Pain Management in Older Adults PDF

OBJECTIVE 8: PAIN & OLDER ADULTS REQUIRED READINGS: CH 16 PAIN Known as the 6th vital sign • Requires comprehensive history/physical assessments Considered one of the most common feelings / symptoms experienced by older adults. Opposite of ‘comfort’. A sensation of distress. A multidimensional ph...

OBJECTIVE 8: PAIN & OLDER ADULTS REQUIRED READINGS: CH 16 PAIN Known as the 6th vital sign • Requires comprehensive history/physical assessments Considered one of the most common feelings / symptoms experienced by older adults. Opposite of ‘comfort’. A sensation of distress. A multidimensional phenomenon as it occurs at a physical, psychological & spiritual level. Without a level of comfort wellness is difficult to achieve. CONSEQUENCES OF UNRELIEVED PAIN Physiological & psychological dimensions- may be affected. Can lead to decreased activity & immobility. May lead to experimentation with multiple self directed and ineffective interventions. May result in reduced socialization / isolation. Can lead to depression / examining meaning in one’s life. ACUTE VS. CHRONIC PAIN Acute • Temporary pain includes pain that is experienced post-op, during a procedure, due to trauma (accident), or an exacerbation of a chronic illness. • Acute psychological & spiritual pain – e.g. early stages of grieving or in depression. Chronic • As health problems increase and age increases so does risk for chronic pain • Not time limited, ongoing. • May vary in intensity & change with activity. • Can be physical, psychological & spiritual. • Can significantly affect a person’s ability to function & quality of life. OTHER TYPES OF PAIN Physical Psychological Spiritual *Pain is often the most common & most feared symptom of people at the end of life, which is same across the lifespan MYTHS ABOUT AGING & PAIN Pain is expected with aging. Pain sensitivity & perception decreases with aging. If older adults do not complain of pain, they are not in pain. People with dementia or cognitive impairment do not feel pain. Narcotic use in older adults is not appropriate / dangerous. FACTS ABOUT PAIN & OLDER ADULTS Pain is NOT a normal part of aging – although occurrence does increase with age Analgesics are safe to use May have increased tolerance to pain Often under report pain Have a variety of reactions to pain HOW PAIN IS EXPRESSED IN OLDER ADULTS Influenced by history, culture & meaning it has for the individual. Not uncommon to express psychological & spiritual pain as somatic complaints. Difficult to assess pain in a person with dementia, aphasia, hearing loss, depression. ASSESSING PAIN: CHALLENGES Cognitively impaired older adults • Often have difficulty expressing pain. • Often have difficulty in responding to questions asked in a health assessment. • Often difficult for a care provider to discern between vocalizations that are characteristic of dementia vs. vocalizations that are characteristic of pain cues in older adults. • Careful observation of behavior & caregiver reports need to be considered if a person cannot reliably communicate pain. Other factors • Individual’s personality / variation of expressions. • Nurse’s own bias & beliefs about pain & how it should be treated (can affect assessment & treatment). ASSESSMENT OF PAIN Function: • How is it affecting function, Activities of Daily Living (ADLs)? Expression of pain: • Behavior cues, non-verbal? (*Facial grimacing is common). Social support: • Resources available to help cope? Affecting roles & relationships? Pain History: • How has it been managed in the past? Cultural factors that may impact meaning, accepting Rx, expression. PAIN INVENTORY TOOLS • BRIEF PAIN INVENTORY / PAIN ASSESSMENT TOOLS. • VISUAL ANALOGUE SCALES. • CHARTS WITH NUMERICAL POINTS ASSIGNED FOR GRADES OR INTENSITY OF PAIN (1-10). PAIN CONTROL STRATEGIES: PHARMACOLOGICAL Non-Narcotic Meds: mild – moderate pain. • 1. Acetaminophen, Tylenol (first line). • 2. Anti-inflammatory drugs: e.g. ibuprofen (Advil), Indocid. Adverse effects: GI irritation, potential GI bleed, assess risk. Narcotic Analgesics: Acute & persistent pain (moderate to severe), e.g. morphine. • *Opioids used cautiously in older adults. Adverse Effects: gait disturbances, dizziness, hypotension, sedation, falls, nausea, pruritis & constipation. PAIN CONTROL STRATEGIES: NONPHARMACOLOGICAL Physical therapy Hypnosis Biofeedback Massage Distraction Imagery Acupuncture Heat vs Cold packs PAIN MANAGEMENT • A COMBINATION OF BOTH PHARMACOLOGICAL & NONPHARMACOLOGICAL MEASURES IS THE MOST EFFECTIVE FOR RELIEVING PAIN. • GOAL OF PAIN MANAGEMENT: • PROMOTE COMFORT AND MAINTAIN THE GREATEST LEVEL OF FUNCTION. Pharmacological Interventions: • older adults are more at risk for adverse drug effects. CONSIDERATIONS Non-pharmacological Interventions: • requires time & interaction with a careprovider, must become a routine rather than a ‘one-time’ intervention. • Often requires that the person is cognitively intact. • Can be expensive without insurances The client is the best judge of pain. Medication administration should be based on ongoing assessments. PAIN MANAGEMENT CONSIDERATIONS No individual should be left with unmanaged pain. Encourage ‘Pain’ management workshops / programs for chronic pain management. Assess for adverse effects of analgesics & anticipate drug interactions. Listen to client; encourage expression of pain; may need to get ‘surrogate report’ (from family / friends). Never minimize pain. ADDITIONAL BARRIERS TO PAIN MANAGEMENT Cost of medications/interventions Fear of addiction to analgesics Pain is viewed as a normal burden of ‘old age’, older adults are expected to ‘learn to live with it’ Hospitalized Client / LTC : EVALUATION • Observe for behaviours before & after administration of pain medication, document. Ask client direct questions about pain relief? • Explore all comfort measures. Recommendations for Community Client: • Keep a journal & record: What causes the pain? How he/she feels after taking pain medication? What makes it worse or better? Any adverse effects? What else helps to relieve pain?