Pain Assessment In Older Adults: A Case Study

Psychological factors are known to contribute to how people experience and cope with pain. However, as people age, they experience normative age-related changes in psychological functioning. Thus, much of what is known about psychology and pain may not necessarily apply to older adults, unless it has specifically been tested in older populations. This is a particularly important point, because pain remains a major problem for millions of older adults. Furthermore, it is expected that the populations of older adults in America will increase significantly in the coming years, as people are living longer now that at any other point in history. Given that psychology changes across the lifespan, and that pain is a problem in older populations, this

5. Zwakhalen, S., Hof, C., & Hamers, J. (2012). Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. Journal Of Clinical Nursing, 21(21/22), 3009-3017. doi:10.1111/j.1365-2702.2012.04313.x

Pain can be categorized as acute or chronic pain. Chronic pain is described as pain that is both long-term and continuous, or is pain that persists after the expected healing time following an injury (British Pain Society, n.d.) Acute pain can provide a warning signal that an illness or injury has occurred. It is defined as pain that lasts less than three months and lessens with healing (Briggs, 2010). Acute pain can then be described in more detail by the following categories; somatic, visceral and neuropathic pain. Somatic pain is a localized pain described as sharp, burning, dull, aching or cramping. It is seen with incisional pain and orthopedic injuries or procedures. Visceral pain refers to an injury to the organs and linings of the body cavities. It produces diffuse pain and can be described as splitting, sharp or stabbing. This is pain that be described from patients with appendicitis, pancreatitis or intestinal injuries and illnesses. Injuries to the nerve fibers, spinal cord and central nervous system cause neuropathic pain. This pain can be described as shooting, burning, fiery, sharp, and as a painful numbness. This can be seen after an

As with all older adults, clients with dementia present with chronic conditions such as arthritis and acute pain experienced in the aging and the end of life process. Moss (2002) gives evidence that most elderly clients who move into long-term care will die in an institution either a nursing home or a hospital many of whom will have dementia. She states that 91% have a strong co morbid condition likely to cause pain.

Dealing with aging dementia patients can be a challenge in and of itself. However, when healthcare providers need to include regulating pain as well, the challenge becomes even greater. Pain management with cognitively impaired patients is a constant problem within geriatric care in modern healthcare facilities (Zwakhalen et al 2006). The reduced self capacity to report pain in its true degrees then makes pain management a challenge for physicians and healthcare providers (Husebo et al. 2007). Thus, research aims to explore effective measures for observing and reporting pain management within aging dementia patients.

The ratings for this scale vary from no pain, a zero, to the worst pain one could possibly endure, a ten ('Misha' Backonja & Farrar, 2015).  This type of tool used for measuring pain is considered a self-assessment.  Meaning, the individual rates his/her pain on the provided scale.  All individuals who have received medical treatment, whether for a serious injury or a yearly physical, has been asked, “What would you rate your pain today, on a scale of one to ten?”.  This pain assessment tool is considered a fully ordered variable due to the individual having a wide range to rate his/her

Patients are surveyed about their recent experience and are asked about the quality of care, communication and timeliness. For example, there are condition categories that the CMS focuses on, such as Emergency department care. The CMS survey will measure the average time that emergency patients had to wait before being seen or receiving pain medication. The CMS report also provides statistics related to how likely patients will experience complications, readmissions and death. For example, hip or knee patients often experience complications after surgery. In addition to this, the CMS survey also monitors the use of medical imaging, such as MRIs and CTs, and how the patient payments match patient

Aim/ purpose of study: Conglomeration of current data on pain and pain management for patients with dementia.

In order to identify and prevent persistent pain in elderly population with dementia, Monacelly et al. (2013) conducted a study in a nursing home in Italy by using Doloplus-2 pain assessment tool. The participants were patients (n=23) with moderate to severe dementia and were unable to express the feeling of pain. Researchers obtained consent from the management and designated legal guardians of the patients. The purpose of the study was to observe the pain symptoms of the same group of elderly population for a period of one year and evaluate the effectiveness of the pain management by using the Doloplus-2 diagnostic pain assessment tool. As an initial part of the study, presence of pain was confirmed in participated patients by using the Doloplus-2

‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ (International association for the study of pain 2014). Pain can be made up of complex and subjective experiences. The experience of pain is highly personal and private, and can not be directly observed or measured from one person to the next (Mac Lellan 2006). According to the agency for health care policy and research 1992, an individuals self-report of pain is the most reliable indicator of its presence. This is also supported by Mc Caffery’s definition in 1972, when he said ‘Pain is whatever the experiencing patient says it is, existing whenever he says it does’.

Managing pain – To determine if Mr Dwight’s pain is well managed, 0-10 numerical pain rating scale with measure of patient pain satisfaction is advised (Phillips, Gift, Gelot, Duong, & Tapp, 2013, p.684). If Mr Dwight reported a lower numerical pain score after implementing interventions for his pain and reports being satisfied then that would support that the goal of managing his pain is achieved.

According to American Geriatric Society (2002), chronic pain often associates with older adult. In United States, most of the older adults are suffering from pain in the absence of disease which is clearly not a normal part of aging (Bell et al. 2004). The common chronic pain in older adult is fibromyalgia, gout, neuropathy such as diabetic neuropathy, osteoarthritis and many more (Hiemenz and White 2002). It is estimated that 30% to 50% of older adult has multiple disease and its interaction with body physiologic changes may results in decreased in ability to respond stressors. Chronic pain among older adult has been associated with negative perception that it will lead to impaired in psychological functioning (American Geriatric Society 2002).

These measurements provide feedback of a patient’s experience with the care offered at a given hospital. These measurements assess a wide range of factors including interpersonal aspects of care, clarity of - and ease of access to - information provided by the physician, speed of medical staff’s response to the patient’s urgent care needs, among other factors. These measurements are used by patients in their subjective evaluation during their process of choosing a hospital for emergency care or

Pain cannot be measured by anyone other than the patient that is having the experience. This is why pain is sometime not understood and misevaluated by healthcare workers. Pain is measured by the Visual analog scale (VAS) of 1-10. One being the least amount of pain and ten being the worst possible. This test is done every four hours and reviewed 30 minutes after a medication administration for pain control. This non-invasive test gives the healthcare worker a measurable idea of the intensity of the pain the patient is experiencing. This also gives the health care worker a perceptive of how well the patient responds to pain after medication administration. Pain is not always seen it can be an eternal feeling.

The most common reason that people seek medical care is pain, and pain is the leading cause of disability (Peterson & Bredow, 2013, p. 51; National Institute of Health, 2010). Pain is such an important topic in healthcare that the United States congress “identified 2000 to 2010 as the Decade of Pain Control and Research” (Brunner L. S., et al., 2010, p. 231). Unfortunatelly, patients are reporting a small increase in satisfaction with the pain management while in the hospital (Bernhofer, 2011). Pain assessment and treatment can be complex since nurses do not have a tool to quantify it. Pain is considered the fifth vital sign, however, we do not have numbers to guide our interventions. Pain is a subjective expirience that cannot be shared easily. Since nurses spend more time with patients in pain than any other healthcare provider, nurses must have a clear understanding of the concept of pain (Brunner, et al., 2010). Concept analysis’ main objective is to clarify ideas, to enhance critical thinking, and to promote communication (Rodgers & Knafl, 2000). This paper will examine the concept of pain using Wilson’s Steps of Concept Analysis (Rodgers & Knafl, 2000).