Pain in Older Adults

• September 24, 2023
• By Rachel Abshear
• In Ohio CEUs News

Pain is an unwelcome companion for many older adults. Whether it’s a nagging ache in the back or a sharp pain in the joints, pain can significantly impede the quality of life for seniors. Understanding its causes, preventive measures, and available treatments is essential for improved well-being.

In this blog post, we will discuss the primary causes of pain, how to prevent it, and treatments for it. We will also explore methods for nursing home staff to enhance their ability to recognize and effectively address pain among their residents. Continue reading to learn more.

By the Numbers

• The National Institute on Aging states that more than 50% of adults 65 years and older report having been bothered by pain that lasted more than 24 hours.
• According to the Centers for Disease Control and Prevention (CDC), about 15% of older adults use prescription medication for pain relief.
• A study published in the Journal of the American Geriatrics Society found that 25% of people aged 65-74, and 21% of people over 75, had pain that persisted for more than 24 hours.

Understanding Pain in Older Adults

Primary Causes

• Osteoarthritis: This is one of the most common causes of pain in older adults. As the protective cartilage at the ends of bones wears away, individuals experience pain, tenderness, and stiffness in the affected joints.
• Osteoporosis: Characterized by weak and brittle bones, this condition can lead to painful fractures with minimal trauma.
• Neuropathic Pain: Conditions like diabetic neuropathy or post-herpetic neuralgia after shingles can cause nerve pain.
• Chronic Illnesses: Diseases such as cancer, cardiovascular diseases, or chronic respiratory diseases can contribute to pain.
• Post-Surgical Pain: After surgeries, older adults might experience persistent pain, either due to the procedure itself or complications.

Prevention

• Regular Exercise: Physical activity helps strengthen muscles, improve flexibility, and promote better bone density. Low-impact exercises like walking, swimming, or tai chi can be particularly beneficial.
• Diet: A balanced diet rich in calcium and vitamin D can aid in bone health. Omega-3 fatty acids, found in fish, have anti-inflammatory properties that can help reduce pain.
• Avoid Smoking and Limit Alcohol: Both can contribute to bone loss, increasing the risk of osteoporosis.
• Safe Environment: Falls are a common cause of fractures in older adults. Keeping the home environment free of hazards can prevent such incidents.

Treatments

Medical Treatments

• Medication: Over-the-counter pain relievers like acetaminophen or NSAIDs can be effective. For chronic or severe pain, doctors might prescribe opioids, but with caution due to addiction risks.
• Physical Therapy: Guided exercises can help improve joint flexibility, reduce pain, and increase strength.
• Surgery: In cases where pain is due to a specific structural problem, such as joint degeneration in osteoarthritis, surgery might be an option.

Holistic Treatments

• Acupuncture: This ancient Chinese practice involves inserting fine needles into specific points in the body, believed to rebalance the body’s energy and relieve pain.
• Massage: Therapeutic massage can help alleviate muscle tension, reduce stress, and improve circulation, aiding pain relief.
• Mindfulness and Meditation: Techniques such as progressive muscle relaxation, guided imagery, and deep breathing exercises can help divert attention from pain and reduce its perceived intensity.
• Chiropractic Care: Adjustments and manipulations by chiropractors can help align the body, potentially relieving pain, especially in the spine.
• Herbal Remedies: Some herbs, like turmeric or ginger, have anti-inflammatory properties and can be taken as supplements or used in foods.

Pain and Senior Living Staff

Staff Education Regarding Pain

Understanding and managing pain in nursing home residents is crucial for their well-being and quality of life. Staff education can play a vital role in ensuring pain is effectively identified and addressed. Here are four educational activities that can help nursing home staff understand pain in their residents:

• Role-playing and Simulation:

1. • Objective: Understand the non-verbal cues and behaviors indicative of pain in non-communicative residents.
   • Activity Details: Create scenarios where staff take on the role of residents displaying various signs of pain, such as facial expressions, vocalizations, body language, and changes in behavior. The other staff members observe and identify signs of pain. Switch roles and repeat. This can also be extended to role-play scenarios that involve communication strategies to validate and address the resident’s pain.

• Interactive Workshops on Pain Assessment Tools:

1. • Objective: Familiarize staff with validated pain assessment tools and their application.
   • Activity Details: Organize workshops to introduce and practice using standardized pain assessment tools like the PAINAD (Pain Assessment in Advanced Dementia) or the Abbey Pain Scale. Use real-life examples or videos to illustrate various pain intensities and behaviors. Provide staff with feedback on their assessments to ensure consistency and accuracy in evaluating resident pain.

• Pain Experience Day:

1. • Objective: Develop empathy by simulating common sources of pain in the elderly.
   • Activity Details: Staff participate in a series of stations where they experience various limitations and discomforts that are common in the elderly. For example:

1. • • Wearing gloves to simulate reduced tactile sensitivity or arthritis.
     • Wearing earplugs or headphones with muffled sounds to experience hearing difficulties.
     • Walking with weights or restrictive devices to simulate mobility challenges or joint pain. By personally experiencing these discomforts, staff may develop a deeper understanding of and empathy for the daily challenges faced by many nursing home residents.

• Case Studies and Group Discussions:

1. • Objective: Enhance critical thinking skills in pain assessment and management.
   • Activity Details: Present real-life or hypothetical case studies that depict residents with varying pain presentations and complexities. Divide staff into groups and ask them to discuss the potential sources of pain, assessment methods, and interventions that might be appropriate. After the group discussions, facilitate a larger group discussion to share insights, consider different perspectives, and ensure comprehensive understanding.

Incorporating these educational activities can provide nursing home staff with the knowledge and skills to better identify and manage pain in their residents, ultimately improving the quality of care provided. Regular refreshers and updates on best practices in pain management can further enhance staff proficiency.

Conclusion

Pain in older adults is a multifaceted issue. Its causes are numerous, ranging from degenerative conditions like osteoarthritis to complications from chronic diseases. Prevention, through lifestyle choices like diet and exercise, plays a crucial role. But when pain does arise, a combination of medical and holistic approaches can offer relief.

Understanding pain in this demographic is not just about recognizing its physical manifestations. It’s also about understanding its emotional and psychological toll. By creating awareness and promoting holistic care, we can ensure that our older generation enjoys a higher quality of life, with minimal pain and discomfort. And by educating our teams in creative ways, we can help support our residents to the greatest extent possible.