The management of elderly patients with pain.

Abstract

This research project is designed to determine a plan of assessment and intervention, which can be used by nurses in the community to help elderly patients cope with painful conditions. A theoretical model is developed, in which coping is defined in terms of the degree of control experienced over pain and other stressors. This model identifies emotional state as the indicator of coping at any particular time. A study is described, in which subjects were 190 retired patients, who were being visited by a district nurse, and who identified that they had persistent or recurrent pain. Data on pain and coping was collected using semi-structured interview. Mood state was measured as the dependent variable. Independent variables for quantitative analysis included pain intensity ratings, pain duration, disability, health, personal and financial problems, age and locus of control. Qualitative data were collected to validate the quantitative findings. Questionnaire data were collected from nurses for purposes of verification and comparison. Nonparametric correlations, and multiple regression analysis, identified that the variables which directly determined coping were feeling the pain to be under control, being occupied, feeling informed about the painful condition, having regrets and non pain-related personal problems (notably bereavement loss). Those who used active occupational and pain-relieving strategies coped better than those who adopted passive coping strategies. Patients generally valued supportive aspects of nursing care, particularly the provision of encouragement and confidence. Nurses systematically underestimated patients' worst pain and overestimated anxiety. There was a significant association between patients' pain complaints and perceived pain exaggeration. Few nurses used a pain assessment protocol, or had received formal education in the management of chronic pain. These results are used to produce guidelines for the nursing management of elderly patients with pain in the community, with particular reference to assessment and intervention, based upon the nursing proces