The assessment of pain in older people

Pain is under-recognised and under-treated in older people. It is a subjective, personal experience, only known to the person who suffers. The assessment of pain is particularly challenging in the presence of severe cognitive impairment, communication difficulties or language and cultural barriers. These guidelines set out the key components of assessing pain in older people, together with a variety of practical scales that may be used with different groups, including those with varying levels of cognitive or communication impairment. The purpose is to provide professionals with a set of practical skills to assess pain as the first step towards its effective management. The guidance has implications for all healthcare and social care staff and can be applied in all settings, including the older person’s own home, in care homes, and in hospital

Vermont Healthy Kids\u27 Meals: Parents\u27 Perspectives

Introduction. Childhood obesity has increased for decades. Options on kids’ menus in restaurants typically involve unhealthy choices such as fries, chicken fingers, and grilled cheese, with soda as the drink. When healthy options are the default choice, children are more likely to eat them. Though initially skeptical of modifications, restaurants will enact changes to maintain customer satisfaction and profits, and there is no significant difference in price of healthier kids’ meals.Methods. 187 paper and electronic surveys were administered throughout Vermont to explore attitudes towards availability, cost, and importance of healthy kids’ meals, as well as income, education, and children in the household. Open-ended questions sought parental opinions.Results. 69% of parents believe healthier food options at restaurants would cost more; however, 95% were willing to pay more. 89% of parents reported feeling concerned or highly concerned about sugary drinks, and 62% of parents were very likely to choose the healthier food option at a restaurant. The majority of parents who reported difficulty in finding healthy meals felt the amount of fruits/vegetables was the most important nutritional factor. Low income Vermonters were most concerned about cost.Conclusions. The majority of parents are concerned about kids’ meal nutrition and are likely to purchase healthier options, even at increased prices. If restaurants enact changes to kids’ menus, prices should remain the same to ensure families of all socioeconomic classes will be able to purchase healthier meals. Priority modifications to meals should include increased amounts of fruits/vegetables and elimination of added sugar.https://scholarworks.uvm.edu/comphp_gallery/1236/thumbnail.jp

P2519: The Impact of Transcatheter Aortic Valve Implantation on Quality of Life: A Mixed Methods Study

Objective: To provide an in-depth understanding of patients' views about the impact of transcatheter aortic valve implantation on self-reported quality of life. Background: Transcatheter aortic valve implantation is considered to be the gold standard of care for inoperable patients diagnosed with severe symptomatic aortic stenosis. Mid- to long-term clinical outcomes are favourable and questionnaire data indicates improvements in quality of life but an in-depth understanding of how quality of life is altered by the intervention is missing. Methods: A mixed methods study design with a total of 89 in-depth qualitative interviews conducted with participants (39% male; mean age 81.7 years), 1 and 3 months post TAVI, recruited from a regional centre in England. Data were triangulated with questionnaire data (SF-36 and EQ5D-VAS) collected, pre, 1 and 3 months post implantation. Results: Participants' accounts were characterised by four key themes; shortened life, extended life, limited life and changed life. Quality of life was changed through two mechanisms. Most participants reported a reduced symptom burden and all explained that their life expectancy was improved. Questionnaire data supported interview data with gradual improvements in mean EQ-5D scores and SF-36 physical and mental domain scores at 1 and 3 months compared to baseline. Conclusion: Findings suggest that TAVI was of variable benefit, producing considerable improvements in either mental or physical health in many participants, while a smaller proportion continued to deteriorate

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.

BACKGROUND: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence

The benefits system in Wales

This evidence supports the call for further devolution of powers in Wales, especially those that increase the ability for Wales to tackle poverty. Doing so, our work here evidence that the 10 years of austerity following the election of the Coalition Government of 2010 opened a chasm for rising socio-inequalities for Wales. This chasm has ensured that low-income people and communities in Wales were hit hard because of Covid-19 and during lockdown.In this evidence we call for further devolution of powers that will enable the Welsh Government to provide equitable financial stability for the people of Wales. Our evidence draws on our own primary research and is supported by a wealth of secondary research from academics, activists and civil society organisations who work on the frontline in supporting those in needs across Wales. This evidence discusses the current levels of poverty inWales and highlights the rising incidence of food bank use as a key identifier. Moreover, the evidence also acknowledges the potential economic impact in Wales as the pandemic dust settles and discusses the attainment (and gaps) of Local Assistance Schemes, furlough, taxation, UC, and the recent £20 uplift. Finally, we end with a significant discussion of evidence surrounding the proposal for a trial of a Universal Basic Income in Wales and discuss the link between this and the Wellbeing of Future Generations in Wales

Managing the symptoms of neuropathic pain: An exploration of patients' experiences

The debilitating effects of chronic neuropathic pain on everyday life are considerable but little is known about how individual sufferers manage these effects. Virtually nothing is known about what patients prefer, what measures they take themselves, when, or in what combinations. The aim of this study was to explore patients’ reports of how they managed their neuropathic pain symptoms. Three focus groups including 10 participants were used to generate qualitative data on both individual and shared experiences of managing their symptoms of neuropathic pain. Discussions were recorded and transcribed verbatim. Data were analysed using thematic analysis, identifying categories and broader themes of importance to patients. The most common management strategy was the use of conventional medications, often associated with poor effectiveness and unpleasant side-effects. Complementary and alternative medicine was ineffective but many found resting or retreating helpful. They exhibited a repeated cycle of seeking help to manage the pain, with each unsuccessful attempt followed by new attempts. Some had tried to accept their pain, but there was insufficient psychological, social, emotional and practical support to allow them to do this successfully. This exploratory study provides a basis from which to develop a larger study to validate and extend the findings. Other issues meriting research are the effectiveness of cognitive behavioural therapies for those with neuropathic pain; and an exploration and subsequent evaluation of different types of social, practical and emotional support needed to help live with neuropathic pain