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 under recognized 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.

All right. 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.

Ok. 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 health care 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 health care 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 a nurse, you'll gather information about your patient's pain offer, pharmacologic and nonpharmacologic pain management interventions and provide patient and family education about pain.

First, to obtain data about your patient's pain, begin by asking them if they have any new or existing pain or discomfort and be sure to give them enough time to process and answer your question.

You'll also look for outward signs of pain, like restlessness, muscle tension, grimacing or changes in vital signs such as tachycardia or tachypnea, especially if they have cognitive impairment or are unable to speak.

Next. Ask your patient to rate their pain numerically or using a visual analog scale.

Ask them to describe what it feels like such as sharp or dull and what they consider to be an acceptable pain level. For those with cognitive impairment.

Use a tool like the pain assessment in advanced dementia or pain ad scale to rate pain based on breathing vocalization, facial expression, body language and consolability.

Remember to review your patient's medical history for chronic conditions that cause pain like arthritis or diabetic neuropathy and determine if their pain is related to these conditions or an acute illness.

All right. Once you've determined the type and intensity of your patient's pain, you'll implement nonpharmacologic and pharmacologic interventions and provide education non pharmacologic pain measures include cutaneous stimulation, like gentle massage or application of warm or cold compresses.

Keep in mind that older adults have thinner skin and less subcutaneous tissue. So remind your patient and their family to avoid injury by placing a barrier between the compress and the skin.

You can also encourage your patient to use relaxation music or biofeedback techniques to promote comfort and coordinate with the physical therapist or gerontologist as needed.

You may also administer medications prescribed for your patient's pain, like non steroidal antiinflammatory drugs or nsaids for mild pain or opioid analgesics for more severe pain, explain how to take their medications as prescribed and discuss possible side effects like abdominal pain, nausea and bleeding for nsaids and sedation, dizziness and constipation for opioids.

All right, it's a quick recap. Pain is an unpleasant, physical or emotional experience that occurs in response to actual or potential tissue damage and is influenced by physical emotional and cultural components.

Unique to everyone. Pain management in older adults is shaped by age related changes in pain perception, consequences of untreated pain and barriers to effective pain management.

As the nurse caring for an older adult with pain, you'll offer pharmacologic and non pharmacologic pain management interventions and provide patient and family education about