Management of Pain Among the Elderly

This article discusses the pharmacological approach to pain management in the elderly. It explains the rationale behind the approach, benefits, and risks. The article also highlights the importance of pain assessment and interdisciplinary team approach towards care.

Management of pain among the elderly
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Introduction
Ageing, according to Roberts, Brox, Jevsevar, & Sevarino is the accumulation of both structural
and functional changes in an individual as time goes by. Often, individuals have the desire to get
old and be wiser without knowing that ageing is associated with different complications such as
the risk of falls and joint pains(Roberts, Brox, Jevsevar, & Sevarino, 2015, p.133).. Furthermore,
ageing is associated with a deterioration in fertility and physiological functions and even death.
Ageing is a natural process and inevitable and human beings have very little influence over the
same. The geriatric nurses are therefore supposed to come up with evidence based interventions
that will assist or improve the quality of life and well-being of the aged individuals. Within the
framework of this assignment, there will be an analysis of pain management as an evidence
based intervention to one of an 80 year old female patient.
Discussion
Explanation of the EB intervention and the rationale
With several studies indicating that pain among the elderly is quite common among people above
65 years, evidence based interventions for pain management are needed. One of the evidence
based nursing intervention that seems effective is the pharmacological approach. This basically
involves suing different drugs or medicines to ensure that pain sublimes (Malara et al., 2016,
p. 1221). Studies propose Acetaminophen as the first line drug to manage pain in the elderly.
Several studies acknowledge that this drug is safe if used correctly. The recommended dosage is
4grams a day. Anti-inflammatory and non-opioid pain modulating drugs are also effective in
pain management (Zis et al., 2017, p. 712) .The American Geriatrics Society (AGS) however
acknowledge that acetaminophen might not be effective in a patient who is experiencing pain

that is as a result of inflammation. Furthermore, opioids are ineffective in cases of diabetic
peripheral neuropathy that can be managed through anticonvulsant therapy. This therefore
implies that prior to selecting the best drug, the relevant nurse should conduct a thorough pain
assessment to determine the type of pain and match it with the correct treatment modality.
Drug-drug interactions are a concern when using the pharmacological approach to manage pain
among the elderly. Geriatrics should therefore conduct a thorough screening of the same so as to
bolster the efficacy of the selected drug (Jones et al., 2016, p. 4). One study for example describe
that Lisinopril and enalapril, which are angiotensin-converting enzyme inhibitors lead to
vasodilation of the kidneys and can compromise the urinary system of the elderly who are on
concomitant high dose NSAIDS in pain management.
Critical analysis of the benefits and risks of the intervention on the health and well-being of
the interviewee
Benefits
There are several benefits of pharmacological interventions in pain management among the
elderly patients. Cao, Elvir-Lazo, White, Yumul, & Tang states that untreated pain is the cause of
distress and discomfort (Cao, Elvir-Lazo, White, Yumul, & Tang, 2016, p. 679). Furthermore,
too much pain leads to negative impacts on prognosis and the well-being of an individual. Pain
also contributes to deterioration in physical and cognitive abilities of the elderly patients
(Cravello et al., 2019, p. 60). Furthermore, it a risk of falls and low life expectancy. Untreated
pain also leads to loss of appetite and sleeping disorders. Pharmacological approach to pain
among the elderly is able to overcome all this conditions. Besides, it can bridge different types of
BPSD such as agitation and aggression.

Risks
Just as the case of using any drugs, there is an increased risk of severe reactions from the drugs
administered. Studies illustrate that severe drug reactions might be as a result of pharmacokinetic
variations (Varrassi, Fusco, Coaccioli, & Paladini, 2014, p. 2). Some of the changes include a
decline in renal excretion and decreased metabolism in the elderly .Furthermore, the reactions
can also be as a result of pharmacodynamics changes that are common with age (Alexander &
Glare, 2017). The common pharmacodynamics changes include high sensitivity to certain
analgesics more so the opioids. Similar studies also associated drug reactions to polypharmacy
where the elderly are subjected to diverse range of drugs due to complexities in their health.
Pharmacological management of pain among the pain might also lead to liver damage (Beard et
al., 2016, p. 2148). Studies note that patients receiving a combination of pain relieving drugs like
propoxyphene and acetaminophen are at risk of liver damage if they exceed a dose of 4 grams a
day.
In order to ensure that pain management in the elderly is effective to optimize the well-being of
old people, it is imperative that care givers be very skillful during pain assessment. Furthermore,
they should comprehend the significance of holistic, interdisciplinary team approach towards
care (Aagaard, Tang, & Wollsen, 2016, p. 126). They should also possess necessary knowledge
on both the pharmacological and the non-pharmacological approaches.
Conclusion
Ageing is a natural process that we should always brace for. However, this change comes with a
decline in physiological functioning of important organs such as kidneys, bones and even the
liver. Furthermore, the elderly are at risk of complications such as cancer and arthritis. These

factors collectively lead to severe pain that affects mobility thus impairs the individuals’ ability
to take part in routine activities. Several randomized controlled trials however note that
pharmacological intervention of pain management is effective and has several benefits to those
who are involved despite few risks such adverse drug reactions. With the ever increasing
population of the elderly, it is therefore important that nurses in the geriatric departments
understand the basics of pain assessment and the pharmacological management of pain among
the elderly.

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