Objective: The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people. Design: Review of evidence since 2010 using a systematic and consensus approach is performed. Results: Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines. Conclusion: Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions.
A retirement village consists of a collection of privately owned or leased flats or maisonettes for elderly adults that are supported by a central hub that provides catering, medical care and social activities. There have been studies of the psychological experience and impacts of such environments, however, there is lack of research that links the retirement village experience to overarching theories of eudaimonic wellbeing, and that uses qualitative methods to find out Wellbeing in retirement villages: Eudaimonic challenges and opportunitiesThe landscape of supported accommodation for the elderly in the UK has changed radically over the past two decades. One of the forms of residence that has increased in prevalence over this time is the 'retirement village' model (Grant, 2007). In a retirement village, elderly residents either own or rent a self-contained apartment or maisonette within a larger community that contains facilities such as dining, leisure and care services. A monthly or annual fee is paid to the community provider for access to these services (Robinson, 2012).In 2009, the BBC published a report that suggested that 25,000 older adults lived in a retirement village on that date 1 , and that number is likely to have increased markedly since then, as villages continue to be built all over the country. The lower age limit for entry into a retirement village is typically set at 55 or 60, but the average age is around 80 (Evans, 2009).Retirement villages are a relatively new social milieu that are likely to be different in their effects on wellbeing and identity, compared with more traditional forms of elderly care environment, due to the greater emphasis on autonomy and on an absence of reference to being a 'care' home. The current study aims to explore how living in a retirement village within the UK is personally experienced by residents as impacting positively and negatively on eudaimonic wellbeing, using Ryff's taxonomic model of wellbeing as an orientating framework. Eudaimonic wellbeingWellbeing is a complex construct that has been operationalized in different ways by psychologists and sociologists. Broadly, these different definitions can be categorized as and satisfaction, and in psychology this has been operationalized in the construct of 'subjective wellbeing' (SWB) (Bauer & Park, 2010). SWB contains the emotional dimensions of happiness, the balance between positive/negative affect, and the cognitive dimension of life-satisfaction (Daatland, 2005). In contrast, eudaimonic wellbeing originates in Aristotelian philosophy and is concerned with optimal experience and functioning in a broader sense than the hedonic type, including positive relationships, a sense of purpose, meaning, and a feeling of growth, as well as the hedonic cognitive-affective appraisals of happiness and satisfaction. In psychology, the eudaimonic conceptualization has been operationalized in psychological wellbeing (PWB), by Ryff (1989). Hahn and Oishi (2006) found that older adults who were asked to recall the "...
Under-assessment and inadequate treatment of pain is a common problem for older adults, particularly those with dementia. This may be in part attributed to knowledge deficits and negative attitudes among healthcare staff and informal caregivers towards pain, its assessment and its management in dementia. Knowledge and attitudes have a significant predictive relationship with behavior, potentially impacting pain assessment and management practices. Despite this there remains a paucity of research in the area and a lack of clarity about existing knowledge levels and attitudes among dementia caregivers. Therefore, the aims of this review were to: identify what knowledge deficits and attitudinal barriers exist amongst dementia caregivers; and identify the scales available to measure these. A search was carried out in the following electronic databases: Academic Search Premier; CINAHL; Education Research Complete; Humanities International Journals; Psychology and Behavioral Sciences Collection; PsychINFO; PsychArticles; Teacher Reference Center; and MEDLINE. A total of 13 articles met the inclusion criteria. A number of knowledge deficits and negative attitudes were identified, particularly in the use self-reports and pain assessment tools in dementia, and the safety of opioids. Understanding and positive attitudes were demonstrated in some areas, such as non-narcotic pain medications and identifying behavioral pain indicators. Of the 4 scales identified, positive results were found for internal consistency and content validity, however further refinement and testing is necessary. It was concluded attitudinal and knowledge barriers exist which should be addressed given their influence over practice behavior, however, there is a willingness and knowledge base from which progress can build.
Psychosocial oncology is coming of age [...]
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