Better Pain Management for Elders in the Intensive Care Unit

Abstract

By 2040, there will be 70 million people older than 65 years in the United States. Approximately 50% have pain on a daily basis, and research shows that their pain is often underdiagnosed and undertreated. Nurses have an obligation to provide state-of-the-art care and advocate for vulnerable older adults in the intensive care unit (ICU). Untreated pain can complicate an ICU stay and delay discharge. This article briefly reviews difficulties in managing pain in ICU patients, suggests creative methods to properly assess pain, and discusses approaches for encouraging elders in ICU to manage their pain effectively.

Assessing pain in verbal older adults

“…If older adult denies pain, a) re-word question and ask if s/he is hurting anywhere 11 and b) ask about specific locations that are suspected/expected to be painful. 12 …”

Intervención interdisciplinaria del paciente con dolor en Unidades de Cuidado Intensivo (UCI): Revisión de tema

“…Sin embargo, este puede potencialmente cronificarse 23 . Como se mencionó previamente, el control inadecuado del dolor agudo es uno de los principales predictores de la cronicidad 24 , así como el afecto negativo que la experiencia dolorosa pueda generar en el paciente crítico 25 pues en dichos casos, este puede inducir o magnificar la hipervigilancia hacia dolor y la activación fisiológica, generando una hipersensibilización ante el dolor 25 .…”

Designing a multidimensional pain assessment tool for critically Ill elderly patients: An agenda for future research

“…Elderly patients make up approximately 50% of admissions to the Intensive Care Units (ICUs)[ 1 ] and considering that most of the procedures in the ICU are painful, most of these patients experience moderate-to-severe pain. [ 2 ] Given that the pain can be treated or at least diminished, its high prevalence in elderly patients may indicate that pain appears to be either underdiagnosed or undertreated in this population. [ 3 ] In this regard, the lack of validated assessment tools has been repeatedly reported to be the reasons of undermanagement of pain.…”

“…[ 4 ] However, selecting and applying a valid and reliable tool for accurate and timely diagnosis of pain in critically ill elderly patients has remained as a challenging issue for clinicians. [ 2 4 ] In addition, the optimal tool for assessing pain in nonverbally critical ill older patients who are ventilator dependent and unconsciousness is understudied. Even, most of the current pain assessment tools are not particularly designed to examine the pain of the ICU elderly patients and are subjected to misinterpretation and poor detection of pain.…”

“…Even, most of the current pain assessment tools are not particularly designed to examine the pain of the ICU elderly patients and are subjected to misinterpretation and poor detection of pain. [ 2 ]…”