Background Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults. Methods The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI<2), mild (BPI 2–3.99), and moderate to severe (BPI 4–10). Medications taken in the previous 2 weeks were recorded from medication bottles in the home interview. Results Half of participants reported using analgesic medications in the previous 2 weeks. Older adults with moderate to severe pain were more likely to use one or more analgesic medications daily than those with very mild pain (49% versus 11%, respectively). The most commonly used analgesic was acetaminophen (28%). Opioid analgesics were used daily by 5% of participants. Adjusted for health and demographic factors, pain severity was strongly associated with daily analgesic use (moderate-severe pain compared to very mild pain, adj. OR=7.19, 95% CI 4.02–12.9). Nearly one-third of participants (30%) with moderate to severe pain felt they needed a stronger pain medication while 16% of this group were concerned they were using too much pain medication. Conclusion Serious gaps persist in pain management particularly for older adults with the most severe chronic pain. Greater efforts are needed to understand barriers to effective pain management and self-management in the older population.

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Chronic pain is a significant problem for older adults. The effect of chronic pain on older people’s quality of life needs to be described and identified. For a decade, the Roy Adaptation Model has been used extensively to explain nursing phenomena and guide nursing research in several settings with several populations. The objective of this study was to use the Roy Adaptation Model to describe chronic pain and present a systematic scoping review of the literature about the middle-range theory of chronic pain among older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses model guided a scoping review search method. A literature search was undertaken using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Ovid, and ProQuest. The search terms were “chronic pain,” “pain management,” “older adult,” “Roy Adaptation Model,” and “a scope review.” The search included articles written in English published for the period of 2004–2017. All articles were synthesized using concepts of Roy’s Adaptation Model. Twenty-two studies were considered for the present review. Twenty-one articles were reports of quantitative studies, and one was a report of a qualitative study. Two outcome measures were found in this systematic scoping review. The primary outcomes reported in all articles were the reduction of pain due to interventions and an increase in coping with chronic pain. The secondary outcome measures reported in all studies were the improvement of physical function, quality of life, sleep disturbance, spiritual well-being, and psychological health related to pain management interventions among older adults. Many interventions of all studies reported improvement in chronic pain management among older adults. However, to improve chronic pain management, nurses need to understand about nursing theories, the context which instruments work, and develop empirical instruments based on the conceptual model.

Background Continuous electronic fetal monitoring (CEFM) is a standard of hospital care during the intrapartum period. We investigated its use on childbirth outcomes in low‐risk pregnancies, and examined whether outcomes differed by gestational age within a term pregnancy. Methods A retrospective secondary data analysis using birth registry data from two diverse northeastern US states from 1992 to 2014. Chi‐square test and the Fisher exact tests were used to examine associations between CEFM and childbirth outcomes. Multivariable Poisson regression models were used to estimate risk ratios of childbirth outcomes related to CEFM use, adjusting for potential confounders. Results Use of CEFM was independently associated with a 10% (State 1) and 40% (State 2) increased risk for primary cesarean delivery and an increased risk for assisted vaginal births (14% and 24%, respectively) after adjustment for confounders. CEFM use was not associated with reduced risk for infant mortality (neonatal mortality, 0‐27 days, and post‐neonatal mortality, 28‐364 days) in term births (37‐41 weeks’ gestation). After stratifying term pregnancies into early term, full term, and late term, use of CEFM was associated with reduced risk for neonatal mortality in early‐term births (37 0/7 weeks’ to 38 6/7 weeks’ gestation) in State 2 (RR 0.44 [95% CI 0.21‐0.92]), but not in State 1. There was no association between CEFM use and infant mortality (neonatal and post‐neonatal) in full‐term or late‐term births. Conclusions The study results do not support universal use of CEFM in pregnancies that are low‐risk and at term.