Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults

Deng, Lisa; Patel, Kanan; Miaskowski, Christine; Maravilla, Ingrid; Schear, Sarah; Garrigues, Sarah K.; Thompson, Nancy E.; Auerbach, Andrew D.; Ritchie, Christine S.

doi:10.1111/jgs.15459

Cited by 27 publications

(22 citation statements)

References 51 publications

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“…Integral to this nursing activity is recognition that the older person's self-report can offer the most accurate and reliable method for identifying and characterising their pain (Herr, 2011). Yet, the Deng et al (2018) study of the prevalence and characteristics of hospitalised older people found up to 20% were suffering from moderate to severe pain. Further, that older patients with pre-existing chronic pain had less reduction in their pain intensity score from admission to discharge when compared to those without chronic pain (Deng et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…() study of the prevalence and characteristics of hospitalised older people found up to 20% were suffering from moderate to severe pain. Further, that older patients with pre‐existing chronic pain had less reduction in their pain intensity score from admission to discharge when compared to those without chronic pain (Deng et al., ). Despite the evidence that this problem exists, there is a lack of knowledge as to why pain care provision for the older person in acute care continues to be less than optimal.…”

Section: Introductionmentioning

confidence: 99%

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Experiences of the older hospitalised person on nursing pain care: An ethnographic insight

Harmon

Summons

Higgins

2019

Journal of Clinical Nursing

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Aims and objectives To present an ethnographic insight into the older hospitalised person (those aged over 65 years) perceptions and experiences of pain care provision by nurses in acute care. Background Pain care provision by nurses remains less than optimal for the older hospitalised person despite numerous evidence‐based guidelines. There is a paucity of research providing input from the experiences of the older hospitalised person in relation to their perspectives of pain care provision by nurses in acute care. Pain care research needs more involvement from those older persons with documented diagnoses of dementia, delirium or cognitive impairment, and intellectual disabilities and those in their end stage of palliation. Design A focused ethnographic study. The consolidated criteria for reporting qualitative research (COREQ) were used to report the findings of this study. Methods A focused ethnographic study was conducted in 8 acute care units within 2 large tertiary referral hospitals on the east coast of Australia. Consisting of semi‐structured interviews (n = 12) of cognitively intact older persons (11 hr). Twenty‐three (23) semi‐structured interviews with nine (9) RN participants (12 hr and 38 min). Participant observation period totalled 1,041 hr. Results The older persons’ experiences of receiving pain care were based on a formulaic assessment process focusing on intensity of pain and pain management options provided often lacked their input. The older persons often did not perceive their pain care provision as being of benefit to themselves. The nurses lacked insight and understanding on the nature of pain for the older person. Conclusion Understanding was gained into how the older persons’ pain care was hampered due to the lack of appropriate, and meaningful pain care provision and provides insight into why the older hospitalised person continues to experience a less than optimal experience. Relevance to clinical practice Older hospitalised persons can gain continuity of pain care when nurses negotiate with them to repattern or restructure their nursing routines for pain care provision. Older people need inclusion into pain care decisions. All vulnerable older persons require nurses to use an evidence‐based pain assessment tool.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experiences of the older hospitalised person on nursing pain care: An ethnographic insight

Harmon

Summons

Higgins

2019

Journal of Clinical Nursing

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“…Furthermore, the median self-reported recovery level prior to each APEP session was 6 of 10 points (Table 4), which may indicate insufficient recovery levels in some participants. Pain, sleep disturbances and fatigue are very common conditions in older people, challenging to manage and often inadequately treated [80–85]. In a future main study (as has been the case in the current study), intensive and adequate management of pain, sleep disturbances and fatigue within usual care procedures should enable affected study participants to participate in (additional) rehabilitation treatments, such as physiotherapy.…”

Section: Discussionmentioning

confidence: 95%

An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients – a randomized, controlled pilot and feasibility trial

et al. 2019

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Background There is inconclusive evidence for the effectiveness of additional exercise in older hospital patients. The aims of this study were (1) to assess the feasibility of an augmented prescribed exercise program (APEP) in older acute medical patients and (2) to measure the potential effects of APEP on mobility capacity in order to assess the feasibility of a large full-scale study. Methods We conducted a single-center, prospective, parallel-group, single-blinded, randomized (1:1) controlled pilot and feasibility trial. Participants were recruited from acute geriatric wards of a general hospital. Key inclusion criteria were: age ≥ 65 years and walking ability. Key exclusion criteria were severe cognitive impairment and medical restriction for physical exercise interventions. Both groups received usual care, including physiotherapy. Intervention group participants were scheduled for additional exercise sessions (20–30 min, 4-5x/week). Feasibility of the trial design was assessed along pre-defined criteria for process, resources and management. Feasibility of the APEP intervention was analyzed by means of adherence, compliance and safety. Outcomes were measured at baseline and prior to hospital discharge. The primary outcome was mobility capacity (de Morton Mobility Index; DEMMI). Secondary outcomes were walking ability, physical endurance, fear of falling, frailty and length of stay. Results Thirty-five participants were recruited (recruitment rate 20.3%). We lost 7 participants to follow-up (retention rate: 80%). Intervention group participants (n = 17) each participated in 5.3 ± 2.2 additional exercise sessions (mean duration: 23.2 ± 4.0 min; mean adherence rate 78% ± 26%). No severe adverse events occurred during study assessments or APEP sessions. There were no statistically significant differences in mean change scores in any outcome measure. A sample of 124 participants would be required to detect a difference of 4 DEMMI points (ES = 0.45) with a power of 80%. Conclusions This small feasibility RCT indicates that an APEP intervention may be safe and feasible in older acute medical patients. APEP may possibly induce small to moderate effects on mobility, but the clinical relevance of these effects may be limited. These results inform the planning of a larger-scale phase III study. Trial registration German Clinical Trials Register ( DRKS00011262 ). Registered 27 October 2016. Electronic supplementary material The online version of this article (10.1186/s12877-019-1246-4) contains supplementary material, which is available to authorized users.

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“…One study reported that between 1999 and 2010, opioid prescriptions for older adult outpatients increased from 4% to 9% . Another examined hospitalised patients aged 65 years and older and found that 51% received opioids before they were admitted and 8 out of 10 patients increased their use of opioids during their hospital stay . In a nationwide study of over 250 000 individuals, the use of prescription opioids was highest among white, educated females between the ages of 70 and 75 .…”

Section: Introductionmentioning

confidence: 99%

Use of cannabis and opioids for chronic pain by older adults: Distinguishing clinical and contextual influences

Bobitt

Kang

Croker

et al. 2020

Drug and Alcohol Review

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Introduction and Aims Chronic pain is one of the most common health‐related conditions experienced by Americans over the age of 65. In this study, we examine the intersection between pain, opioids and cannabis use among older adults in Colorado and Illinois and examine how medical needs and other variables associated with a persons' background and attitudes influence choices concerning the use of opioids and cannabis to treat pain. Design and Methods Data were collected via a survey about cannabis and opioids use, and questions related to individual need factors (e.g. pain, quality of life) and contextual factors (e.g. sex, finances, personal attitudes, interaction with physicians) were included in this study. We built a logistic regression model to evaluate factors associated with drug use and a multinomial regression model to understand factors that influence drug choices between cannabis and opioids. Results A total of 436 individuals completed the survey; 62 used opioids only, 71 cannabis only and 72 used both. When comparing drug users to non‐drug users, pain was significantly associated with using cannabis and/or opioids when controlling for other covariates. However, when we compared cannabis users to opioid users, pain was no longer a determining factor. Instead, other contextual factors such as sex, personal beliefs and physician attitudes influenced an individual's choice between cannabis or opioids. Discussion and Conclusions This study showed that contextual factors appear to have more influence on an individual's decision to use cannabis as an alternative to opioids than individual need or characteristics.

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Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults

Abstract: Twenty percent of older adults admitted to a general medicine service had moderate to severe pain. Further research about optimal pain management in hospitalized older adults, particularly those with chronic pain, is necessary to improve care in this population.

Cited by 27 publications

References 51 publications

Experiences of the older hospitalised person on nursing pain care: An ethnographic insight

Experiences of the older hospitalised person on nursing pain care: An ethnographic insight

An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients – a randomized, controlled pilot and feasibility trial

Use of cannabis and opioids for chronic pain by older adults: Distinguishing clinical and contextual influences

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