Fluctuation between Powerlessness and Sense of Meaning--A Qualitative Study of Health Care Professionals' Experiences of Providing Health Care to Older Adults with Long-Term Musculoskeletal Pain

Health care professionals' experiences of possibilities and constraints in caring for older adults living with long-term pain in community home care

Caring for a growing population of older adults with complex health problems in their homes is part of every-day work for many health care professionals in the world. This qualitative interview study explores the way health care professionals perceive possibilities and constraints when caring for older adults living with long-term pain in community home care in Sweden. The study aims to understand the relationship between health care professionals' subjective experiences and social structures such as the organization of care and shared norms and values in regard to their perceived space of action. Findings provide insight into how institutional structures such as organization and time, conflate with cultural notions, norms, and ideals, and how these enable and constrain health care professionals in their daily work but also create dilemmas. Findings suggest centering the meaning of structuring aspects in social organizations as a tool for reflection on priorities, improvement, and development in care settings.

Pain and health-related quality of life (HRQoL): a national observational study in community-dwelling older adults

PURPOSE

Regarding the epidemiology of pain in older adults, data are lacking about the association between pain severity and its impact on health-related quality of life (HRQoL). This study was aimed to investigate pain prevalence and sites, self-reported interferences with daily life activities, and the effect of pain severity on HRQoL in a Swiss community-dwelling population aged ≥ 65 years.

METHODS

This is a cross-sectional survey conducted with a national sample of individuals randomly selected from population records, stratified by age and gender. Respondents answered a face-face interview addressing pain location, intensity and interferences, and quality-of-life variables. Logit regression models were applied for binary outcomes, linear regression for continuous outcomes, and Poisson regression for count outcomes. For each analysis, Wald Chi square and 95% confidence intervals were used.

RESULTS

Among the 2995 individuals considered, 36.4% reported pain. The results indicate that pain prevalence and intensity increased from age 80 onwards. Pain intensity was strongly associated with functional health, i.e., all scales involving physical activities were affected in individuals reporting severe pain; it was also associated with the individuals' perception of their overall HRQoL.

CONCLUSION

Our results point to the importance of devoting attention to pain intensity rather than to the number of pain sites. Because of the demographic transition, the management of pain problems should emphasize early referral and timely treatment to prevent the burden of disease and functional loss associated with pain intensity.

Purposefulness as a critical factor in functioning, disability and health

Guided by theoretical frameworks of health and illness such as the International Classification of Functioning, Disability, and Health (ICF), we seek to describe the importance of purposefulness in the context of rehabilitation. We argue that ascribing meaning to life events, particularly changes in health, and acting in a manner that is driven by purpose is a universal characteristic of human beings. The ability to contextualize purposefulness within the broader biopsychosocial model of illness may provide a greater understanding of the relationship of purpose in the process of rehabilitation.

We support the notion that purposefulness is an ever-present component throughout our lives and it exists as a convergence of personal factors, past experiences, and our personal narrative. Having a sense of purposefulness and being able to understand the meaning of different aspects of our lives is what allows us to find purpose while experiencing a health condition. More importantly, and in the context of rehabilitation efforts, we believe that if purposefulness can be identified or collectively defined by the individual, then rehabilitation outcomes may be enhanced.

In a variety of contexts ranging from disease, aging, severe trauma, and even war, purposefulness and its component elements consistently distinguish themselves as being essential for regaining a sense of direction and facilitating one’s response to any health condition.