When it comes to geriatric care, almost 50% of elderly patients living at home and 80% of older patients in LTC report persistent pain. According to statistical data, this pain is undertreated and under recognized and can have severe consequences, such as withdrawal from socialization, disturbance in sleep, immobility related postoperative complications, anxiety, depression and similar mental health problems, increased risk of fractures and mobility issues, impaired healing and immune system, and increase in dependency.
There are various barriers that cause this undertreatment of pain and issues with pain management in elderly patients -
Barriers Related to Healthcare Professionals
Healthcare professionals are often undereducated about pain management and assessment, and this can be a huge barrier. Concern about regulatory scrutiny can also stop professionals from providing the best care possible. In elderly patients, the risk of side-effects, particularly related to opioids, is another huge barrier. In elderly patients suffering from cognitive impairment, it is pretty difficult to assess the pain and this can be a potential barrier. Finally, a frequent barrier is the assumption that pain is part of aging and is out of control.
Barriers Related to Patients and Family
Patients can sometime underreport pain because they don’t want to be branded as drug seekers and don’t want to come across as bad patients. Addiction related to pain meds is a huge barrier too. Fear about certain side effects can stop both the families and the patient from treating and reporting pain. Finally, when family and patient do not understand the treatment goals, there can be some amount of under treatment.
Barriers Related to the Healthcare System
General bias related to the use of opioids, time, and cost related factors are serious healthcare system barriers that lead to under treatment of pain.
The above mentioned barriers are most noticed in elderly patients who are cognitively impaired. Following are some clues that both professionals and caregivers can look out for:
Noting Facial Expressions - It should be noted if patients exhibit facial expressions that hint towards pain, such as distorting face, blinking quickly, closing eyes tight, wrinkling the brows, making a grimacing face, looking scared, and frowning.
Listening For Vocalizations - Often, patients vocalize their pain in the form of noisy breaths, chants, grunts, sighs, groans, and moans. Sometimes, they can call out or ask for help as well. Because of the frustration related to the pain, patients can also become verbally abusive towards primary caregivers.
Noticing Body Movement - Noticing body movements of patients can also give plenty of clues regarding under treated pain. These clues include changes in mobility or gait, restrictions in movement, back and forth rocking, pacing, constant fidgeting, and tenseness or rigidity in posture.
Watching Out For Changes in Behavior - Under treated pain can also lead to behavioral changes in patients, such as stopping routine activities, wandering around, changes in period of rest and sleep, changes in appetite, outright refusal to eat, and so on.
Noting Changes in Mental Status - Mental changes include increased irritability, confusion, crying, and acting or looking distressed.
If any of these signs are noticed, they should be reported to the doctor immediately so that care can be offered to the elderly patient.
Barriers Related to Healthcare Professionals
Healthcare professionals are often undereducated about pain management and assessment, and this can be a huge barrier. Concern about regulatory scrutiny can also stop professionals from providing the best care possible. In elderly patients, the risk of side-effects, particularly related to opioids, is another huge barrier. In elderly patients suffering from cognitive impairment, it is pretty difficult to assess the pain and this can be a potential barrier. Finally, a frequent barrier is the assumption that pain is part of aging and is out of control.
Barriers Related to Patients and Family
Patients can sometime underreport pain because they don’t want to be branded as drug seekers and don’t want to come across as bad patients. Addiction related to pain meds is a huge barrier too. Fear about certain side effects can stop both the families and the patient from treating and reporting pain. Finally, when family and patient do not understand the treatment goals, there can be some amount of under treatment.
Barriers Related to the Healthcare System
General bias related to the use of opioids, time, and cost related factors are serious healthcare system barriers that lead to under treatment of pain.
The above mentioned barriers are most noticed in elderly patients who are cognitively impaired. Following are some clues that both professionals and caregivers can look out for:
Noting Facial Expressions - It should be noted if patients exhibit facial expressions that hint towards pain, such as distorting face, blinking quickly, closing eyes tight, wrinkling the brows, making a grimacing face, looking scared, and frowning.
Listening For Vocalizations - Often, patients vocalize their pain in the form of noisy breaths, chants, grunts, sighs, groans, and moans. Sometimes, they can call out or ask for help as well. Because of the frustration related to the pain, patients can also become verbally abusive towards primary caregivers.
Noticing Body Movement - Noticing body movements of patients can also give plenty of clues regarding under treated pain. These clues include changes in mobility or gait, restrictions in movement, back and forth rocking, pacing, constant fidgeting, and tenseness or rigidity in posture.
Watching Out For Changes in Behavior - Under treated pain can also lead to behavioral changes in patients, such as stopping routine activities, wandering around, changes in period of rest and sleep, changes in appetite, outright refusal to eat, and so on.
Noting Changes in Mental Status - Mental changes include increased irritability, confusion, crying, and acting or looking distressed.
If any of these signs are noticed, they should be reported to the doctor immediately so that care can be offered to the elderly patient.