|Wednesday, 20 February 2008 23:46 | Print page:|
The Australian Society for Geriatric Medicine [Position Statement No. 10 - Point 1] states:
"Australia is at the forefront of international research and practice in virtually every field of health care, except residential aged care.
The above statement is sad, but true. I am fortunate that I am still at an age when I can detail my pain episode experiences, and find there are remedies available. Many of our elders are not as fortunate.
Growing old gracefully is one thing. Doing it pain free is far more important!
Too Many Seniors Suffer Needlessly from Untreated Pain
Senior citizens are undertreated for pain far more often than younger patients. According to various studies conducted (America), 40% to 80% of elderly nursing home residents suffer needlessly due to inadequate pain treatment ( Cancer Pain Release; World Health Organization; Facts on Dying, Brown University).
Pain in elderly patients is not always assessed properly, and may be under-reported. Too frequently elderly patients do not report their pain because they fear retaliation, the possibility of addiction, or loss of respect. They may be stoical or believe that pain is a natural part of ageing.
Formal pain assessment should be routine. Such formal assessment can be carried out with a very simple assessment tool that evaluates pain intensity, quality, location, and duration. However, formal pain assessments may not be sufficient for those with speech, hearing or cognitive deficits or who fear reporting pain. Close observations of behaviour may reveal expressions, movements, and activities indicative of pain.
Some health care professionals erroneously believe that the elderly are less sensitive to pain, or give weak doses of pain medications for fear that older patients will not tolerate opioids. They may equate pain management with addiction, or various other avenues of fear authority based.
Pain Management and Monitoring
Sometimes the elderly are not able to speak about their pain. This may be further complicated with illness or injuries like dementia, brain damage, or a stroke. This makes it very hard for caregivers and family to recognise the existence of pain.
Monitoring the use of analgesics and other pain medication is time consuming. In nursing homes, pain management may be limited if staffing is inadequate. Also, some nursing homes are unwilling to stock restricted drugs that may be useful in the treatment of pain.
Diagnosing a senior’s pain may be difficult. Although grimacing, restlessness, moaning, and agitation may often indicate pain, they are not definitive signs of pain.
The under-treatment of pain has been considered neglect, negligence, or even elder abuse. If you are concerned about the under-treatment of your elderly relative’s pain, talk to his or her physician and nursing team. Also keep records of the problem.
Prevalence of Pain in the Elderly
Pain is reported to be twice as prevalent in the elderly as in younger individuals (Crook et al., 1984). In community-dwelling elders, the prevalence of pain ranges from 25-50% (Mobily et al., 1994). In the long-term care setting, prevalence can be as high as 85% (Stein et al., 1996).
According to the American Geriatrics Society (AGS) Panel on Chronic Pain in Older Persons (1998), chronic pain in the long-term care setting is generally under-recognised and under-treated.
Treatment of chronic non-cancer pain among those with non-terminal illness especially, has been neglected. Teno et al., in their study “The Prevalence and Treatment of Pain in US Nursing Homes,” found that pain is a common condition in nursing homes, and that nearly one sixth of all nursing home residents were reported to be in daily pain. For residents with cancer, slightly more than one in five was in daily pain.
More problematic was the fact that:
There are several specific reasons rooted in the nature of pain and societal attitudes toward it. Pain is subjective and lacks objective biological markers.
Pain - Common Misconceptions
Some of the common misconceptions about chronic pain in elderly people include:
The most accurate and reliable evidence of the existence of pain and its intensity is the residents’ self-report. Elderly people often describe discomfort, hurting, or aching, rather than use the specific word “pain.”
Unrelieved chronic pain is not an inevitable consequence of ageing: The presence of pain is always abnormal. Certain conditions that cause chronic pain are more common in the elderly. Some of these conditions include: joint disease, osteoporosis, neuropathic pain, peripheral vascular disease, immobility, and amputations. It is important to not only treat symptoms of pain, but to also understand the underlying foundation of pain.
Describing your Pain
Caregivers want you to talk to them about your pain. This helps them learn what may be causing the pain and how best to treat it. You need to tell caregivers if you have trouble hearing their questions or seeing things. Caregivers can use special tools and ways to help you better understand their questions about your pain.
When you see your caregiver, he/she will ask you to answer the following questions.
What if I cannot talk?
Sometimes you may not be able to speak about your pain. You may have illness or injuries like dementia, brain damage, or a stroke. This makes it very hard for your caregivers and family to know you are in pain. Your family may help caregivers understand your pain by watching for physical signs of pain. When you have had pain for awhile you may also adapt or get used to the pain. This means you may act normal or opposite of how your family thinks you should act even though you are having very bad pain.
Following are some signs that your family can watch for that may tell them you are in pain: