Pain In Older Adults: A Psychological Analysis

Currently in my facility, we do not have a policy regarding geriatric and/or demented patients and pain control. I believe this needs to be changed because although we have an initial assessment protocol, we do not have any kind of protocol to control a geriatric or demented patients pain. Since demented patients are quite often left unable to communicate their feelings, I believe there would be, less adverse effects and better patient outcomes for this group of people and better satisfaction with their families.

As with all older adults, clients with dementia present with chronic conditions such as arthritis and acute pain experienced in the aging and the end of life process. Moss (2002) gives evidence that most elderly clients who move into long-term care will die in an institution either a nursing home or a hospital many of whom will have dementia. She states that 91% have a strong co morbid condition likely to cause pain.

To most people, pain is a nuisance, but to others pain controls their life. The feeling discomforts us in ways that can sometimes seem almost imaginable. These feelings can lead to many different side effects if not dealt with or diagnosed. These effects can include depression, anxiety, and incredible amount of stress. The truth about pain is that it is vital to our existence. Without the nervous system responding to pain, we would have no idea if we were touching a hot stove, being stuck by a porcupine’s needles, or something else that could leave a lasting effect upon our bodies without us even knowing anything about it.

Dealing with aging dementia patients can be a challenge in and of itself. However, when healthcare providers need to include regulating pain as well, the challenge becomes even greater. Pain management with cognitively impaired patients is a constant problem within geriatric care in modern healthcare facilities (Zwakhalen et al 2006). The reduced self capacity to report pain in its true degrees then makes pain management a challenge for physicians and healthcare providers (Husebo et al. 2007). Thus, research aims to explore effective measures for observing and reporting pain management within aging dementia patients.

Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include

According to The World Health Organisation (1999), defined pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is traditionally described as acute or chronic pain. The prevalence of chronic pain (CP) is higher than of acute of pain, as it affects 7.8 million people of all ages in the UK (Chronic Pain Policy Coalition., 2006). The current leading cause of mortality that is accounting for 60% of all deaths is due to chronic diseases and is also a problem as causes an increasing burden on the health care service (World Health Organisation., 2007). CP can affect a person’s quality of life if managed poorly, statistics shows that 25% of people lose their job and 22% leads to depression. (Chronic Pain Policy Coalition.,

Pain is one of the most influential symptoms that leads individuals to reach out to health care professionals to seek relief. Pain is subjective and unique to each person. Some individuals may have a higher pain tolerance than others. According to Frandsen (2014), “Pain is an unpleasant, sensory, emotional sensation associated with actual or potential tissue injury” (p. 889). Pain may be caused by a variety of elements, such as tissue or nerve damage and surgery. There are three main categories that pain is classified by, which are origin, duration, and cause. The main focus of this paper is on acute pain, chronic pain, and phantom pain. It is crucial to know how to assess each type of pain, as well as how to enhance it, or decrease the pain.

The proper way to ensure that this is not a constant problem is to make sure that initial pain assessments as well as re-assessments are done in a timely manner. It seems as though the initial pain assessment was completed using the pain scale but the re-assessment was not complete and documented in the proper amount of time. In order to ensure proper documentation of the re-assessment once the first pain assessment has been completed and an intervention has properly been administered, the first action step will be to make sure that the reassessment is complete within one hour of pain intervention. With electronic mars it is easy to build in a recheck into the system to alert the nurse that a reassessment is needed once the pain medication has been administered to the patient. When a pain intervention is done, a flag will come up to remind the nurse taking care of the patient that a reassessment is due. This will also resolve the issue on the tracer audit of how does the nurse know the intervention worked. Another issue on the audit was if no pain intervention was done what was the reason for it not being done.

The concept of pain differs across cultures and healthcare disciplines, and devising ways to accurately define and assess pain is one of the underlying anxieties associated with the concept of pain. Since the population of the United States is a melting pot of traditions and customs, cultural differences between patients and caregivers may affect the perception and reporting of pain. According to Bird (2003) when measuring pain, cultural-related variations must be taken into consideration because measures of pain may be culturally specific. There are a variety of pain measurement tools available for use and each has its

“Pain is a complex, multidimensional experience that can cause suffering. [While] pain is inevitable, suffering is optional” (Kinder, 2014, p. 114). The control of pain is, as Kinder puts it very complex, without appropriate measures it can be easily side stepped especially in the elderly. To ensure patient center care it is important that all aspect of one’s quality of life is address, this is emphasizing by pain being a component of vital signs. Being a vulnerable population the elderly is often under assessed as they minimized their problems so as not to be a burden in addition to the fact that they may believe that their pain is a normal part of aging.

panel on pain assessment in older persons,13 have corroborated these conclusions.14 In particular, these authors highlight the need for more evaluation of observational pain measures, including validation against the criterion standard of self-report in intact and impaired populations. Almost all research on measuring pain in persons with dementia has focused exclusively on

Pain is defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is always subjective.” (Jarvis, 2016) In our society today, the older adults and older adults who suffer from dementia are poorly assessed in terms of pain assessment. Studies have shown that about 35-48% of older adults living at home suffer from chronic pain, another 45-85% of older adults living nursing homes lives with chronic. Older adults suffer from chronic pain as most suffer from conditions that can lead to chronic pain. The health care professional with the proper pain assessment skills can better manage and treat pain in the older adult. The assessment

The illness schema, comprised of the affective and behavior consequences of the illness, has been shown to have an impact on goal achievement and quality of life (Covic et al., 2004). The self-schema, including self-relevant descriptions and episodes of behaviors, is related to self-esteem. The self-schema also ensures that self-relevant information is processed first (Pincus & Morley, 2001). The SEMP model argues that the pain schema is enmeshed with the illness and the self schema when pain experience is continual and remitting. Because pain sensations are self-relevant for chronic pain patients, prioritized processing of pain information produces congruent cognitive biases. In certain cases, preference is also given to generally negative information in processing (Pincus & Morley, 2001).

The most common reason that people seek medical care is pain, and pain is the leading cause of disability (Peterson & Bredow, 2013, p. 51; National Institute of Health, 2010). Pain is such an important topic in healthcare that the United States congress “identified 2000 to 2010 as the Decade of Pain Control and Research” (Brunner L. S., et al., 2010, p. 231). Unfortunatelly, patients are reporting a small increase in satisfaction with the pain management while in the hospital (Bernhofer, 2011). Pain assessment and treatment can be complex since nurses do not have a tool to quantify it. Pain is considered the fifth vital sign, however, we do not have numbers to guide our interventions. Pain is a subjective expirience that cannot be shared easily. Since nurses spend more time with patients in pain than any other healthcare provider, nurses must have a clear understanding of the concept of pain (Brunner, et al., 2010). Concept analysis’ main objective is to clarify ideas, to enhance critical thinking, and to promote communication (Rodgers & Knafl, 2000). This paper will examine the concept of pain using Wilson’s Steps of Concept Analysis (Rodgers & Knafl, 2000).

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (1979). Pain is actually the culprit behind warranting a visit to a physician office for many people (Besson, 1999). Notoriously unpleasant, pain could also pose a threat as both a psychological and economic burden (Phillips, 2006). Sometimes pain does happen without any damage of tissue or any likely diseased state. The reasons for such pain are poorly understood and the term used to describe such type of pain is “psychogenic pain”. Also, the loss of productivity and daily activity due to pain is also significant. Pain engulfs a trillion dollars of GDP for lost work time and disability payments (Melnikova, 2010). Untreated pain not only impacts a person suffering from pain but also impacts their whole family. A person’s quality of life is negatively impacted by pain and it diminishes their ability to concentrate, work, exercise, socialize, perform daily routines, and sleep. All of these negative impacts ultimately lead to much more severe behavioral effects such as depression, aggression, mood alterations, isolation, and loss of self-esteem, which pose a great threat to human society.