Geriatric considerations - Pain management: Nursing

Pain is an unpleasant physical or emotional experience that occurs in response to actual or potential tissue damage, and is shaped by physical, emotional, and cultural components unique to everyone. Due to higher prevalence of acute and chronic health conditions, older adults are at increased risk of experiencing pain that’s often left underrecognized and undertreated.

As the nurse, you’ll recognize age-related changes to pain perception and the consequences of untreated pain; identify barriers to effective pain management; and provide patient-centered care for older adults experiencing pain.

Alright, so as one ages, a decreased density of nerve fibers can delay the transmission of pain signals from the origin site to the brain. This delayed transmission increases the risk of injury since it takes longer for the brain to perceive pain. For example, it might take an older adult more time to realize their hand is on a hot surface, increasing the risk of burns. Also, pain sensation resolves more slowly with age, meaning many older adults must tolerate pain for longer.

Now, a common myth is that older adults feel less pain than younger adults, which is not only untrue, but it can lead to undertreatment of pain and poor health outcomes. Physical consequences of inadequately treated pain include impaired mobility, resulting in decreased muscle strength, increased fall risk, and poor sleep and appetite; and delayed healing and rehabilitation, leading to increased healthcare visits and costs.

Other consequences include a significant impact on quality of life and mental health, contributing to new or worsening depression, anxiety, or social isolation, which can increase the risk of substance use and even impair cognition over time.

Okay, so there are several barriers to effectively identifying and managing pain in older adults. Some of the most common barriers can stem from the patient or the healthcare team.

Now, a patient’s personal beliefs, values, and experiences can influence if and how they seek treatment for pain. For example, older adults may underreport pain due to concern of being labeled a “bad patient,” or out of fear the pain could signify an underlying problem, like cancer.

They may also avoid taking prescription pain medication for fear of opioid addiction or due to previous adverse side effects of pain treatment. Lastly, socioeconomic barriers, like high medication cost, limited transportation, and inadequate insurance coverage, can limit effective pain management.

As far as the healthcare team goes, professionals may have limited knowledge about pain identification and management for older adults, especially patients with impaired cognition or communication abilities. Values and beliefs regarding pain can also influence how healthcare providers view pain. For example, they may disregard a patient’s self-reported pain if there are no observable signs, like wincing or guarding. Additionally, healthcare providers with prescriptive authority can be less inclined to order pain medications due to fear of polypharmacy or scrutiny by regulatory agencies.

As the nurse, you’ll gather information about your patient’s pain, offer pharmacologic and non-pharmacologic pain management interventions, and provide patient and family education about pain.