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CET

Clinical updates: Older people

Presented at: EFIC Virtual Pain Education Summit

Speakers

Irmela Gnass

Professor, Institute of Nursing Science and Practice, Paracelsus Medical University, Germany
BIOGRAPHY
Patricia Schofield

Professor, Pain & Ageing, Sheffield Hallam University, United Kingdom
BIOGRAPHY
Juanita Cheuk-Alam-Balrak

Nurse Practitioner, Teacher, Researcher, Acute Pain Service of the Erasmus Medical Center, Rotterdam, The Netherlands
BIOGRAPHY

Abstract

Chair: Irmela Gnass, Germany

Principles of pain assessment in older people including those with cognitive impairment

Irmela Gnass, Germany

Based on the effects of age on pain mechanisms and experiences, the lecture will mainly focus the options of pain assessment in older people, including the continuum from self-report, care givers, family towards behavioral observation.

Rarely nurse known why older people can’t understand the necessity or the process of pain assessment. Misconceptions about pain assessment are also seen within professional nursing teams. Theoretical frameworks might enhance the understanding on communication abilities of pain experience of older people. Furthermore, it might give some explanation of influencing factors in pain assessment on both sides, observer and older people or family.

In the lecture beside a theoretical framework some validated pain assessment tools available for use with older people will be presented, including though for people with cognitive impairment. In addition, cut-off points or thresholds which should led to pain treatment are named and discussed.

Older people don’t seldom suffer on chronic pain. That experience last for a longer time period. Therefore, the relevance of a systematic pain re-assessment will be presented and discussed due its influence on the care plan for older people.

Managing pain in older people: Pharmacological issues

Patricia Schofield, United Kingdom

The aim of the session is to explore the pharmacological interventions for the management of pain in the older population and to discuss the role of the nurse in the administration and monitoring of these interventions.

Objectives:

• Critically discuss the different types of analgesics and potential combinations
• Understand the principles of safe prescribing and administration considering the appropriateness of the prescription
• Prevent and manage common side effects and adverse events associated with pain treatment

It is well documented that 40-80% of the older population have poorly controlled chronic pain. However, older adults present many challenges when it comes to prescribing drugs to manage pain. There are a number of factors which come into play. These include multiple co-morbidities such as frailty or cognitive impairment along with age associated changes which impact upon the kidneys and the liver which in turn impacts upon the metabolism of drugs. Furthermore, many older adults are often taking a combination of drugs which may interact against each other. Finally, older adults and health care professionals have fears and misconceptions regarding prescribing and administering in this population which prevents appropriate drug administration including fears of addiction and dependence.

Managing pain in older people: Non-pharmacological approaches

Juanita Cheuk-Alam-Balrak, Netherlands

Pain is multidimensional and described as such. In the brain a diversity of regions and structures interact and connect concerning pain experience. Pain management demands interacting on several dimensions. Especially among older people multidimensional treatment form a interprofessional team is necessary. Older people are more likely to develop (chronic) pain due to age related diseases and/ or disorders. A strong collaboration between professionals, patient and relatives is important in order to maintain self-management, function, activity and participation of the elderly.

Due to an altered physiology pharmacy in older people is not always effective and sometimes even contraindicated. Thus making a non-pharmacological approach even more important and necessary.

A biopsychosocial approach is necessary for effective multimodal treatment of pain. Non pharmacological approaches needs to be part of integrated health care.

In this presentation the necessity of a non-pharmacological approaches in older people is explained. Several therapies (e.g. nutrition, aroma therapy and music) are briefly discussed.

Q&A