Optimizing Pain Management in Long-term Care Residents

Evelyn Hutt, MD; Martha D. Buffum, DNSc, APRN, BC, CS; Regina Fink, RN, PhD, FAAN; Katherine R. Jones, RN, PhD, FAAN; Ginette A. Pepper, PhD, RN, FAAN

Disclosures

Geriatrics and Aging. 2007;10(8):523-527. 

In This Article

Abstract and Introduction

Abstract

Pain is common among long-term care residents and is often undertreated. A high prevalence of dementia, sensory impairment, and disability, as well as structural issues such as staffing patterns and turnover in long-term care facilities make assessment and management of pain challenging. An overview of the evidence regarding the assessment and treatment of pain in individual residents, and recommendations for improving the overall quality of pain management in the long-term care setting, is presented.

Introduction

Pain is common among long-term care (LTC) residents, and is often underreported, underassessed, and undertreated.[1] The American Geriatrics Society (AGS) Panel on Persistent Pain in Older Persons estimated that 45-80% of LTC residents have substantial pain,[2] and 25% of those with daily pain received neither analgesic medication nor nonpharmacologic treatment for their pain.[3] A high prevalence of dementia, sensory impairment, and disability in the LTC population makes assessment and management of pain challenging. Staffing patterns, nursing staff and administrative turnover, limited physician presence, and hierarchical, as opposed to team-oriented, organizational cultures in many homes exacerbate the problem.[4] The consequences of poor pain management include sleep deprivation, anorexia, depression, anxiety, agitation, decreased activity and functional status, delayed healing, interference with relationships, and lower overall quality of life.[5,6,7,8] This article will provide an overview of the evidence regarding the assessment and treatment of pain in individual residents, and recommendations for improving the overall quality of pain management in the LTC setting.

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