Management of pain in older people within the nursing home: a preliminary study

Abstract

The provision of continuing care for older people has largely shifted from the hospital setting to the community, and nursing homes increasingly provide support for older people, many of whom exhibit multiple pathology and complex health and social care needs. However, the quality of pain management within this setting has been identified as an issue of concern. It has been estimated that approximately two-thirds of people aged 65 years and over experience chronic pain, and that the prevalence of chronic pain in nursing home residents is between 45% and 80%. However, there exist a number of barriers to the identification and management of chronic pain among older people resident in nursing homes, including sensory impairments in older people themselves and educational deficits among professionals. Such barriers need to be overcome if pain management is to be improved. The present study involved administering a pre-piloted postal questionnaire to the managers of 121 nursing homes within a geographically defined area. Sixty-eight (56%) were completed and returned. The questionnaire broadly covered the following: prevalence of chronic pain and use of interventions; assessment and management strategies; education and training; and communication barriers. Overall, 37% of nursing home residents were identified as experiencing chronic non-malignant pain (pain lasting longer than 3 months not caused by cancer) and 2% were reported as experiencing chronic malignant pain (pain lasting for more than 3 months caused by cancer). Paracetamol was identified as the most 'often' used analgesia for both pain modalities. Sixty-nine per cent of nursing homes did not have a written policy regarding pain management and 75% did not use a standardised pain assessment tool. Forty-four per cent of nursing homes provided education or training sessions for qualified staff and 34% provided this for care assistants. Forty per cent of qualified staff and 85% of care assistants had no specialist knowledge regarding the management of pain in older people. The present study confirms the need for the development of effective pain management strategies underpinned by appropriate training and education in order to meet the particular needs of older people.

Assessment of pain in adults with cognitive impairment: A review of the tools

“…Figures for the USA suggest between 37-47% (Ferrell et al 1990, Horgas & Tsai 1998, Parmalee et al 1993. Similar figures have been reported by investigators within the UK (Allcock et al 2002, Schofield 2005. As there appears to be around 50% of the care home population that are cognitively impaired it is quite worrying that they could be neglected within the literature as they are potentially unable to articulate their pain and this could suggest the potential for poor pain control, or pain control that is not tailored to their specific needs.…”

Dying in a rural residential aged care facility: An action research and reflection project to improve end‐of‐life care to residents with a non‐malignant disease

“…(2007) views pain assessment as integral to the development of an optimal pain management plan. Standardised assessment tools are used to improve the identification and assessment of pain (Allcock, McGarry & Elkan, 2002).…”

“…However, the failure of organisations to provide standardised pain assessment tools was identified in a study of 65 nursing homes in the United States, where it was found that 75% of those nursing homes did not use a standardised pain assessment tool (Allcock et al, 2002).…”

“…The contribution of poor or lack of communication between senior staff and those who deliver the direct care, has been shown to contribute to failures in pain assessment and identification (Allcock, McGarry & Elkan, 2002). A group education session in Facility Two revealed other reasons why pain was not assessed, including the staff being too busy, or not educated and that the RN would not give pain medication and the lack of a pain medication order.…”

The prevalence, impact and management of musculoskeletal disorders in older people living in care homes: a systematic review

“…For all these reasons, musculoskeletal disorders may be regarded as low priority complaints, resulting in less attention to assessment and management by carers and clinicians [7]. Adding to these challenges, assessing pain and the symptoms of musculoskeletal disorders can be difficult in the older population, complicated by cognitive decline, co-morbidities and environmental barriers which people can have in accessing healthcare services [11,12].…”