Chronic Pain Assessment and Management in the Elderly Nursing Home Resident - Annotated Bibliography Example

Chronic Pain Assessment and Management in the Elderly Nursing Home Resident Brochet B., Philippe M., Gateau P. B. and Dartigues J. F. “Population-Based Study of Pain in Elderly People: A Descriptive Survey”. Medicine: Age and Ageing 27(3):279-284. 1998. In a deliberate attempt to highlight pain in the aged, the issue of how grave and prevalent chronic pain among the general population is (Brochet et al, 282). Establishing how prevalent the condition is important in this study since it implies how the findings would benefit stakeholders in the management of the condition. “The commonest locations were limb joints and back. The prevalence of pain was 44.5% for limb joints, 29.6% for back, 11.6% for neck and 11.3% for limbs (joints expected). The prevalence for persistent pain was 19.04% for limb joints, 12% for back and 10.4% for limbs (joints expected).” Regarding the study, it is apparent that management of pain among the aged is a question of fact as to what pain the patient is suffering from. This is clearly depicted by the variation in areas of pain experiences by the patients. This work highlights specific management approach for nurses. Correct medication and control is therefore made possible. Text in this work can be adopted in the assessment and management of chronic pain in the elderly. Monti D A., and. Kunkel S. E. J., “Practical Geriatrics: Management of Chronic Pain among Elderly Patients”. Psychiatric Services 49(1):1537-1539. 1998. The work by Monti and Kunkel (1538) elaborates not only the use of palliative care in the management of elderly people but also emphasises the importance of pain management. Explanation is given in the fact that pain management alone has been found to be inadequate. Knowledge of chronic pain management upon assessment requires supplementation in the use of the improvements studied. “Inadequate assessment strategies result in inadequate pain management. It is important for the clinician to perform a careful history and physical examination, use appropriate pain assessment instruments, and evaluate the patient for psychiatric co-morbidity”. Persistent pain in the elderly has been found to increase with age raising alarm for their quality of life. Management improvement is aimed at early and proper detection, and timely medication. Improvement of pain assessment in the elderly is a major area of research embarked by geriatric specialists which mainly incorporates advancement of knowledge on detection, pain analysis and the relevant treatment. Pharmacological prescriptions have to target a specific problem since the elderly are prone to drug interaction conditions. Manfredi P. L., Breuer B., Meier D. E. and Libow L., “Pain Assessment in Elderly Patients with Severe Dementia”, Journal of Pain and Symptom Management, 25(1):48-52. 2003. There was a great revelation in the work done by Manfredi et al (49) by virtue of finding out that facial expressions as commonly used in the detection of pain in an individual could not be a reliable in dementia affected old. Conversely, it is hard to ask questions regarding pain perception by a dementia patient who is old. “Based on interviews with patients who could report pain, we defined characteristics of decubitus ulcers associated with reports of pain during dressing changes. We then evaluated 9 patients who had ulcers with these characteristics but were unable to communicate verbally because of severe dementia.” This study finely outlines the need to device pain assessment procedures that take care of aged patients who can not communicate their pain perception. It is expected that pain felt could be expressed by a certain facial expression which is however absent in dementia victims. The relevant pain detection necessitated by such conditions would make sure that suffering would be alleviated in old patients even without a statement from their mouths. Nurses can adopt management practices that enable efficiency in assessment and treatment of chronic painful experiences by their clients. Berger M. P. F., Hamers J. P. H. and Zwakhalen S. M. G., “The Psychometric Quality and Clinical Usefulness of three Pain Assessment Tools for Elderly People with Dementia”, Journal of the International Association for the Study of Pain, 126(1):210-220. 2006. Berger et al (210-220) explained the major pain detection tools that could assess pain in patients with severe dementia, a condition that renders victims speechless and unable to express feelings such as pain. Pain is an important parameter in old patient’s management and made complex if they can not speak out their feelings. “In view of the need for valid, reliable, and clinically useful scales to assess pain in elderly people with dementia, this study evaluated the psychometric properties of translated versions of the PAINAD, PACSLAC, and DOLOPLUS-2 scales”. The said versions of pain detectors were used and the sensitivity thereon analysed to raise the chances of detection in management of pain. A pain scale can therefore be created using the results of these tools which will act as an important step towards the detection of pain. Apparently, this study comes closer in unravelling the research question on the relevant knowledge useful in the assessment and management of pain in the elderly, who suffer from chronic conditions such as dementia. Gaqliese L. and Melzack R., “Chronic Pain in elderly People”, Journal of the International Association for the Study of Pain 70:13-14. 1997. As general rule, there is rampant pain among the aged as age progresses due to biological loss of function for the body system. Absence of proper assessment as well as management capacity poses the aged to untold suffering. “Three significant factors which may contribute to this are (1) lack of proper pain assessment; (2) potential risks of pharmacotherapy in the elderly; and (3) misconceptions regarding both the efficacy of non-pharmacological pain management strategies”. A direct relationship can be made to the inadequacy of pain assessment and management procedures and suffering among the aged. Reviews of these patterns give insights to adoption of batter practices in the care given to the elderly. The elderly require expertise in the manner in which their day to day life is handled or else the most disturbing aspects remain ignorantly unhandled. Bercedis P.,  Keefecf F. and  Weinerabcd D., “Chronic Pain-Associated Behaviors in the Nursing Home: Resident versus Caregiver Perceptions”, Journal of the International Association for the Study of Pain, 80.3:577-588. 1999. Cognitive impairment in the elderly is huge challenge for care givers and nurses. This is a relevant finding towards establishing knowledge on assessment and management of pain in elderly people. “Pain assessment in nursing home residents poses challenges since many of these individuals are too cognitively impaired to respond to traditional self-report instruments. Assessment of pain behavior in this population offers a logical alternative”. It is imperative that in any assessment that solutions are directed to the core areas of the study. This work outlines the importance of this argument. Nurses should learn the specific behaviours attributed to pain and discomfort. A friendly treatment lowers tension and instances of pain. Bostonf J. R., Liebera S. J., Jill S., Rudyabc T. E. and Weinerabd D. K., “The Impact of Chronic Low Back Pain on Older Adults: A Comparative Study of patients and controls”. Journal of the International Association for the Study of Pain, 131.3:293-301. 2007. One type of a specific pain that disturbs the elderly is chronic low back pain. It may disable the elderly and assessment should be perfected to ensure disability is avoided. “Many older adults remain quite functional despite CLBP, and because age-related co-morbidities often exist independently of pain (e.g., medical illnesses, sleep disturbance, mobility difficulty), the unique impact of CLBP is unknown”. Cognitive ability has to be present to perform the test. The occurrence of this condition should be managed with caution. Riley J. L. , Gilbert G. H. and Heft M. W., “Health Care Utilization by Older Adults in Response to Painful Oro-facial Symptoms”, 81.1:67-75. 1999. Specific signs that can be relied for the detection of response to available medication were studied. Intensive pain is likely to push an elderly patience to seek medication. “Some pain intensity threshold may exist at which health care seeking behaviour is initiated. The overall number of visits was not predicted by pain intensity but by other qualities more associated with time or level of dysfunction caused by the symptom”. Sufficient knowledge that elderly patients may remain with pain until when it compels them should be used in assessment and management of the elderly. Tarzian Top of Form J. A, and Hoffmann D. E., “Barriers to Managing Pain in the Nursing Home: Findings from a State-wide Survey”, Journal of the American Medical Directors Association 5.2:82-88. 2004. There exist some hindrances to the manner in which pain management of the elderly is exercised. Personal attitudes by both the nurses and patients alike should be approached for improvement of assessments and management. “Perceived barriers to providing adequate pain management included lack of knowledge about pain management among nurses and physicians, lack of a standardized approach to treating pain, physicians’ personal attitudes toward treating pain...” Directors of nurses responded well to questions of improvement of assessments and pain management. However, personal factors such as negative attitude are a barrier to efficiency. Holleran E. A., Mezey M., Mia K. and Molony S. L., “Assessing Pain as a Fifth Vital Sign in Long-Term Care Facilities: Recommendations from the Field”, Journal of Gerontological Nursing 31.3. 2005. Assessment of pain is a key item in the long term care facilities, an example being those for the aged. It is vital that in the management of any such facility, pain gets considerable attention. “Findings are presented in terms of recommendations related to pain criteria, assessment methods, frequency of pain assessment, and responsibility for pain assessment, monitoring strategies, education, documentation, and pain management education...” Knowledge towards proper management cannot be complete without the underlying issues being solved. Bottom of Form Read More