Exercises for Older Adults With Knee and Hip Pain

Half of all older adults report knee and/or hip pain. Obesity and sedentary lifestyle contribute to the incidence and prevalence of painful knee and hip conditions. Weight loss should be a priority in overweight or obese patients. Improving joint function over time requires a balance of rest and usage. Practitioners should assess joint disorders and recommend exercises for reducing knee and hip pain with patients when appropriate. Instruction should include a combination of 1) stretching and flexibility, 2) strength training, and 3) endurance conditioning exercises. Even small improvements in exercise can make meaningful improvements in pain, movement, endurance, and quality of life.     

A Community-Based Program That Provides Free Choice of Intervention for Older People With Chronic Pain

This study sought to evaluate the efficacy of a community-based intervention program that provides free choice of intervention for improving outcomes for community-dwelling older people with chronic nonmalignant pain. A quasiexperimental before and after nonequivalent group design was used. The treated group was composed of 71 participants, and the untreated group was composed of 40 individuals. A 6-month follow-up measurement was included to determine the long-term effects of the program. The findings of the program showed significant benefits for those who completed the program compared with those who did not participate. Evaluation of the program suggested that an initial educational seminar had a positive impact that empowered the participants to make more informed choices regarding interventions for managing pain. Significant reduction in pain intensity and improved level of physical activity were reported by the participants at completion of the interventions. However, results of a 6-month follow-up showed that only the benefits for physical activity were maintained. The findings show that the present program improved the short-term outcomes for older people with chronic pain and has potential as a clinical option for accessible and low-cost pain management for older people with chronic pain.     

Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults

Chronic pain, and the ethical management thereof, is the single most imperative health issue of this decade. Although a growing majority of individuals with chronic pain are middle-aged, the largest proportion of sufferers are older adults. Shifting tides in practice and research have led to population-focused approaches to pain management; however, the practice of many healthcare providers remains reactive and individualistic, limiting the discovery and implementation of long-term solutions for pain management in older adults. Yet, nurses and other health professionals have an opportune position to provide expert pain care by proactively providing evidence-based care for patients systematically. The purpose of this article is to stimulate discussion on three paradigms important to population-focused pain management: (1) prevention; (2) restoration and rehabilitation; and (3) palliation, which are in line with current national policy initiatives for improving patients’ care experience, improving overall health and quality of life, and reducing associated health care costs.     

Prevalence of Pain and Effects of a Brief Mindfulness-Based Intervention on Chinese Community-Dwelling Older Adults with Chronic Pain

This study aimed to screen the prevalence of pain in Chinese community-dwelling older adults and to evaluate the effects of a brief mindfulness-based intervention on chronic pain. The prevalence of pain among Chinese older adults was 40.5%. The brief mindfulness intervention had significant effects on reducing pain intensity (P = 0.004), and increasing the mindfulness measures: observing, acting with awareness, non-judging and non-reactivity inner experience (all P values < 0.05). Pain prevalence among Chinese older adults was relatively high. This study showed that a brief mindfulness-based intervention reduced ratings of pain intensity and enhanced ratings of the perception of mindfulness.     

Pain Experiences and Coping Strategies in Rural Older Adults With Chronic Musculoskeletal Pain in Mountainous Areas of Taiwan

BackgroundAlthough rural communities are home to a higher proportion of older residents, they provide fewer healthcare services than do urban core communities. Chronic musculoskeletal (MSK) pain is often associated with reduced daily activity and quality of life in older adults, particularly those in rural areas.AimsThis study investigated the pain experiences and coping strategies in rural older adults with MSK pain in Taiwan.MethodsA structured questionnaire was used to collect data from rural older adults with chronic MSK pain in mountainous areas of Taiwan.ResultsIn total, 55 rural older adults were enrolled in this study. The most common pain sites were the low back and knees. The main cause of pain was osteoarthritis. Three quarters of the participants suffered from moderate to severe chronic MSK pain on average. The results revealed that behavioral strategies were used more often than cognitive strategies. Regarding behavioral strategies, the most common non-pharmacologic and pharmacologic pain coping strategies were to rest and to take Chinese medicine, respectively. The most common cognitive strategy for pain coping was to talk to others.ConclusionsThe findings suggested that pain management for chronic MSK pain in rural older adults was inadequate in mountainous areas of Taiwan. Most rural older adults used multiple coping strategies to deal with their pain, and behavioral strategies were favored over cognitive strategies.     

Chronic Musculoskeletal Pain and Foot Reaction Time in Older Adults

This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionnaire. With participants seated, simple foot reaction time was measured as self-selected foot response time to an intermittent light, and choice foot reaction time was measured as response time to the light on the corresponding side of the sensored gait mat. We performed multivariable linear regression to determine associations of pain and foot RT, adjusted for sociodemographic and health characteristics, and serially adjusted for cognitive function (MMSE or Trail Making A). Pain severity and interference were associated with slower simple foot reaction time (P < .05). Pain severity and knee pain were associated with slower choice foot reaction time (P < .05). Adjustment for cognitive measures had little impact on the pain-RT relationship. This significant relationship was only observed among participants with less education. These results support the idea that chronic pain may lead to slower foot RT, thus could represent a fall hazard in older adults. Neuromotor mechanisms underlying the pain-fall relationship warrant further investigation.PerspectiveThis study provides insights on the mechanisms underlying the pain-fall relationship. Chronic pain may contribute to slower foot RT thus increase fall risk in older adults. This may help inform interventions such as stepping training to reduce fall risk in older adults living with chronic pain.     

Development of an Assistive Technology Intervention for Community Older Adults

Aim: To explore the use of the Ecological Validity Model as a guiding framework in the provision of a culturally sensitive assistive technology (AT) intervention for community older people. Methods: Twenty-seven Hispanic adults aged 70 years and older and four individuals with expertise in AT participated in a concurrent nested mixed method study where the quantitative method (content validity ratio exercise) was embedded in the dominant qualitative method (focus groups). Results: Findings informed the development of the Assistive Technology Life Enhancement Program (ATLEP), an intervention consisting of seven modules addressing AT devices with culturally sensitive elements. Conclusions: The Ecological Validity Model, as well as the input from older adults, were both effective methodological strategies in tailoring the ATLEP intervention to the needs and circumstances of community-living older people living in Puerto Rico.     

Multifidi Muscle Characteristics and Physical Function Among Older Adults With and Without Chronic Low Back Pain

Objective

To determine whether multifidi size, intramuscular fat, or both, are associated with self-reported and performance-based physical function in older adults with and without chronic low back pain (LBP).

The Effects of Opioids on Cognition in Older Adults With Cancer and Chronic Noncancer Pain: A Systematic Review

ContextOpioids are prescribed to manage moderate-to-severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment.ObjectivesTo identify, appraise, and synthesize evidence on the impact of opioids on cognition in older adults with cancer/chronic noncancer pain, and screening tools/neuropsychological assessments used to detect opioid-induced cognitive impairment.MethodsA systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (international prospective register of systematic reviews registration: CRD42018092943). MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science were searched up to December 2018. Randomized controlled trials, quasi-experimental studies, and observational studies of adults aged 65 years and older with cancer/chronic noncancer pain taking opioids were included. A narrative synthesis was conducted.ResultsFrom 4036 records, 10 met inclusion criteria. Five studies used one screening tool, and five studies used a range of neuropsychological assessments; assessing 14 cognitive domains. Most studies demonstrated no effect of opioid use on cognitive domains, whereas four studies showed mixed effects. In particular, attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory were worsened. Changes to cognitive function were predominantly observed in studies with higher mean doses of opioids (120–190.7mg oral morphine equivalent daily dose).ConclusionBoth improvements and impairments to cognition were observed in studies with higher mean opioid doses. In clinical practice, a brief screening tool assessing attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory may be beneficial to detect worsening cognition in older adults with chronic pain using opioids.     

A Concept Analysis of Coping with Chronic Pain in Older Adults

ObjectivesThere is no consensus on the definition of coping with chronic pain in older adults. The lack of a definition affects communication in interdisciplinary care, limits assessments of coping in clinical practice, and influences the development of knowledge on the subject. The aim of this paper is to report on a concept analysis of coping with chronic pain in older adults and to construct a definition of the concept.DesignA concept analysis was conducted.Data sourcesA literature search was conducted in the CINAHL, MEDLINE, PsycINFO, and PubMed databases.Review methodsRodgers’ evolutionary method was used for the concept analysis.ResultsThe search yielded 32 articles. Surrogate terms included “living with pain,” “pain management,” “managing pain,” “self-management,” “adapting to pain,” “dealing with pain,” and “adjustment to pain.” Related concepts were categorized under methods of coping, pain relief, and seeking help. The following definition, which takes into consideration the antecedents, attributes, and consequences of coping with chronic pain, was constructed: “Dealing with chronic pain is a process in which various attitudes and beliefs can result in the making of changes in daily life and activities. An action to adopt coping strategies is required, so self-involvement is needed. However, demographic characteristics, physical factors, psychological factors, social factors, relevant knowledge about one's own conditions and coping, and factors related to coping strategies affect how older adults deal with chronic pain. The actions that they choose to deal with chronic pain could lead to positive and/or negative outcomes.”ConclusionsCoping with chronic pain involves more than the use of coping strategies. This analysis provides suggestions on clinical assessments and interventions. The concept of coping with chronic pain requires continual development.     

Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies

It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP.PerspectiveThis article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.     

Pain Management in Older Adults

Background

Chronic pain is prevalent among older adults but is underrecognized and undertreated. The approach to pain assessment and management in older adults requires an understanding of the physiology of aging, validated assessment tools, and common pain presentations among older adults.

Objective

To identify the overall principles of pain management in older adults with a specific focus on common painful conditions and approaches to pharmacologic treatment.

Methods

We searched PubMed for common pain presentations in older adults with heart failure, end-stage renal disease, dementia, frailty, and cancer. We also reviewed guidelines for pain management. Our review encompassed 2 guidelines, 10 original studies, and 22 review articles published from 2000 to the present. This review does not discuss nonpharmacologic treatments of pain.

Results

Clinical guidelines support the use of opioids in persistent nonmalignant pain. Opioids should be used in patients with moderate or severe pain or pain not otherwise controlled but with careful attention to potential toxic effects and half-life. In addition, clinical practice guidelines recommend use of oral nonsteroidal anti-inflammatory drugs with extreme caution and for defined, limited periods.

Conclusion

An understanding of the basics of pain pathophysiology, assessment, pharmacologic management, and a familiarity with common pain presentations will allow clinicians to effectively manage pain for older adults.