Chronic pain is particularly problematic in the elderly population, especially those aged 65 and older. It has been estimated that half the elderly population living in standard communities suffer from chronic pain, whilst some estimates place the prevalence to be up to 80% in some nursing homes (King, 2012). Although this is problematic in itself, the elderly population is growing and will make up 20% of the total by 2030 (Rastogi & Meek, 2014) which makes chronic pain of particular interest to nursing staff. Additionally, pain management can be complex as different types of pain respond to different medications, and individuals do not always have the prescribed response. With this in mind, the aim of this project is to identify some barriers to management of chronic pain in the elderly population residing in the community as a way of understanding how better to deal with this problem.
The method for the current study is a literature review, in which articles relevant to pain management in the elderly population were identified. Articles were selected from reputable databases, including CINAHL, PUBMED, Cochrane library, Medline and the Johanna Briggs Institute. The inclusion criteria for this study was articles written in English within the last 5 years. Excluded from this study were articles that were not peer-reviewed, those written over 5 years ago, and conducted on the elderly in nursing homes. The major keywords identified for use in Boolean Search were “elderly”, “pain management”, “chronic pain” and “community”.
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"Pain Management in the Elderly Within the Community".
Ashburn & Lingaraju (2013) identified that chronic pain in the elderly population looks set to be a growing problem in the common years and is likely to become more frequently encountered by clinical staff. It is also noted, importantly, that chronic pain is not an inevitable part of aging and treatments should be similar to those used in younger patients. The most common types of pain that were identified in the community were lower back pain, osteoarthritis, postherpetic neuralgia and cancer pain, although cancer pain is evidently disease-based. This study notes that management of the psychosocial aspects of chronic pain may be one of the most important methods of dealing with it, particularly through validated techniques such as cognitive-behavioral therapy. Brown, Kirkpatrick, McKenzie & Swanson (2011) also found that psychological aspects of pain may play a role.
Ayres, Reid & Warmington (2012) suggested six steps to finding the best types of pain management for the elderly population. Firstly, it is important to conduct a comprehensive pain history and review the problem list. The clinical staff should then establish treatment goals and uncover any possible barriers to therapy. It was also noted that starting with low dosages is important with analgesia, partly to prevent addiction but also because high dosages are often seen to be unnecessary. Regular assessments are also suggested to monitor effects and outcomes. Hartzler, Kroustos, Leavitt & Schepen (2012) found that both pain and pain management were perceived differently in the elderly population and this has an effect on its effectiveness.
Meek & Rastogi (2012) found that personalized methods of control were important in dealing with these different perceptions and needs of elderly patients. Egan & Cornally (2013) found that one of the major barriers to effective pain management was a lack of personalization as well as the aforementioned fact that many perceive pain in later life as inevitable. Gong, Li, Li & Mao (2013) suggested that self-management strategies are effective in older arthritis patients and that the effectiveness of these tie in with pain experiences.
The overarching theme of these results is that the elderly population do not have to suffer through pain as an inevitable consequence. Despite this, the perceptions among the population are that it is part of daily life, and this can be a major barrier to effective pain management. Bearing this in mind, it is important to incorporate psychosocial pain management mechanisms into care to ensure that the mechanisms are working. Ashburn & Lingaraju (2013) suggest cognitive-behavioral therapy as one method of breaking down cognitive barriers to effective pain management, and other research supports the fact that this can be beneficial when incorporated into care (Meek & Rastogi, 2013).
Bearing this in mind, it is important to create a personalised pain management plan for protecting the elderly population – something which will become more important as this population grows. Despite the fact that Ayres et al. (2012) suggest that pain management should be applied to the elderly as it would be in the young, this does not necessarily mean that the method of its application will be the same, although the drugs used will be just as effective in either population. It is important to create a pain management plan which incorporates results from pain assessments, the needs of the individual and their attitudes towards long-term pain management.
The two overarching themes of this research are that pain management in the elderly members of the community should be personalized to their needs and based on a thorough assessment and that pain management mechanisms would do well to incorporate psychosocial methods of pain management. This second factor will help to overcome the misconception that pain is an inevitable part of aging, and has been shown to provide better results when used in combination with traditional pain interventions than medication alone. Bearing this in mind, clinical staff would do well to increase their understanding of pain management in the elderly and to work towards providing personalized management programs to combat this growing problem.
