In our ongoing effort to meet both mandates of “Connections”,informing readers about RGP services and promoting wellness by providing information on matters relevant to aging and health, following is an article by Deanna Kerr, R

In our ongoing effort to meet both mandates of “Connections”,informing readers about RGP services and promoting wellness by providing information on matters relevant to aging and health, following is an article by Deanna Kerr, R.N., Geriatric Outreach Assessment Team.

PAIN IN THE OLDER PERSON

Can you imagine being 90 years old swimming in a pool for the first time in your life? This scenario is the result of the many exciting new developments in the recognition and treatment of pain in geriatric patients. The perspective of health professionals on pain and its treatment has evolved. This new perspective recognizes that older persons feel and experience pain like people of any age and are entitled to seek methods of relieving pain.

Pain is a sensation, an emotional experience, that may occur anywhere in the body. “Pain is what the person says it is and not what others think it ought to be.” (McCaffery and Beebe, 1989). The experience of pain is shaped by personality, background, cultural, social and life experiences.

It is important to appreciate that old age is not a disease and that pain is not a natural part of growing old. Older persons do not tolerate pain better than younger persons. Age does not dull the ability to sense pain. "A survey of 200 elderly patients revealed that 66% of these patients suffered frequent pain or were in permanent pain." (Rapin, 1991). A Canadian survey “(1994-1995) of older persons 65-74 years living in the community reported that 29 % had chronic pain, and 35% of those 75 years and older reported having chronic pain. Common pain symptoms in those over the age of 65 were reported to be a result of chronic bronchitis/emphysema (59%), back problems (non-arthritic)(54%), stomach/intestinal ulcers (54%), migraine headaches (51%), arthritis/ rheumatism (49%), diabetes (47%), and heart disease (43%)." (Millar, 1996).

Depression, less active social life, sleep problems and ambulatory problems are consequences of pain among older persons. Pain and its treatment have significant implications on quality of life. Despite the frequency and effect on quality of life, pain has been of limited interest to health professionals. "A survey of a variety of textbooks dealing with cancer revealed that 25% of the pages were devoted to pain and its treatment. Out of eleven geriatric medicine textbooks, only two included a chapter on pain and pain control. A survey of eight geriatric nursing journals indicated that out of a total of 5000 pages, only 18 pages were devoted to treatment of pain." (Rapin, 1991).

Why do older persons not talk about their pain? There may be a number of contributing factors. They may want to protect themselves and family members. They may be afraid to admit they have pain because they are concerned about how it will effect their future. They may be concerned about losing their ability to make decisions about their own health, and afraid of potential future painful diagnostic tests. They may believe pain is expected with aging. Older persons may be reluctant to take medication because they fear the pain may get worse and the medication will be ineffective. They may also feel the potential side effects may change their behaviour or personality. They wonder about whether they will become addicted to the medication. When in hospital they believe that the staff are too busy to hear their complaints of pain. They believe that caregivers know pain is present and are doing all they can to relieve it. Sometimes they have not had time to build a trusting relationship with the health professional. They do not wish to displease anyone.

Healthcare professionals need to maintain their expertise in pain management in order to ensure adequate pain management. It is important to realize that the person's self-report of pain is the single most reliable indicator of pain intensity.

The healthcare professional needs to assist the person in verbalizing their pain and acknowledge the person’s pain. By having the person actively participate in their care they will have a sense of control. You need to teach the person to use a pain scale and keep a pain diary.

Older persons need to be educated to understand that medications and non-drug interventions can relieve pain. It is important to speak to them about their fears of addiction, tolerance and drug dependency. Support the person to focus on their strengths, their abilities and the choices available to them.

As healthcare professionals, we need to advocate for the person in pain. Pain medication needs to be given on a regular basis. Frequent reassessment of pain is required and effectiveness of medication monitored. Concerns about addiction should not interfere with appropriate administration of analgesic.

For individuals who are not able to verbalize their pain due to education, language, culture or memory problems, you need to observe their behavior. Note their facial expressions, whether they are guarding or rubbing a body part, any alteration in sleep, change in appetite, gait or behavior. Those who have been familiar with the person’s behaviors will be able to know something is wrong because the person is not him/herself. You also need to involve the caregivers in sharing their observations. "Appearances and behavioral changes speak volumes for those who are unable to do so for themselves." (Baker, A., Bowring L., Brignell A., and Kafford D., Spring 1996) It is the appearances and behavioral changes that replace the verbal declaration, "I have pain."

Older persons present unique challenges to healthcare professionals in the assessment and management of their pain. Healthcare professionals need to be knowledgeable in the older person's beliefs and attitudes about pain. In this way they will be able to effectively educate the older person on how to seek help and how to manage their pain.

The 90 year old person whom I mentioned at the beginning of this article was experiencing arthritic pain. She was able to express what the pain was like for her. Those listening then responded with appropriate ways to treat the pain. Pool therapy was part of her treatment plan. As a result of managing her pain, she was able to continue to enjoy life's experiences. As she said, " Can you imagine being 90 and being in a pool for the first time?”