Pain Assessment with Cognitively Impaired Older People in the Acute Hospital Setting

Abstract

1 8 v o l . 5 -n o . 3 -s e p t e m b e r 2 0 1 1 r e v i e w s i n p a i n The unique needs of older peopleThe high prevalence of pain in older people is associated with chronic underlying health disorders (e.g. arthritis, peripheral vascular disease) and acute pain conditions such as cancer and surgical procedures. Older people offer distinct challenges within the acute surgical environment as pain not only causes much suffering but also lowers the individual's quality of life (3), and predisposes them to a number of medical conditions, including depression, sleep disturbances, anxiety and occasionally aggressive behaviour (4,5). For those people with cognitive impairment, admission to the acute hospital setting can cause immense stress, resulting in an increase in disorientation and the emergence of behaviours that challenge ward staff.Despite an increased awareness of the need to assess and treat pain effectively, it would appear that healthcare professionals remain reluctant to prescribe analgesia for older patients in general, and for patients with cognitive impairment in particular (6,7). Horgas and Tsai (8) reported that the more confused and disorientated a patient becomes the less likely they are to be prescribed and administered IntroductionPostoperative pain assessment and management continues to challenge healthcare professionals. As the number of older people (65yrs or above) requiring care within the NHS continues to rise, over recent years there has been an increasing number of studies exploring the recognition and measurement of pain in this patient group. Numerous papers outline a variety of pain assessment tools that aim to assist healthcare professionals with identifying the nature and individual characteristics of pain. Furthermore, in accordance with the Joint Commission on the Accreditation of Healthcare Organisations (1) and The Royal College of Anaesthetists and The British Pain Society (2), incorporating pain assessment into the core elements of patient observations has been heralded as being fundamental to identifying appropriate pain relief strategies. Nevertheless, it would appear that applying and sustaining the principles of pain assessment into practice remains problematic. s u m m a r y p o i n t s• Research reveals that older people continue to experience much suffering from acute and chronic pain conditions.• People with cognitive impairment receive less analgesia than their cognitively intact peers.• Postoperative pain assessment with older people in the acute hospital setting remains a challenge.• Context and culture have a significant impact of pain assessment practices.• Due to a paucity of research exploring how pain assessment and management practices with cognitively impaired older people may be realised in the acute hospital setting, there is a need for further research to be conducted.v o l . 5 -n o . 3 -s e p t e m b e r 2 0 1 1 1 9 r e v i e w s i n p a i n issues, acute hospital settings do not always have a care environment conducive to meeting the needs of older...

Pain and dementia: an overview of the literature

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The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective

“…Australia [ 2 , 3 ]; Canada [ 4 ]; Brazil [ 5 ]; and the United Kingdom (UK) [ 6 ]) have reported sub-optimal management, with limited pain assessment, a lack of documentation in healthcare settings, and longer waits for older people to receive analgesia. The majority of published research into pain management in older adults has been carried out in community or home care settings and relatively little is known of how pain is assessed or managed in acute settings [ 2 , 3 , 7 ].…”

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