The prevalence and management of current daily pain among older home care clients ☆

In this review we identified cohort and cross-sectional studies which assessed pain in community-dwelling older people (> 65 years) reliably characterised as frail. Secondly, we considered biologically plausible mechanisms which may alter pain perception, or contribute to, or exacerbate pain in an older person with frailty. Thirdly, we considered specific implications of pain management for this group of people. From the limited data from the seven included studies, it would appear that the presence of pain is higher in older people with frailty compared to people characterised as pre-frail or not frail. Thus, older people reporting pain are more likely to be frail. However, a lack of prospective data precludes inferences about the direction of the relationship: that is whether pain or frailty is the antecedent. Further research is needed to understand the direction of the relationship, and to identify appropriate pain management strategies for older people with frailty.

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“…Pain is therefore common amongst older people, with prevalence rates of persistent pain in older adults in the community at over 40% 3 .…”

Section: Introductionmentioning

confidence: 99%

Pain in older people with frailty

Brown

Young

Clegg

et al. 2015

Rev. Clin. Gerontol.

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“…Its prevalence ranges from 45% to 80%. In these individuals, the presence of pain is known to be associated with depression, sleep disorders, functional impairment, decreased sociability and greater use of the health system, with consequent increase in costs 4,5 . Improved recognition and clinical management of these conditions could provide substantial improvement in quality of life for older people, as well as reductions in social-economical burdens related to chronic pain.…”

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confidence: 99%

“…The negative impact of pain in AD includes different painful conditions associated with older age, such as osteoarthritis, cancer and trauma. Numerous studies show a higher prevalence of pain in adults with dementia [1][2][3][4][5][6] . Non-treated pain is associated with depression, sleep problems, cognitive decline and greater functional dependence.…”

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confidence: 99%

“…[3] Body movements: rigid, tense body posture, defending an area of the body, shaking a body region. [4] Changes in interpersonal relationships: aggression, fighting, resistance to care, reduced social interactions, social withdrawal, verbal abuse, denying to eat, changes in appetite, increases sleep periods, increased wandering and interruption of previously established routines. [5] Mental status changes: crying, tears, irritability, increased confusion.…”

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confidence: 99%

“…The scale includes the presence of pain, its frequency and intensity, as reported by patients (self-report) and by caregivers for the previous three days. In a recent study using this scale, almost half of the individuals in long-term institutions experienced daily pain and one out of five was not receiving pain relief 4 . The prescription of analgesics was lower in patients with cognitive decline and in those with communication difficulties.…”

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confidence: 99%

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The assessment and management of pain in the demented and non-demented elderly patient

Andrade

Faria

Caramelli

et al. 2011

Arq. Neuro-Psiquiatr.

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Persistent pain is a frequent health problem in the elderly. Its prevalence ranges from 45% to 80%. Chronic diseases, such as depression, cardiovascular disease, cancer and osteoporosis have a higher prevalence in aged individuals and increase the risk of developing chronic pain. The presence of pain is known to be associated with sleep disorders in these patients, as well as functional impairment, decreased sociability and greater use of the health system, with consequent increase in costs. Alzheimer's disease patients seem to have a normal pain discriminative capacity and they may probably have weaker emotional and affective experience of pain when compared to other types of dementia. Many patients have language deficits and thus cannot properly describe its characteristics. In more advanced cases, it becomes even difficult to determine whether pain is present or not. Therefore, the evaluation of these patients should be performed in a systematic way. There are three ways to measure the presence of pain: by direct questioning (self-report), by direct behavioral observation and by interviews with caregivers or informants. In recent years, many pain scales and questionnaires have been published and validated specifically for the elderly population. Some are specific to patients with cognitive decline, allowing pain evaluation to be conducted in a structured and reproducible way. The next step is to determine the type of painful syndrome and discuss the bases of the pharmacological management, the use of multiple medications and the presence of comorbidities demand the use of smaller doses and impose contraindications against some drug classes. A multiprofessional approach is the rule in the management of these patients. Key words: Alzheimer's disease, pain, chronic pain, elderly, cognitive impairment.Avaliação e manejo da dor em pacientes idosos com e sem demência RESUMO Dor persistente é um problema de saúde frequente no idoso e sua prevalência varia de 45 a 80%. Doenças crônicas, como depressão, distúrbios cardiovasculares, câncer e osteoporose tem alta prevalência em indivíduos idosos e aumentam o risco de desenvolver dor crônica. Nestes indivíduos, a presença de dor está associada a distúrbios do sono, prejuízo funcional, diminuição da sociabilidade e maior procura dos serviços de saúde, com o consequente aumento dos custos de saúde. Pacientes com Alzheimer têm uma capacidade discriminativa dolorosa normal e uma experiência afetiva e emocional da dor mais atenuada quando comparados com outros tipos de demência. Muitos pacientes

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Pain assessment for cognitively impaired older adults: Do items of available observer tools reflect pain‐specific responses?

Kappesser

Voit

Lautenbacher

et al. 2020

European Journal of Pain

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Background A number of observational tools are available to assess pain in cognitively impaired older adults, however, none of them can yet be regarded as a “gold standard”. An international research initiative has created a meta‐tool compiling the facial, vocalization and body movement items of the majority of available tools. Objective of this study was to investigate the pain specificity and the validity of these items. Method N = 34 older adults with or without cognitive impairment were videotaped in three different conditions (one reference, two painful conditions) in their nursing homes. They were further asked to self‐report their pain in each condition. The occurrence of non‐verbal behaviours was coded as present or absent using the items of the meta‐tool. Results The majority of non‐verbal behaviours was not pain sensitive as they occurred less than three times across participants and conditions. Of the remaining items, two facial items (“pained expression” and “raising upper lip”), one vocalization item (“using pain‐related words”) and one body movement item (“guarding”) were found to be pain specific and valid. One additional item, the vocalization item “gasping”, was pain specific, but not associated with pain self‐report, and three additional items, the facial items “frowning” and “narrowing eyes” and the vocalization item “mumbling” were correlated with pain self‐report but did not help to separate pain from non‐pain conditions. Conclusions Systematic evaluation of items of existing observational pain assessment tools under naturalistic conditions seems a promising approach in the process of further investigating and improving tools. Significance Only few items stemming from observational pain assessment tools were found to be pain sensitive and specific as well as valid in this study. The investigation of existing tools not only on tool but additionally on item‐level can provide helpful insights and thereby can help to improve the original tools and establish a gold standard for nonverbal pain assessment in older adults with cognitive impairments.

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The prevalence and management of current daily pain among older home care clients ☆

Cited by 102 publications

References 57 publications

Pain in older people with frailty

Pain in older people with frailty

The assessment and management of pain in the demented and non-demented elderly patient

Pain assessment for cognitively impaired older adults: Do items of available observer tools reflect pain‐specific responses?

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