included in the final review consisting of 35 research papers, 10 opinion pieces and 8 grey literature sources. Factors associated with prescribing patterns were categorised according to whether they were patient-related, prescriber-driven, or system-driven. Patient factors included age, gender, race, and cognition; prescriber factors included attitudes towards opioids and judgements about ‘normal’ pain; and policy/system factors related to the changing policy landscape over the last three decades, particularly in the USA. Conclusions: A large number of context-dependent factors appeared to influence opioid prescribing for chronic pain management in older adults, but the findings were inconsistent. There is a gap in the literature relating to the UK healthcare system; the prescriber and the patient perspective; and within the context of multi-morbidity and treatment burden.
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Comer C, Lee H, Williamson E, Lamb S. Understanding the mechanisms of a combined physical and psychological intervention for people with neurogenic claudication: protocol for a causal mediation analysis of the BOOST trial. BMJ Open 2020; 10:e037121. [PMID: 32878759 PMCID: PMC7470505 DOI: 10.1136/bmjopen-2020-037121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Conservative treatments such as exercise are recommended for the management of people with neurogenic claudication from spinal stenosis. However, the effectiveness and mechanisms of effect are unknown. This protocol outlines an a priori plan for a secondary analysis of a multicentre randomised controlled trial of a physiotherapist-delivered, combined physical and psychological intervention (Better Outcomes for Older people with Spinal Trouble (BOOST) programme). METHODS AND ANALYSES We will use causal mediation analysis to estimate the mechanistic effects of the BOOST programme on the primary outcome of disability (measured by the Oswestry Disability Index). The primary mechanism of interest is walking capacity, and secondary mediators include fear-avoidance behaviour, walking self-efficacy, physical function, physical activity and/or symptom severity. All mediators will be measured at 6 months and the outcome will be measured at 12 months from randomisation. Patient characteristics and possible confounders of the mediator-outcome effect will be measured at baseline. Sensitivity analyses will be conducted to evaluate the robustness of the estimated effects to varying levels of residual confounding. ETHICS AND DISSEMINATION Ethical approval was given on 3 March 2016 (National Research Ethics Committee number: 16/LO/0349). The results of this analysis will be disseminated in peer-reviewed journals and at relevant scientific conferences. TRIAL REGISTRATION NUMBER ISRCTN12698674.
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Affiliation(s)
- Christine Comer
- Musculoskeletal and Rehabilitation Services, Leeds Community Healthcare NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Hopin Lee
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
- The Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
| | - Esther Williamson
- The Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
| | - Sarah Lamb
- The Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Polacsek M, Boardman GH, McCann TV. Factors influencing self-management of depression in older adults: a qualitative study. Aging Ment Health 2020; 24:939-946. [PMID: 30621440 DOI: 10.1080/13607863.2018.1562538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: A considerable body of work addresses prevalence and treatment options for depression in older adults. However, less is known about their capacity to self-manage their depression. Effective self-management of depression has the potential to improve individuals' quality of life through information, empowerment and perceived control, while enabling more efficient health service utilisation. The aim of this paper was to identify the barriers and facilitators to self-management of depression in older adults.Method: A qualitative study comprising in-depth, semi-structured interviews with 32 older adults with a diagnosis of moderate depression.Results: Three over-arching themes captured the barriers and facilitators to participants' capacity to self-manage their depression. Perspectives on age and depression represented how views of older age and mental health influenced the approach to self-management. Ability to access the health care system concerned the ability to identify and engage with different services and support. Individual capacity for self-management reflected participants' views on and the resources required for effective self-management.Conclusion: This study offers a better understanding of the factors that positively or negatively influence older adults' ability to self-manage their depression. Strategies to improve self-management should address misconceptions about age and depression, and older adults' interest in and capacity to embrace self-management practices.
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Affiliation(s)
- Meg Polacsek
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,National Ageing Research Institute, Parkville, Victoria, Australia
| | - Gayelene H Boardman
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Terence V McCann
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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Hovey A, Edick C, Brownlee K. Utilization of social workers in home care: An analysis of service use. Home Health Care Serv Q 2020; 39:80-94. [PMID: 32264771 DOI: 10.1080/01621424.2020.1749920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Social workers are well positioned to address mental health complications impacting home care populations, yet social work has one of the lowest utilization rates of offered home care supports in Ontario. This study analyzed care plan data of frontline in-home social work services. Results identified adjustment to illness as the most common category and that seniors required significantly fewer visits and days on service than non-seniors. Most patients were able to accomplish their social work-based goals. Results highlight a need for further research and for capitalizing on the untapped potential value of social work home care services for patients.
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Affiliation(s)
- Angela Hovey
- School of Social Work, Lakehead University, Orillia, Ontario, Canada
| | - Cole Edick
- School of Social Work, Lakehead University, Orillia, Ontario, Canada
| | - Keith Brownlee
- School of Social Work, Lakehead University, Orillia, Ontario, Canada
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Musich S, Wang SS, Slindee LB, Keown K, Hawkins K, Yeh CS. Using Pain Medication Intensity to Stratify Back Pain Among Older Adults. PAIN MEDICINE 2020; 20:252-266. [PMID: 29394401 PMCID: PMC6374135 DOI: 10.1093/pm/pny007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective To examine the prevalence of musculoskeletal back pain among older adults stratified by pain medication intensity to 1) review treatment patterns and 2) consider targeted back pain prevention interventions. Methods A random sample of older adults age 64 years and older was utilized to identify new and recurring back pain. Prescription pain medications from drug claims were used to stratify to five unique intensity levels. The characteristics of each level were determined using regression models. Results About 10% had musculoskeletal back pain. Of these, 54% (N = 20,645) had new back pain and 46% (N = 17,252) had recurring back pain. Overall, about 35% received physical therapy. Pain medication intensity levels included no prescription pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, low-dose opioids, and high-dose opioids (new back pain: 39%, 10%, 6%, 23%, and 23%, respectively; recurring back pain 32%, 9%, 4%, 17%, and 38%, respectively). NSAID and muscle relaxant users were younger, healthier, and received physical therapy. Opioid users were younger, in poorer health, used sleep medications, received physical therapy, and had more falls and higher health care utilization and expenditures. Conclusions New and recurring back pain patients can be stratified by pain medication intensity to review treatment patterns and target back pain prevention programs. Those with back pain but taking no prescription pain medications may benefit from back pain prevention programs. More research on guidelines for treatment options for those on high levels of pain medications is warranted.
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Affiliation(s)
| | | | - Luke B Slindee
- Informatics and Data Science, Optum, Minnetonka, Minnesota
| | - Karen Keown
- UnitedHealthcare Alliances, Optum, Minneapolis, Minnesota
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Nissen SK, Pottegård A, Ryg J. Trends of Opioid Utilisation in Denmark: A Nationwide Study. Drugs Real World Outcomes 2019; 6:155-164. [PMID: 31535353 PMCID: PMC6879688 DOI: 10.1007/s40801-019-00163-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Opioid use has more than doubled over recent decades, and Denmark occupies fifth place in the global ranking. These increases have been partly attributed to the ageing population. Objective Our objective was to assess the impact of age over time on utilisation of the most commonly used opioids in Denmark. Methods We retrieved nationwide sales data on opioid sales in Denmark from 1999 to 2017. We investigated utilisation trends in age groups for the four opioids with the highest use. We used three volume-based metrics (defined daily doses/1000/day, oral morphine equivalents/1000/day, and packages dispensed/year) and one person-based metric (users/1000/year). Results The four opioids selected according to users/1000/year were tramadol (46.1), codeine and combination products (12.4 for codeine, 3.7 for codeine and acetylsalicylic acid, and 4.2 for codeine and paracetamol), morphine (17.0), and oxycodone (12.1). Overall utilisation according to volume and person metrics increased for all except codeine and combination products. Tramadol doses or strength increased, albeit less with increasing age. Oxycodone doses or strength decreased for all age groups but were nearly unchanged for the age group ≥ 80 years. Conclusion Tramadol is the most utilised opioid in Denmark and was prescribed at increasing doses or strengths over the study period, particularly in the younger (< 80 years) age groups. Overall, oxycodone was prescribed at decreasing doses or strengths over time but remained unchanged for the age group ≥ 80 years. There is a need to address the pharmacological treatment of pain in terms of age, with tramadol and oxycodone being possible targets for regulatory efforts. Electronic supplementary material The online version of this article (10.1007/s40801-019-00163-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Søren Kabell Nissen
- Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense C, Denmark.
| | - Anton Pottegård
- Department of Public Health, University of Southern Denmark, Clinical Pharmacology and Pharmacy, J. B. Winsløwsvej 19, 3, 5000, Odense C, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J. B. Winsløwsvej 19, 3, 5000, Odense C, Denmark
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Correlates of a Recent History of Disabling Low Back Pain in Community-dwelling Older Persons: The Pain in the Elderly (PAINEL) Study. Clin J Pain 2019; 34:515-524. [PMID: 29077624 DOI: 10.1097/ajp.0000000000000564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the correlates of a recent history of disabling low back pain (LBP) in older persons. MATERIALS AND METHODS The Pain in the Elderly (PAINEL) Study was derived from the Frailty among Brazilian Older Adults (FIBRA) Network Study. Data were collected through face-to-face/telephone interviews and clinical examination. A series of logistic regressions assessed associations between a recent history of disabling LBP and sociodemographic, physical/lifestyle, and psychological factors. RESULTS Of the 378 community-dwelling elders included in the study (age±SD, 75.5±6.1), 9.3% experienced LBP that was bad enough to limit or change their daily activities during the past year. Those reporting a recent history of disabling LBP were more likely to be women and under financial strain, to present poor self-rated health, overweight, multimorbidity, low physical activity level, fatigue, depressive symptomatology/diagnosis and fear beliefs, and to report decreased sleep time, prolonged sitting time, chronic pain (in location other than lower back), and frequently recurring LBP. The multivariate logistic regression analysis indicated that overweight (odds ratio [OR], 29.6; 95% confidence interval [CI], 2.3-391.0), low physical activity level (OR, 4.4; 95% CI, 1.3-15.4), fatigue (OR, 10.3; 95% CI, 2.4-43.4), depression diagnosis (OR, 4.9; 95% CI, 1.3-18.4), and frequently recurring LBP (OR, 4.6; 95% CI, 1.0-20.1) were independently associated with a recent history of disabling LBP. DISCUSSION Our study supports the link between disabling LBP and other age-related chronic conditions in a middle-income country with a rapidly aging population.
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Lewis CB. Academy of Geriatric Physical Therapy Inaugural Carole B. Lewis Lecture Award Address to the Membership at the Combined Sections Meeting Washington, DC January 24, 2019. J Geriatr Phys Ther 2019; 42:59-62. [PMID: 30882546 DOI: 10.1519/jpt.0000000000000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Polacsek M, Boardman GH, McCann TV. Help-seeking experiences of older adults with a diagnosis of moderate depression. Int J Ment Health Nurs 2019; 28:278-287. [PMID: 30120874 PMCID: PMC8351636 DOI: 10.1111/inm.12531] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 02/03/2023]
Abstract
Depression is the most prevalent mental illness among older adults. However, help-seeking by older adults is frequently delayed, resulting in longer duration of untreated symptoms, poorer health outcomes, and consequent higher healthcare use. Early help-seeking and access to appropriate support benefits individuals, while providing better outcomes from health systems constrained by limited resources. The aim of this study, which is abstracted from a larger study, was to identify the factors that inhibited and enabled formal help-seeking in older adults with a diagnosis of moderate depression. Corbin and Strauss' approach to grounded theory informed data collection and analysis. Two themes and related subthemes concerning help-seeking barriers and facilitators were abstracted from the data. Help-seeking barriers were attributable to stigma, self-motivation, accessing formal support, ageism, and difficulty obtaining an initial diagnosis. Help-seeking facilitators were accepting personal responsibility, mental health literacy, therapeutic alliances, and informal support. Findings have implications for the role of mental health nurses, who are well-placed to provide support to community-based older adults with depression. More broadly, mental health nurses and other clinicians should seek to reduce help-seeking barriers and implement ways to facilitate help-seeking in this cohort.
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Affiliation(s)
- Meg Polacsek
- Institute for Health and SportVictoria UniversityMelbourneVic.Australia
| | | | - Terence V. McCann
- Institute for Health and SportVictoria UniversityMelbourneVic.Australia
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Claréus B, Renström EA. Patients' return-to-work expectancy relates to their beliefs about their physician's opinion regarding return to work volition and ability. J Pain Res 2019; 12:353-362. [PMID: 30697062 PMCID: PMC6339447 DOI: 10.2147/jpr.s179061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose This study investigates the relationship between sick-listed patients’ return to work (RTW) expectancy and how they perceive that their physicians evaluate their ability and volition for RTW. Methods Hierarchical logistic regression controlling for sociodemographic factors and pain characteristics was carried out on cross-sectional data from 205 participants (mean age= 47.24±9.66 years, 83.9% women). They were currently on full-time sick leave with a total duration of 10 years or less and represented various diagnosed and undiagnosed pain conditions. Results A positive expectation for RTW within a year was significantly associated with the belief that the physician favorably evaluated one’s ability (OR= 1.44, 95% CI= 1.13–1.83) and volition (OR= 1.42, 95% CI= 1.11–1.83) to RTW. This held even when other variables significantly associated with RTW expectancy were accounted for. Beyond beliefs, only age made a significant contribution in our final model (OR= 0.94, 95% CI= 0.90–0.98). Conclusion The results indicate that patients’ beliefs regarding their physician’s opinion about their ability and volition for RTW influence their own RTW expectancy. Rehabilitation might be facilitated if health care professionals address and affirm patients’ ability and volition for RTW, regardless of patients’ pain characteristics or if the total duration of their sick leave is <10 years. As other studies have found that RTW expectancy is one of the strongest predictors for actual RTW, future research should test the effect of beliefs about physicians’ opinions on actual RTW rates.
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Affiliation(s)
| | - Emma A Renström
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
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50
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Nahin RL, Sayer B, Stussman BJ, Feinberg TM. Eighteen-Year Trends in the Prevalence of, and Health Care Use for, Noncancer Pain in the United States: Data from the Medical Expenditure Panel Survey. THE JOURNAL OF PAIN 2019; 20:796-809. [PMID: 30658177 DOI: 10.1016/j.jpain.2019.01.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/09/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
We used data from the nationally representative Medical Expenditure Panel Survey to determine the 18-year trends in the overall rates of noncancer pain prevalence and pain-related interference, as well as in health care use attributable directly to pain management. The proportion of adults reporting painful health condition(s) increased from 32.9% (99.7% confidence interval [CI] = 31.6-34.2%;120 million adults) in 1997/1998 to 41.0% (99.7% CI = 39.2-42.4%; 178 million adults) in 2013/2014 (Ptrend < .0001). Among adults with severe pain-related interference associated with their painful health condition(s), the use of strong opioids specifically for pain management more than doubled from 11.5% (99.7% CI = 9.6-13.4%) in 2001/2002 to 24.3% (99.7% CI = 21.3-27.3%) in 2013/2014 (Ptrend < .0001). A smaller increase (Pinteraction < .0001) in strong opioid use was seen in those with minimal pain-related interference: 1.2% (99.7% CI = 1.0-1.4%) in 2001/2002 to 2.3% (99.7% CI = 1.9-2.7%) in 2013/2014. Small but statistically significant decreases (Ptrend < .0001) were seen in 1) the percentage of adults with painful health condition(s) who had ≥1 ambulatory office visit for their pain: 56.1% (99.7% CI = 54.2-58.0%) in 1997/1998 and 53.3% (99.7% CI = 51.4-55.4%) in 2013/2014; 2) the percentage who had ≥1 emergency room visit for their pain; 9.9% (99.7% CI = 8.6-11.2%) to 8.8% (99.7% CI = 7.9-9.7%); and 3) the percentage with ≥1 overnight hospitalization for their pain: 3.2% (99.7% CI = 2.6-4.0%) to 2.3% (99.7% CI = 1.8-2.8%). PERSPECTIVE: Our data illustrate changes in the management of painful health conditions over the last 2 decades in the United States. Strong opioid use remains high, especially in those with severe pain-related interference. Additional education of health care providers and the public concerning the risk/benefit ratio of opioids appears warranted.
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Affiliation(s)
- Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland.
| | - Bryan Sayer
- Social & Scientific Systems, Silver Spring, Maryland
| | - Barbara J Stussman
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
| | - Termeh M Feinberg
- Yale University School of Medicine, Yale Center for Medical Informatics, New Haven Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; University of Maryland Baltimore School of Medicine, Center for Integrative Medicine, Baltimore, Maryland
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