Are you in a world of pain? Well, you are not alone. Pain is a common complaint of the elderly. As the number of individuals older than 65 years continues to rise, chronic diseases associated with pain will likely increase. Healthcare professionals will face a significant challenge in pain management in older people.
How people express their pain is a major factor in how healthcare professionals diagnose and treat various injuries and illnesses. But what if the elderly can’t clearly express what hurts and doesn’t hurt? They are often either untreated or undertreated for pain. Reasons for this include the belief that pain a normal part of aging, misconceptions about addiction to pain medications, and a lack of routing socialization, sleep disturbance, as well as increased healthcare utilization and costs. This set of factors can decrease the quality of life through unsuccessful treatments. It can cause a reduction in the functional performance and physical capacity of elderly people in carrying out daily, leisure or occupational activities, with their families or in society.
Some old people believe that the inability to deal with pain is a sign of being soft or weak. Older adults were more likely than their younger counterparts to express such “stoicism” (the individual remains competent and independent, although it can act as a barrier to effective pain management.) Stoicism increases with age, with older adults being less likely than younger adults to report their pain symptoms. It is possible that older adults were raised in a society that stressed the importance of stoicism, leaving them less likely to complain about minor aches and pains. Statements like, “I maintain my pride and go on as if nothing had happened,” and “pain is something that should be ignored”.
Identifying and measuring pain begins with self-report. Providing older adults with more time in consultation aids communication and may be enhanced by using simple assessment tools.Engagement with self-management and coping with pain should be an essential aspect of any pain management service. This can be challenging in a population with sensory deficits and disparities in cognition, literacy, and language.
Simply worded questions and tools, which can be easily understood, are the most effective. Pain management requires an interdisciplinary approach. Education and training of staff to recognize pain and to act on their findings are paramount to pain management. Documentation of pain assessment and the effect of interventions are essential to allow communication among healthcare professionals about the current status of the patient’s pain and responses to the plan of care.
The most common self-report assessment tools for pain include:
- Multidimensional Pain Inventory
- McGill Pain Questionnaire
- Pain rating index, BPI (Brief Pain Inventory)
- InterRAI (collaborative network of researchers) LTCF
- The Standardized Evaluation of Pain (StEP)
- Oswestry Disability Index (ODI) and items from Short Form 36
The self-report assessment tools for mood most commonly used are:
- Geriatric Depression Scale
- The Center for Epidemiological Studies-Depression (CES-D)
- Depression Rating Scale (DRS)
- Depression, Anxiety, Stress Scale (DASS)
- Hospital Anxiety & Depression Scale (HADS)
- The Diagnos-Techs Adrenal Stress Index
- The Cambridge Examination for Mental Disorders of Older People (CAMDEX)
- Persistent Vegetative State, and selected items from K6, Minimum Data Set (MDS), SF-36).
The guideline developed by the British Pain Society and British Geriatrics Society summarized the pain assessment tools that have been validated for use in older adult populations. Recommendations are made for use of specific tools in older people and in those with dementia. Gaps in the evidence are identified as subjects for future research. There is a need for more research into pain and aging and it is hoped that the guideline will improve recognition of pain in older people and help to drive future research studies.
Schofield P. and Abdulla A. Pain Assessment in the Older Population: What the Literature Says. Age and Ageing. May 2018.