Managing pain in the older person

The UK population is ageing and a significant proportion of older people experience persistent pain. However, pain assessment in this group can be challenging, particularly when the older person has cognitive or communication impairment. Nurses working in primary and secondary care should take a more proactive role to help overcome patient, professional and institutional barriers to pain assessment and management. This article examines the age-related physiological changes that complicate the prescribing and administering of analgesic drugs in older patients and necessitate careful patient monitoring. It outlines the principles of medication administration for pain management in older people and provides examples of assessment tools that can be used in older patients.     

Treating pain in the older person

Clinical guidance on the management of pain in elderly patients is presented. The way in which pain presents in elderly people and how it differs form other segments of the population are discussed.     

The nutritional needs of the older person

Older people have particular nutritional requirements that are different from other groups. The nutritional status of many older people is poor in respect of some key nutrients. Older people are at higher risk of malnutrition if they are ill, live alone or have difficulty in eating. Older patients should have their nutritional status and nutritional intake monitored regularly to ensure they are receiving adequate nutrition.     

Arthritis in the older person: Part 2

Part 1 of this article, in last month's Nursing Older People, identified the major musculoskeletal disorders affecting older people, the signs and symptoms of these and drug therapies available. Part 2 discusses non-pharmacological treatment options, patient education, multi-disciplinary support and how people living with musculoskeletal disorders can be helped to achieve quality of life     

Arthritis in the older person: part 1

Part 1 of this two-part article identifies the major musculoskeletal disorders affecting older people, the signs and symptoms of these disorders and the available drug therapies.     

Addressing the skin-care needs of the older person

Major skin changes are one of the many features occurring with ageing and it is estimated that 70% of elderly people have skin problems (APGS, 2000). A report into skin diseases in elderly people highlighted that older people were noted to suffer from a lack of sensitivity to their skin care needs and related problems, training was lacking for healthcare professionals and service provision was not planned (APGS, 2000). The aim of this article is to highlight the importance of skin care in the older person and increase the nurse's knowledge in relation to the care of ageing skin; the skin changes associated with age and practical advice and guidance when caring for an older person's skin.     

Focusing nursing care on the older person

The second article in our two-part series on gerontological nursing features two case studies that flag up examples of good practice in two clinical areas. The first describes a nurse manager's four-year catering services review, which resulted in a new approach to nutrition and benefited older patients in a rural hospital. The second describes how a charge nurse and staff on a long-stay elderly care ward used a psychosocial approach to end ward routines and introduce individualised care. The results, although not yet formally assessed, are encouraging and staff hope their experience and collaboration with the University of Paisley will help other nurses working in the specialty.     

Human immunodeficiency virus and the older person

This article outlines some of the issues which older people who are infected and/or affected by human immunodeficiency virus (HIV) may face. HIV does not discriminate against age, however, clinicians are now seeing an increasing number of HIV positive older people in their everyday practice. This trend is set to continue as HIV becomes more of a chronic health condition as a consequence of more sophisticated treatment regimens. The older population has largely been ignored in the quest to reduce the incidence of HIV infection. This article calls for more research to be conducted taking into account the unique needs of the older population. There is no place in contemporary nursing practice for practitioners to hold erroneous and outdated myths concerning the sexuality and lifestyle choice of the older person.     

Incontinence-associated dermatitis: protecting the older person

As the older population in the UK continues to grow, so too will the number of people presenting with dermatological problems. Older people's skin is subject to dehydration internally and environmental factors externally. If, in addition, the individual suffers continence problems, he or she is at risk of painful incontinence-associated dermatitis, or even formation of a moisture lesion. The use of an effective barrier cream that gives protection while not interfering with continence pad efficacy can be an invaluable means of comfort to the older person.     

Achieving quality older person care

Perhaps the most important consideration when looking at the standards of care given to older people is to make sure that we listen to their opinions and incorporate their wishes into our plans for improving care.     

Management of the older person with diabetes in the community

As the incidence of diabetes increases in the UK, community nurses will have increasingly larger caseloads of elderly patients with diabetes. It is important that nurses assess the patient's understanding of the disease and its treatment. The aim of good diabetic control is to reduce morbidity from the complications of the disease. Factors that affect the patients' quality of life; the patients' ability to manage their condition; and the importance of providing education and support for both the patients and their carers are discussed. The importance of diet, blood glucose monitoring and taking diabetic medication appropriately are explained.     

Infection control and care of the older person

Elderly people are vulnerable to infections, particularly those linked with the use of antibiotics. Once infected, they may be a risk to others in hospital or primary care. Strict adherence to infection control measures is required in the care of these patients.