Pain Assessment and Management in Elderly Patients

This report evaluates pain assessment and management strategies for elderly patients. It discusses the sources of pain in the elderly, pain assessment tools, and multi-disciplinary pain management approaches. The report emphasizes the importance of effective communication and patient-centered care.

Running header; pain assessment and management. 1
A report on pain assessment and pain management of elderly patients.
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Caring for the elderly. 2
Introduction
This is a report that involves critical reasoning in the clinical area. Clinical
reasoning/clinical judgment/decision making/problem solving/critical thinking is usually used
interchangeably. This is a process in which the nurses and other clinicians gather
cues/information, processes this information, get/come to an understanding with a patient
situation/problem, planning on the care and interventions and then implementing these
interventions. This is followed with an evaluation of the intervention, a reflection on the process
and lastly, the lessons are learned from the process (Hoffman, 2007; Kraischsk & Antony 2011;
Laure et al., 2011). The clinical reasoning is a process that depends on a person’s personality,
attitudes, preconceptions and philosophical perceptions (McCarthy,2013). It is a cyclic process.
In this report, the focus will be on an event/nursing problem in the clinical area that I had been
rotating for the last three weeks. I rotated the OPERA (Orderly Persons Evaluation Review
Assessment) ward for three weeks. The problem I identified was on effective pain management. I
will evaluate the different strategies that nurses use so as to effectively manage the pain of the
aged.
Pain as a result of old age.
Hajjar et al., (2007) reports that multiple medical conditions; diabetes, cancer, arthritis
and heart conditions/condition are the major pathological conditions that are the sources of pain
in the elderly. These conditions cause acute or/and chronic nociceptive that is, somatic and
visceral or/and neuropathic pain. According to Backstrom, Whitman & Flynn (2011), states that
musculoskeletal degeneration is one of the most significant sources of pain in the elderly clients.
The lumbar spinal stenosis is of the major problems in the aged. It causes lower back pain,
causes depression and disabilities. These translate to reduced quality of life in the aged, increases

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risks of falls, and significant disabilities. In most cases the elderly experiences different types of
pain, in different location. In most cases, the pain is treated using the standard opiates and
narcotics. Most of these medications cause very serious adverse effects as the elderly patients
have diminishing hepatic and renal functioning. Dalacorte & Rigo (2011), states that in most
cases pain in the elderly patients, in most cases it is undertreated.
Pain assessment
In the wards, I observed the nurses using several tools/strategies to assess the client's
pain. The first strategy I saw them use was the PQRST acronym to assess pain. P stands for the
place/location of pain, Q for the quality of pain, R for the radiation of pain S-severity, the effects
that the pain has on the physical activity, eating and sleeping and lastly, T-timing for the
duration, the frequency of pain and the duration of one episode. They also used the Numerical
Rating Scales (NRS) where the patients were asked to rate their pain from 0-10). I observed them
using Lowa Pain Thermometer Scales. This was done mostly on patients who had difficulty in
communicating. They were shown a thermometer and asked to point the point at which their pain
would be on the rising mercury. The base indicated no pain while the top part indicated a pain
that is unbearable. In addition to this, the patients whose cognitive functioning was moderately or
severely impaired they used observational pain measurement scales. I observed the nurses using
a checklist to assess four factors; the facial expressions, social personality and mood, the activity
and body movement and others; sleeping patterns, eating habits physiological and vocalization
changes.
The pain assessment and measurement of the elderly requires several additional
considerations when selecting the tools. They need to be easily understood and simply worded
(Flaherty, 2012). Aging brings about functional impairment; vision, hearing, cognitive and many

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others. This means that they are unable to use a visual analog scale when assessing their pain,
although they can give a self-report about their pain, the verbal rating scale. For the patients with
cognitive impairment, they can benefit from Numerical Rating Scales (NRS) (Rockville, 2012;
Acute Pain Management, 2012) and the Lowa Pain Thermometer Scales. They can also benefit
from the observational pain measurement scales, for example, the Pain Assessment Checklist for
Seniors with Limited Ability to Communicate (PACSLAC), (Fuchs Lacelle &
Hadijistavropoulos, 2014).
Pain management
I observed that the patient’s pain management was not only the responsibility of the
nurses rather it involved so many parties. It was a multi-discipline procedure. It involved the
nurses, pharmacists, dietician, clergy, social workers, the speech, occupational and the physical
therapist. Mitchell & Golden (2015) reports that caring for the old/elderly should be a team-
based health care. The major role of the nurse that I was able to detect was to coordinate all these
teams. This was done through effective communication. According to Mitchell & Golden (2015)
for a successful team based health care provision adequate and effective communication is very
important. It was the nurse’s role to ensure that there was effective pain management among the
teams. These teams worked together in unison so as to provide the best care to the patient and
his/her family. The nurses contributed the following in the patient’s care; they performed an
intensive physical assessment on the patient, took history, educated the patient/relatives on the
pain management. They kept the patient’s pain diary, did a comprehensive pain assessment on
the patient, assesses the patient’s compliance to pain medication, their effectiveness, and the side
effects. I also observed that the care integrated the family members.

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Lastly, I observed them providing both the pharmacological and non-pharmacological
pain management modalities. The most common pain medications that they received included
the standard opioids that are morphine, oxycodone, fentanyl, and hydromorphone. They were
also given narcotics. These drugs are commonly known to cause hallucinations, cognitive
impairment, depress respiration and increase agitation, gastrointestinal events (nausea, diarrhea,
constipation), dizziness, sedation, and a decline of the daily activities. (Maison, 2007; Lynch,
2011) therefore, I observed the nurse’s monitoring this patient very diligently and closely. I
observed that the nurses observed/monitored the patient’s bowel program so closely as opiates
cause constipation. This is one of the major complications in the aged as they already get
constipated as a result of old age. It can cause impaction and later on bowel obstruction.
In the non-pharmacological pain medication, which was used together with the
pharmacological therapies included, physical therapy (the massage, the hot and cold compresses
and electrophysical modalities). They ensured that the patient’s exercised as a way to relieve
their pain. The nurses conducted psychological therapy on the patients through counseling
(Prowse, 2007; Rockville, 2012). Lastly, the nurses conducted both the complementary and
alternative therapies so as to ensure effective pain management (Prowse, 2007; Rockville, 2012).
Conclusion
The above clearly shows that the nurses at OPERA wards were skillful and
knowledgeable in pain assessment and management in elderly patients. On pain assessment, they
choose the best for the patient on the basis of the patient’s degree of functional impairment. It
also shows that they were able to use their clinical reasoning as they assessed each patient
individually (patient-centered care) and involved the patient’s family on the patient’s care. On
assessment they were able to identify the patient’s condition(situation), come up with the goals

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(improve the patient’s quality of life by managing their pain), formulating action plans (to start
the patient on both the pharmacological and non-pharmacological interventions), intervening by
starting the patient on the given medication/therapies and lastly evaluate the interventions for
effectiveness and adverse effects.

Caring for the elderly. 7
References
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