Managing Pain in the Institutionalized Elderly

The Nursing Role
  • Nancy Wells
  • Merrie Kaas
  • Karen Feldt
Part of the The Springer Series in Adult Development and Aging book series (SSAD)

Abstract

Pain is a common symptom across all age groups but becomes increasingly prevalent in older adults, who experience a variety of chronic diseases that are potentially painful (Ferrell, 1991; Foley, 1993; Harkins, 1988). Attention has recently been focused on the adequate assessment and treatment of pain in the elderly institutionalized population (Ferrell, 1991; Parmelee, Smith, & Katz, 1993; Sengstaken & King, 1993). Although elders residing in the community may not adequately treat pain for a variety of reasons (e.g., personal beliefs and reluctance to take pain medications), institutionalized elders, whether in acute-care or long-term-care settings, rely on nursing staff to appropriately assess pain, administer pain medications as necessary, and evaluate the response to such medications (Carr, 1990; Lavies, Hart, Rounsefell, & Runciman, 1992; Seers, 1987). Nurses wield much of the control over the management of pain in institutional environments.

Keywords

Pain Relief Pain Management Nursing Staff Cancer Pain Pain Assessment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Agency for Health Care Policy and Research. (1992). Acute pain management: Operative or medical procedures and trauma. Clinical practice guideline. Rockville, MD: AHCPR Pub. No. 92-0032.Google Scholar
  2. American Pain Society, Committee on Quality Assurance Standards. (1991). American Pain Society quality assurance standards for relief of acute pain and cancer pain. In M. R. Bond, J. E. Charlton, & C. J. Woolf (Eds.), Proceedings of the With World Congress on Pain. Amsterdam: Elsevier Science.Google Scholar
  3. Arndt, M., & Bigelow, B. (1994). The impact of individual and contextual factors on nursing care and the implementation of AHCPR practice guidelines. Medical Care Review, 61, 61–82.CrossRefGoogle Scholar
  4. Bensink, G. W., Godbey, K. L., Marshall, M. J., & Yarandi, H. J. (1992). Institutionalized elderly relaxation, locus of control, self-esteem. Journal of Gerontological Nursing, 18(4), 30–38.PubMedGoogle Scholar
  5. Bondestam, E., Hovgrem, K., Johansson, G., Jern, S., Herlitz, J., & Holmberg, S. (1987). Pain assessment by patients and nurses in the early phase of acute myocardial infarction. Journal of Advanced Nursing, 12, 677–682.PubMedCrossRefGoogle Scholar
  6. Brody, E. M., & Kleban, M. H. (1983). Day-to-day mental and physical health symptoms of older people: A report on health logs. The Gerontologist, 23, 75–85.PubMedCrossRefGoogle Scholar
  7. Cariaga, J., Burgio, L., Flynn, W., & Martin, D. (1991). A controlled study of disruptive vocalizations among geriatric residents in nursing homes. Journal of the American Geriatrics Society, 39, 501–507.PubMedGoogle Scholar
  8. Carlson, C. R., Ventrella, M. A., & Sturgis, E. T. (1987). Relaxation training through muscle stretching procedures: A pilot case. Journal of Behavior Therapy and Experimental Psychiatry, 18, 121–126.PubMedCrossRefGoogle Scholar
  9. Carr, E. C. J. (1990). Postoperative pain: Patients’ expectations and experiences. Journal of Advanced Nursing, 15, 89–100.PubMedCrossRefGoogle Scholar
  10. Chandler, J., & Chandler, J. (1988). The prevalence of neuropsychiatric disorders in a nursing home population. Journal of Geriatric Psychiatry and Neurology, 1, 71–76.PubMedCrossRefGoogle Scholar
  11. Choiniere, M., Melzack, R., Girard, N., Rondeau, J., & Paquin, M. J. (1990). Comparison between patients’ and nurses’ assessment of pain and medication efficacy in severe burn injuries. Pain, 40, 143–152.PubMedCrossRefGoogle Scholar
  12. Chrischilles, E. A., Foley, D. J., Wallace, R. B., Lenke, J. H., Hanlon, J. T., Gylnn, R. J., Ostfeld, A. M., & Guralink, J. M. (1992). Use of medications by persons 65 and over: Data from the established populations for epidemologic studies of the elderly. Journal of Gerontology, 47(5), M137–M144.PubMedCrossRefGoogle Scholar
  13. Cleeland, C. (1987). Barriers to the management of cancer pain. Oncology, 1(2 Suppl), 19–26.PubMedGoogle Scholar
  14. Closs, S. J., Fairtlough, H. I., Tierney, A. J., & Currie, C. T. (1992). Pain in elderly orthopaedic patients. Journal of Clinical Nursing, 2, 41–45.CrossRefGoogle Scholar
  15. Cohen, F. L. (1980). Postsurgical pain relief: Patients’ status and nurses’ medication choices. Pain, 9, 265–274.PubMedCrossRefGoogle Scholar
  16. Collins, G., & Stone, L. A. (1966). Pain sensitivity, age and activity level in chronic schizophrenics and in normals, Journal of Psychiatry, 112, 33–35.CrossRefGoogle Scholar
  17. Crook, J., Rideout, E., & Browne, G. (1984). The prevalence of pain complaints in a general population. Pain, 18, 299–314.PubMedCrossRefGoogle Scholar
  18. Dirks, J. F., Wunder, J., Kinsman, R., McEhinny, J., & Jones, N. F. (1993). A pain rating scale and a pain behavior checklist for clinical use: Development, norms, and the consistency score. Psychotherapy Psychosomatics, 59, 41–49.PubMedCrossRefGoogle Scholar
  19. Donovan, M., Dillon, P., & McGuire, L. (1987). Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain, 30, 69–78.PubMedCrossRefGoogle Scholar
  20. Evans, D., Funkenstein, J., & Albert, M. (1989). Prevalence of Alzeheimer’s disease in a community population of older adults. Journal of the American Medical Association, 262, 2551–2556.PubMedCrossRefGoogle Scholar
  21. Fagerhaugh, S. Y., & Strauss, A. (1977). Politics of pain management: Staff-patient interactions. Menlo Park, CA: Addison-Wesley.Google Scholar
  22. Faherty, B. S., & Grier, M. R. (1984). Analgesic medication for elderly people post-surgery. Nursing Research, 33, 369–372.PubMedCrossRefGoogle Scholar
  23. Ferrell, B. A. (1991). Pain management in elderly people. Journal of the American Geriatrics Society, 39, 64–73.PubMedGoogle Scholar
  24. Ferrell, B. A. (1993). The assessment and control of pain in the nursing home. In L. Z. Rubenstein & D. Weilan (Eds.), Improving care in the nursing home (pp. 241–250). London: Sage.Google Scholar
  25. Ferrell, B. A., Ferrell, B. R., & Osterweil, D. (1990). Pain in the nursing home. Journal of the American Geriatrics Society, 38, 409–414.PubMedGoogle Scholar
  26. Ferrell, B. R., Ferrell, B. A., Rhiner, M., & Grant, M. M. (1991). Family factors influencing cancer pain. Postgraduate Medicine Journal, 67 (Suppl. 2), S64–S69.Google Scholar
  27. Ferrell, B. R., McCaffery, M., & Ropchan, R. (1992). Pain management as a clinical challenge for nursing administration. Nursing Outlook, 40, 263–268.PubMedGoogle Scholar
  28. Foley, K. M. (1993). Pain management in the elderly. In W. R. Hazzard, E. L. Bierman, J. P. Blass, W. H. Ettinger, & J. B. Halter (Eds.), Principles of geriatric medicine (3rd ed.), (pp. 317–331). New York: McGraw-Hill.Google Scholar
  29. Forrest, M., Hermann, G., & Andersen, B. (1989). Assessment of pain: A comparison between patients and doctors. Acta Anaesthesiology Scandinavia, 33, 255–256.CrossRefGoogle Scholar
  30. Fraser, J., & Kerr, J. R. (1993). Psychophysiological effects of back massage on elderly institutional patients. Journal of Advanced Nursing, 18(2), 238–245.PubMedCrossRefGoogle Scholar
  31. Greenlee, K. K. (1991). Pain and analgesia: Considerations for the elderly in critical care. AACN Clinical Issues in Critical Care Nursing, 2, 720–728.PubMedGoogle Scholar
  32. Gu, X., & Belgrade, M. J. (1993). Pain in hospitalized patient with medical illnesses. Journal of Pain and Symptom Management, 8, 17–21.PubMedCrossRefGoogle Scholar
  33. Hall-Lord, M. L., Larsson, G., & Bostrom, I. (1994). Elderly patients’ experiences of pain and distress in intensive care: A grounded theory study. Intensive and Critical Care Nursing, 10, 133–141.PubMedCrossRefGoogle Scholar
  34. Hardy, J. D., Wolff, H. G., & Goodell, H. (1943). The pain threshold in man. American Journal of Psychiatry, 99, 744–751.Google Scholar
  35. Harkins, S. W., & Chapman, C. R. (1977). Age and sex differences in pain perception. In D. J. Anderson & B. Mathews (Eds.), Pain in the trigeminal region (pp. 435–441). Amsterdam: Elsevier.Google Scholar
  36. Harkins, S. W., Price, D., & Martelli, M. (1986). Effects of age on pain perception: Thermoreception. Journal of Gerontology, 41, 58–63.PubMedCrossRefGoogle Scholar
  37. Harkins, W. (1988). Pain in the elderly. In R. Dubner, G. F. Gebhart, & M. R. Bond (Eds.), Proceedings of the Fifth World Congress on Pain (pp. 355–367). Amsterdam: Elsevier Science.Google Scholar
  38. Herr, K. A., & Mobily, P. R. (1991). Complexities of pain assessment in the elderly: Clinical considerations. Journal of Gerontological Nursing, 17(4), 12–19.PubMedGoogle Scholar
  39. Herr, K. A., & Mobily, P. R. (1993). Comparison of selected pain assessment tools for use with the elderly. Applied Nursing Research, 6, 39–46.PubMedCrossRefGoogle Scholar
  40. Houston, K. (1993). An investigation of rocking as relaxation for the elderly. Geriatric Nursing, 14(4), 186–189.PubMedCrossRefGoogle Scholar
  41. Hurley, A. C., Volicer, B. J., Hanarahan, P. A., Houde, S., & Volicer, L. (1992). Assessment of discomfort in advanced Alzheimer’s patients. Research in Nursing and Health, 15, 369–377.PubMedCrossRefGoogle Scholar
  42. International Association for the Study of Pain. (1979). Pain terms: A list with definitions and notes on usage. Pain, 6, 247–252.CrossRefGoogle Scholar
  43. Jacox, A., Ferrell, B., Heidrich, G., Hester, N., & Miaskowski, C. (1992). A guideline for the nation: Managing acute pain. American Journal of Nursing, 92(5), 49–55.PubMedGoogle Scholar
  44. Juhl, I. U., Christensen, B. V., Bulow, H. H., Wilbeck, H., Dreijer, N. C., & Egelund, B. (1993). Post-operative pain relief, from the patients’ and nurses’ point of view. Acta Anaesthesiologica Scandinavica, 37, 404–409.PubMedCrossRefGoogle Scholar
  45. Keller, E., & Bzdek, V. M. (1986). Effects of therapeutic touch on tension headache pain. Nursing Research, 35, 101–106.PubMedGoogle Scholar
  46. Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain, 23, 345–356.PubMedCrossRefGoogle Scholar
  47. Kodiath, A. (1991). Pain and promise of aging America. Holistic Nursing Practice, 6(1), 58–65.PubMedGoogle Scholar
  48. Kuhn, S., Cooke, K., Collins, M., Jones, J. M., & Mucklow, J. C. (1990). Perceptions of pain relief after surgery. British Medical Journal, 300, 1687–1690.PubMedCrossRefGoogle Scholar
  49. Lavies, N., Hart, L., Rounsefell, B., & Runciman, W. (1992). Identification of patient, medical and nursing staff attitudes to postoperative opioid analgesia: Stage 1 of a longitudinal study of postoperative analgesia. Pain, 48, 313–320.PubMedCrossRefGoogle Scholar
  50. Marks, R. M., & Sachar, E. J. (1973). Undertreatment of medical inpatients with narcotic analgesics. Annals of Internal Medicine, 78, 173–181.PubMedCrossRefGoogle Scholar
  51. Marzinski, L. R. (1991). The tragedy of dementia: Clinically assessing pain in the confused, nonverbal elderly. Journal of Gerontological Nursing, 17(6), 25–28.PubMedGoogle Scholar
  52. McCaffery, M., & Beebe, R. (1989). Pain: Clinical manual for nursing practice. St. Louis: Mosby.Google Scholar
  53. McCaffery, M., & Ferrell, B. (1991). How would you respond to these patients in pain? Nursing, 21(6), 34–37.PubMedGoogle Scholar
  54. McCaffery, M., Ferrell, B., O’Neil-Page, E., & Lester, M. (1990). Nurses’ knowledge of opioid analgesic drugs and psychological dependence. Cancer Nursing, 13, 21–27.PubMedCrossRefGoogle Scholar
  55. Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277–299.PubMedCrossRefGoogle Scholar
  56. Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30, 191–197.PubMedCrossRefGoogle Scholar
  57. Melzack, R., & Wall, P. D. (1988). The challenge of pain (2nd ed.). London: Penguin Books.Google Scholar
  58. Miaskowski, C., Nichols, R., Brody, R., & Synold, T. (1994). Assessment of patient satisfaction utilizing the American Pain Society quality assurance standards on acute and cancer-related pain. Journal of Pain and Symptom Management, 9, 5–11.PubMedCrossRefGoogle Scholar
  59. Mobily, P. R., Herr, K. A., Clark, M. K., & Wallace, R. B. (1994). An epidemiologic analysis of pain in the elderly. Journal of Aging and Health, 6(2), 139–154.CrossRefGoogle Scholar
  60. Moss, M. S., Lawton, M. P., & Glicksman, A. (1991). The role of pain in the last year of life of older persons. Journal of Gerontology, 46, P51–P57.PubMedCrossRefGoogle Scholar
  61. Mumford, J. M. (1965). Pain perception threshold and adaptation of normal man teeth. Archives of Oral Biology, 10, 957–968.PubMedCrossRefGoogle Scholar
  62. Nelson, L., Taylor, F., Adams, M., & Parker, D. E. (1990). Improving pain management for hip fractured elderly. Orthopaedic Nursing, 9(3), 79–83.PubMedCrossRefGoogle Scholar
  63. Newman, F., Griffin, B., Black, R., & Page, S. (1989). Linking level of care to level of need: Assessing the need for mental health care for nursing home residents. American Psychologist, 44, 1315–1324.PubMedCrossRefGoogle Scholar
  64. Oberle, K., Paul, P., Wry, J., & Grace, M. (1990). Pain, anxiety and analgesics: A comparative study of elderly and younger surgical patients. Canadian Journal on Aging, 9(1), 13–22.CrossRefGoogle Scholar
  65. Owen, H., McMillian, V., & Rogowski, D. (1990). Postoperative pain therapy: A survey of patients’ expectations and their experiences. Pain, 41, 303–307.PubMedCrossRefGoogle Scholar
  66. Parke, B. (1992). Pain in the cognitively impaired elderly. Canadian Nurse, 88(7), 17–20.PubMedGoogle Scholar
  67. Parmelee, P. A., Smith, B., & Katz, I. R. (1993). Pain complaints and cognitive status among elderly institution residents. Journal of the American Geriatrics Society, 41, 517–522.PubMedGoogle Scholar
  68. Potter, P. A., & Perry, A. G. (1989). Fundamentals of Nursing: concepts, process, and practice. St. Louis: Mosby.Google Scholar
  69. Rhiner, M., Ferrell, B. R., Ferrell, B. A., & Grant, M. M. (1993). A structured nondrug intervention program for cancer pain. Cancer Practice, 1(2), 137–143.PubMedGoogle Scholar
  70. Richards, J. S., Nepomuceno, C., Riles, M., & Suer, Z. (1982). Assessing pain behavior: The UAB pain behavior scale. Pain, 14, 393–398.PubMedCrossRefGoogle Scholar
  71. Rudy, T. E., Kerns, R. D., & Turk, D. C. (1988). Chronic pain and depression: Toward a cognitive-behavioral mediation model. Pain, 35, 129–140.PubMedCrossRefGoogle Scholar
  72. Ryan, P., Vortherms, R., & Ward, S. (1994). Cancer pain: Knowledge, attitudes of pharmacological management. Journal of Gerontological Nursing, 20, 7–16.PubMedGoogle Scholar
  73. Ryden, M. B., & Feldt, K. S. (1992). Goal-directed care: Caring for aggressive nursing home residents with dementia. Journal of Gerontological Nursing, 18(11), 35–41.PubMedGoogle Scholar
  74. Saxon, S. V. (1991). Pain management techniques for older adults. Springfield, IL: Charles C Thomas. Schuster, J. M., & Goetz, K. L. (1994). Pain. In C. E. Coffey & J. L. Cummings (Eds.), Textbook of geriatric neuropsychiatry (pp. 334–350). Washington, DC: American Psychiatric Press.Google Scholar
  75. Seers, K. (1987). Perceptions of pain. Nursing Times, 83(48), 37–39.PubMedGoogle Scholar
  76. Sengstaken, E. A., & King, S. A. (1993). The problem of pain and its detection among geriatric nursing home residents. Journal of the American Geriatrics Society, 41, 541–544.PubMedGoogle Scholar
  77. Sherman, E. D., & Robillard, E. (1960). Sensitivity to pain in the aged. Canadian Medical Association Journal, 83, 944–947.PubMedGoogle Scholar
  78. Short, L. M., Burnett, M. L., Egbert, A. M., & Parks, L. H. (1990). Medicating the postoperative elderly: How do nurses make their decisions? Journal of Gerontological Nursing, 16(7), 12–17.PubMedGoogle Scholar
  79. Simington, J. A. & Laing, G. P. (1993). Effects of therapeutic touch on anxiety in the institutionalized elderly. Clinical Nursing Research, 2(4), 438–450.PubMedCrossRefGoogle Scholar
  80. Turk, D. C. Okifuji, A., & Scharff, L. (1995). Chronic pain and depression: Role of perceived impact and perceived control in different age cohorts. Pain, 61, 93–101.PubMedCrossRefGoogle Scholar
  81. Vortherms, R., Ryan, P., & Ward, S. (1992). Knowledge and attitudes regarding pharmacologic management of cancer pain in a statewide random sample of nurses. Research in Nursing and Health, 15, 459–466.PubMedCrossRefGoogle Scholar
  82. Walker, J. M., Akinsanya, J. A., Davis, B. D., & Marcer, D. (1990). The nursing management of elderly patients with pain in the community: Study and recommendations. Journal of Advanced Nursing, 15(10), 1154–1161.PubMedCrossRefGoogle Scholar
  83. Ward, S. E., Goldberg, N., Miller-McCauley, V., Mueller, C., Nolan, A., Pawlik-Plank, D., Robbins, A., Stormoen, D., & Weissman, D. E. (1993). Patient-related barriers to management of cancer pain. Pain, 52, 319–324.PubMedCrossRefGoogle Scholar
  84. Ward, S. E., & Gordon, D. (1994). Application of the American Pain Society quality assurance standards. Pain, 56, 299–306.PubMedCrossRefGoogle Scholar
  85. Wilder-Smith, C. H., & Schüler, L. (1992). Postoperative analgesia: Pain by choice? The influence of patient attitudes and patient education. Pain, 50, 257–262.PubMedCrossRefGoogle Scholar
  86. Wood, C. (1993). Mood change and perceptions of vitality: A comparison of the effects of relaxation, visualization and yoga. Journal of the Royal Society of America, 86(5), 254–258.Google Scholar
  87. Woodrow, K. M., Friedman, G. D., Siegalaub, A. B., & Cohen, M. F. (1972). Pain tolerance: Differences according to age, sex, and race. Psychosomatic Medicine, 34, 548–556.PubMedGoogle Scholar
  88. Zalon, M. L. (1993). Nurses’ assessment of postoperative patients’ pain. Pain, 54, 329–334.PubMedCrossRefGoogle Scholar
  89. Zullich, S. G., Grasela, T. H., Fielder-Kelly, J. B., & Gengo, F. M. (1992). Impact of triplicate prescription program on psychotrophic prescribing patterns in long-term care facilities. Annals of Pharmacotherapy, 26, 539–546.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Nancy Wells
    • 1
  • Merrie Kaas
    • 2
  • Karen Feldt
    • 3
  1. 1.Department of Nursing ResearchVanderbilt University Medical CenterNashvilleUSA
  2. 2.School of NursingUniversity of MinnesotaMinneapolisUSA
  3. 3.Ramsey Nursing Home ServicesSt. PaulUSA

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