Assessment and Management of Pain in Older Adults: A Review of the Basics

Patricia Bruckenthal, PhD, RN, ANP; Yvonne M. D'Arcy, MS, CRNP, CNS

Disclosures

Topics in Advanced Practice Nursing eJournal. 2007;7(1) 

In This Article

Case Scenario: Arthritis Pain That Is "Acting Up"

Jane Jones is your neighbor. She is 72 years old and lives alone. She is quite active and likes to spend time outside. You often see her working in her garden when the weather allows or walking her dog. You haven't seen her recently, and you meet her one day as she comes out of her house. She tells you that her "arthritis is really acting up and her knees ache all the time." She has been trying to walk daily to maintain her activity.

She has diabetes and hypertension that are controlled with oral medications. Her feet have started to burn and the pain keeps her up at night. When you ask her what her doctor has said about her pain, she states, "Well, he thinks it is just a part of getting old and tells me to take acetaminophen when my knees or feet hurt. He tells me to do what I can and continue to try to stay active. He doesn't want to give me stronger pain medications because of my age. The pain is so bad, though, that I can't get out too much. When I go into his office, they ask me about my pain and I tell them it's a 6 on their pain scale. Don't you think there is something better that I can take for the pain? I'd give anything to get a decent night's sleep."

Jane Jones' dilemma is not unusual. She is an older patient with chronic daily pain. Her pain is not only musculoskeletal from her osteoarthritis, but she also has diabetic neuropathy in her feet. According to the American Geriatric Society, Jane would be a good candidate for careful use of opioids, possibly an extended-release medication, and the careful addition of an adjuvant medication for her neuropathy.

Jane's pain has certainly had an impact on her quality of life. She had a very good baseline activity level, and if her pain was relieved she might return to her former activity level. Given good pain control, Jane could return to the things that she loved doing. Without good pain control, Jane is limited to a life of limited activity and pain. The information in the following pages provides some options for better pain relief that would drastically improve Jane's quality of life.

About 80% of patients who live in long-term care facilities have chronic pain.[1] Older patients who live in the community experience pain to a lesser degree, but it is still a significant number, reported to be as high as 25% to 50%.[1] For minority patients who live in communities, the number of patients who reported experiencing daily pain was 28%, and physical limitations related to pain were reported to be 17%.[2] Significant predictors for severe pain in ethnically diverse populations were:

  • Being a Medicaid recipient;

  • Having 2 or more comorbidities;

  • Having a low educational level; and

  • Psychological distress.

Generally, patients who have pain seek effective pain medication. However, 1 in 5 older patients reported taking pain medication only occasionally during a 1-week period of time. Is this imbalance a result of:

  • Undertreatment by prescribers;

  • Financial difficulties (ie, affording the cost of medications); or

  • Reluctance of older patients to take pain medications?

Consider the effects of untreated pain. Whatever the reason, the consequences result in[1]:

  • Depression;

  • Anxiety;

  • Decreased socialization;

  • Sleep disturbances;

  • Impaired ambulation; and

  • Increased healthcare utilization and costs.

Older patients can remain active and productive if their pain is adequately relieved. Nurses caring for older patients can help advocate for better pain relief when they encounter patients who are not receiving appropriate treatment for pain. A healthcare provider can effectively treat pain in older patients, such as the patient in the case study, by careful prescribing, frequent reevaluation, and combining treatments to achieve better pain control.

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