Talking to older people in care homes : perceptions of their pain and their preferred management strategies : results of a pilot study

This paper describes a qualitative study that was conducted within the care home setting o determine the pain experiences of residents, their preferred strategies and the staff attitudes and understanding about pain. An exploratory cross sectional study within six care homes within one district was conducted using several methods of data collection. The residents and staff were interviewed and a questionnaire given to a random sample of staff. Several key themes were identified by residents including a reluctance to report pain, acceptance that pain wass normal and low expectations of help from medical interventions, fear of chemical or pharmacological interventions, age related rerceptions of pain and lack of awareness of potential pain relieving strategies. Staff interviews highlighted that they wanted to know if the residents were in pain, wanting to do more and an interest in using complementary therapies. Recommendations are made for further research in this area.University of Sheffiel

Assessment and management of pain in older adults with dementia : a review of current practice and future directions

Pain in older adults has received increasing attention within the literature during the last decade, and in the past 12 months, there have been a number of papers published that highlight several key issues in the area. In terms of pharmacology and complementary therapies, there is still a need to evaluate their use in older adults in general. We have seen guidelines introduced and we need to consider how well these are being implemented. However, most importantly, we are now seeing increasing evidence supporting the use of three behavioural pain assessment scales, which look promising for the future

The assessment and management of pain in older people : a systematic review of the literature

This paper presents the findings of a systematic literature which was carried out to determine the most appropriate strategies that could be carried out for the assessment and management of pain in residents living in care homes. Five hundred and seventy-one papers were initially identified and from this total 70 papers were found to be appropriate. These papers were organised into five key themes; Assessment & Behavioural Assessment, Barriers/Attitudes/Perceptions, Cognitive Behavioural Therapy, Complementary Therapies and Education/Guidelines. Most of the papers related to pain in this group were pharmacological suggesting that health care professionals generally feel that pharmacological approaches are the only way to manage pain in this group. Nevertheless, the non-pharmacological papers do suggest that there are other methods of pain control which should be considered. Recommendations for further research are made.Burdett Trust for Nursin

Developing annotated bibliographies : a tool for education, collaboration and research development

The purpose of this paper is to present the process of developing an annotated bibliography as a tool for education and research. The authors of the paper will describe the process and demonstrate the findings from two recently completed bibliographies around pain in the older adult and pain in the terminal stages of palliative care. The benefits of this type of project will be discussed. Both bibliographies have been developed by a team of researchers within the University of Sheffield and are available for students to access as an educational tool. From the work collated within the bibliographies, the research team have been able to identify develop two research proposals that have been submitted for funding.University of Sheffiel

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

Assessment of pain in older people : where are we now and what needs to be done?

The purpose of this paper is to present the findings of a review of the literature into pain and older people. The funded study was part of the development of an annotated bibliography published in August 2005. The review included all major databases and involved the collection of 214 papers between the dates of 1995 and 2005. The papers were divided into several major themes, which include experiences, management (pharmacological and non-pharmacological), assessment, and attitudes. Within this paper, the results of the review into pain assessment will be discussed, which includes 42 of the collected papers. The other sections will be published later. The paper will discuss issues pertaining to the development of specific tools for older people, a discussion of tools already available, comparisons of staff versus older people’s perceptions of pain scales, and articles with cognitive impairment as a focus. Recommendations for further study are made.University of Sheffiel

Assessment of Pain in adults with cognitive impairment : a review of the tools

The aim of this paper is to discuss the results of a review into the literature related to chronic pain and the older adult. Several themes within the review have been identified and reported elsewhere and the final report has been published by the University of Sheffield in the form of an annotated bibliography. This report focuses upon the findings of the in relation to the assessment of pain in the adult with cognitive impairment. Issues surrounding assessment in the non-cognitively impaired older adult have also been reported elsewhere. For this paper nine studies will be discussed which report the development and testing of pain assessment scales the focus of which is upon behavioural indicators of pain. Some scales have been omitted from the review and the rationale for this decision will be discussed. Each of the selected scales will be discussed and the authors will make recommendations for both clinical practice and for future research based upon the validity, reliability and user friendliness of the scales. From the paper it can be concluded that the Abbey, DOLOPLUS-2 and PACSLAC appear to be the most reliable and valid and in terms of the “user friendliness” would be appropriate to explore further. Recommendations are made for further multi-centre evaluation of these scales.University of Sheffiel

Culture and Race in Provider-Client Relationships

Given that minority group members are underrepresented in the teaching, medical, and legal professions, minority group members often have White teachers, doctors, and lawyers. This is frequently the case even when students, patients and clients would prefer service providers similar to them in racial or ethnic background. This paper identifies possible cultural barriers to effective one-on-one relationships between White teachers, doctors and lawyers and those who receive their services, explores the potential for biased expectations to influence the services provided and outcomes attained, and contrasts the goals of White and minority educators, doctors, and lawyers, arguing that these differences have potentially negative implications for service recipients. Policy approaches to mitigating potential problems caused by the lack of match are considered, as are potential problems arising from an overly narrow emphasis on match

Development of advanced analgesic dressings for chronic wound healing

Background: Pain is a ubiquitous problem in patients with chronic leg wounds. Recent studies have reported that 17 - 65% of patients experience severe or continuous pain that, associated with other characteristics of chronic ulcers such as odour, have debilitating effects on the patients including both their mental and psychological wellbeing. The aim of this work is to develop advanced wound dressings for local delivery of an analgesic drug that can help to manage pain associated with chronic leg ulcers in older adults. The addition of hyaluronic acid (HA) in the composition added beneficial and well recognized HA properties in the wound healing process. Methods: Advanced dressings loaded with an analgesic drug (lidocaine) were formulated as lyophilised xerogels (wafers) by freeze-drying. Different HA ratios by weight were used to improve the wafer characteristics. The dressings were tested for functional characteristics including mechanical strength, porous microstructure, stability, polymorphic/amorphous transitions, hydration, swelling and in vitro mucoadhesion. An HPLC method was developed to assess lidocaine release from wafers. Results: On the basis of feasibility study of the use of analgesic dressings in older adults with leg ulcers, an advanced dressing loaded with lidocaine was formulated. Wafers, due to their porous nature, have proved to be suitable for medium to high exuding wounds (common in leg ulcers), whilst still maintaining their physical integrity. Both blank and drug-loaded wafers were soft, flexible, elegant in appearance and non-brittle in nature. The addition of HA had an influence on wafer structure changing their properties, but mechanical characterisation demonstrated that the wafers were strong enough to withstand normal stresses but also flexible to prevent damage to newly formed skin tissue. The lidocaine release from the optimised dressing showed continuous release for over 12 h. Conclusions: Wafer seems to be a very promising system for delivery of analgesic drug to the wound. Further studies are in progress to evaluate in vitro activity of the dressings and role of HA in the wound healing process

What do we mean by 'older adults' persistent pain self-management'? A concept analysis.

Background: No standard definition exists for the concept “persistent pain self-management” or how it should be defined in relation to older adults. Poorly defined concepts can result in misunderstandings in the clinical setting and can hinder research through difficulties identifying or measuring the concept. Objective: To ascertain attributes, referents, antecedents, and consequences of the concept older adults' persistent pain self-management and develop a theoretical definition. Design: Rodgers evolutionary model of concept analysis was used to systematically analyze articles from the academic and grey literature (N = 45). Data were extracted using standardized extraction forms and analyzed using thematic analysis. Findings: This concept was discussed in three ways: as an intervention, in reference to everyday behaviors, and as an outcome. Five defining attributes were identified: multidimensional process, personal development, active individuals, symptom response, and symptom control. Patients' perceived need and ability to manage pain with support from others is necessary for pain self-management to occur. Numerous physical, psychological, and social health consequences were identified. A theoretical definition is discussed. Conclusions: Our findings have clarified existing use and understanding regarding the concept of older adults' persistent pain self-management. We have identified three areas for future development: refinement of the attributes of this concept within the context of older adults, an exploration of how providers can overcome difficulties supporting older adults' persistent pain self-management, and a clarification of the overall theoretical framework of older adults' persistent pain self-management