A literature review on fatigue among older people in pain: prevalence and predictors

Objective.  The aim of the study was to survey existing research about fatigue among older people with chronic non-malignant pain.
Method.  A structured literature review was carried out using the Medline database. The terms 'fatigue' and 'tiredness' were used synonymously. These subject headings were combined with pain. A literature search was made in 2004 and included articles back to 1995.
Results.  The review of studies from the last decade resulted in 11 articles of relevance. The result showed that fatigue was common among older people and even more common among those in pain. However, there was discordance regarding the prevalence, and the figures ranged from 30% to 98%. Fatigue was found to be associated above all with pain, functional limitations/functioning, and low quality of life. No articles were found focusing on interventions against fatigue.
Conclusions.  Fatigue is common in old age and even more common when people are in pain. However, knowledge seems to be sparse especially regarding interventions in daily care. Thus, more studies are needed that focus on fatigue to get firm evidence about the prevalence among older people in pain. In addition, studies about interventions against fatigue are urgently needed so that the care of older people can include actions against fatigue and to improve quality of life.
Relevance to clinical practice.  It is of importance that fatigue is not ignored in the care of older people. By intervening against symptoms such as fatigue it will most likely ease the pain and improve quality of life.     

Pain assessment in older people with dementia: literature review

Title.  Pain assessment in older people with dementia: literature review.
Aim.  This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers.
Background.  Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain.
Data sources.  Searches were conducted of CINAHL, Medline and other databases for the period 1993–2007 using the search terms pain, dementia, assess*, barrier* and obstacle*.
Methods.  Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute.
Results.  Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools.
Conclusion.  More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.     

An evaluation of the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people

Objectives.  This paper reports the results of a study that aimed to evaluate the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people.
Background.  With repeated exposure to very sick older people in hospitals or nursing homes, nursing students are at risk of adopting stereotypical views about this section of the population as frail and dependent.
Design.  A pre- and post-test design was used to conduct the study.
Methods.  Using Kogan's Attitudes Towards Old People Scale, the attitudes of nursing students were tested at the beginning of a degree programme in Adult Nursing ( n  = 130) and one year later ( n  = 94) following a series of visits to a well-older person in the community.
Results.  Nursing students reported positive attitudes towards older people and these were retained throughout the first year of their nurse training. No statistically significant differences were found associated with any of the five independent variables in either pre- or postintervention students.
Conclusions.  The attitudes of nursing students towards older people remained positive. While it is possible that the experiential and educational interventions utilized in this study may have contributed to the retention of positive attitudes, further research is required to test this hypothesis.
Relevance to clinical practice.  Nurses have a major role to play in responding to the health and social care needs of older people and their families. The cultivation of positive attitudes is a key factor in enabling practising nurses to respond to this challenge.     

The impact of ageing simulation education on healthcare professionals to promote person-centred care towards older people: A literature review

AimThis review aimed to explore the impact of ageing simulation for healthcare professional education to promote person-centred care towards older people.BackgroundAgeing simulation is an emerging educational approach to facilitate the learning of healthcare professionals on ageing and older people. However, there is limited evidence available exploring its use and impact on the person-centred care of older people.DesignAn integrative review approach was used.MethodsFour databases were searched from January 2010 to April 2020 including CINAHL, MEDLINE, Web of Science and PsychINFO, 21 papers were identified and analysed.ResultsThree interrelating themes were identified to outline the findings across the reviewed studies: ageing simulation use (theme 1), characteristics (theme 2) and impact (theme 3). Results showed literature available on ageing simulation is varied, ranged in study quality and applied several ageing simulation iterations making comparisons across the studies difficult.ConclusionsDespite these challenges it was clear ageing simulation is a promising educational approach currently being used to promote person-centred care for older people in healthcare professionals. Ageing simulation successfully improved the ageing knowledge, empathy levels and attitudes towards older people of healthcare professionals.     

Autonomy for older people in residential care: a selective literature review

Autonomy is an important concept because it brings dignity to peoples' lives, regardless of physical circumstances. The United Nations (UN) Madrid International Plan of Action on Ageing emphasises the need to include older adults in autonomous decision-making processes. However, many older people living in residential care find that their autonomy is curtailed. This is largely because autonomy for older people is poorly understood, and hence, nurses working with older people need to become clear about what autonomy is and how it can be facilitated. In this, the first of three papers, the literature is reviewed specifically to establish the meaning of autonomy for older people in residential care as opposed to autonomy in a wider context. This important distinction may help nurses working with older people to begin to facilitate autonomy more effectively.     

Best practice interventions to improve the management of older people in acute care settings: a literature review

AIM: This paper is a report of a literature review of experimental evidence describing interventions to manage the older adult in the acute care hospital setting. BACKGROUND: Older people are increasingly being cared for in a system largely geared towards acute care. This approach is often inadequate to meet the needs of older patients with chronic and complex conditions. In response to these challenges, evidence-based interventions are required to improve health outcomes. METHOD: The MEDLINE and CINAHL databases and the Internet were searched using the keywords elderly, older, geriatric and aged care. Studies published between 1985 and 2006 were included if they reported, in English, a controlled trial of an intervention designed to improve the management of older adults in the acute care setting. The findings were synthesized using the method of a modified integrative literature review. FINDINGS: Only 26 controlled trials met the inclusion criteria. The following elements of interventions appear critical in providing optimal health outcomes for older people admitted to acute care: (1) a team approach to care delivery either directly in a designated unit for older patients or indirectly using gerontological expertise in a consultancy model; (2) targeted assessment techniques to prevent complications; (3) an increased emphasis on discharge planning and (4) enhanced communication between care providers across the care continuum. CONCLUSION: A multidisciplinary team approach, using gerontological expertise, in acute care settings is recommended to improve the care of older patients. Care delivery should occur in a specially designed unit, with communication strategies that emphasize discharge planning.     

Living with persistent pain: experiences of older people receiving home care

BACKGROUND: Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge. AIM: To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain. METHODS: Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis. FINDINGS: Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living. CONCLUSION: This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain.     

Postoperative pain in older people: a review of the literature

Aims and objectives. The literature review was conducted to explore those factors which complicate pain management in older people to inform future research, education and nursing practice in this area. Background. Acute pain management in hospitalized older people is complex because of the physiological changes of ageing, pharmacological factors and under‐representation of this patient group in reported research about assessing acute pain. Methods. A review of the literature was undertaken using electronic databases and specified search terms, some hand searching was also used and included the grey literature, textbooks and conference proceedings. A computerized literature search was carried out using CINAHL, Bandolier, Cochrane, Medline, the British Nursing Index and the International Association for the Study of Pain website for the period 1992–2004. The search terms were acute pain, older people, elder care, pain assessment and acute pain services. Thirty‐seven research‐based reviews and published studies and 17 policy documents were included. Conclusions. Managing acute pain well in older adults involves understanding the influence of a series of integrated factors: attitudes and beliefs, physiological ageing processes, pharmacological factors and the social construction of the older person in healthcare contexts. Relevance to clinical practice. This review offers new insight into those factors which, taken together, add complexity to managing acute pain in older people well. Moreover, nurses are the professional group mainly responsible for assessing pain, administering and now prescribing analgesia and evaluating the quality of pain relief in older people. On this basis, they are also the group most likely to effect improved patient outcomes.     

英国护士的老年态度模型构建研究

目的:探索英国护士对老年人的态度,并构建态度模型,为进一步的干预提供信息及依据。方法:对英国伦敦某护理学院参加继续教育课程的730名注册护士进行问卷调查,调查内容包括护士基本资料、是否喜欢护理老年患者、老年知识和对老年人态度等。结果:共收回有效问卷580份,有效回收率为79.5%。本研究构建的态度模型中,纳入的因素能解释43.6%的预测变量,包括对变老的焦虑水平、对老年人使用健康资源的态度、老年知识、喜欢护理老年患者、教育与年龄的交互效应。结论:纳入的因素能较好地解释态度,提示应该制定相关的干预措施,高校及教育机构应该逐步增加老年人方面的教育内容。本研究肯定了干预措施的重要性,对老年人的健康服务提供具有重要意义。     

Health professionals' attitudes toward older people and older patients: A systematic review

Attitudes toward older people and older patients among healthcare professionals are of concern throughout the world, but there are no recent systematic reviews which have examined and compared the attitudes across the various healthcare professionals who provide healthcare to older people. A comprehensive literature search (2000–2011) was undertaken on electronic databases (CINAHL, MEDLINE, EMBASE, British Nursing Index, PsycINFO, Chinese Biomedical database, China Medical Academic Conference and China Academic Journal) using a combination of terms. We identified 2179 articles indexed with these terms. Initial screening was undertaken by two researchers and then checked by a third researcher. In total, the reviewers selected 117 articles which, on the basis of their abstracts, appeared to meet the criteria for inclusion. We obtained the full texts and two reviewers assessed each full text paper to further examine whether it met all the criteria. The final review identified 51 studies. Publications over the last 10 years show that attitudes towards older people and older patients range from neutral to positive among healthcare professionals and highlight the need for well-designed studies of both qualified and student healthcare professionals recruiting random samples across multiple sites and utilizing validated instruments consistently to permit comparison over time and across countries.     

Multi‐professional communication for older people in transitional care: a review of the literature

Aims and objectives. To synthesise research‐reporting literature about multi‐professional communication between health and social care professionals within transitional care for older people, with particular attention on outcomes, enabling contextual factors and constraints. Background. Older adults experience high rates of morbidity and health care usage, and frequently transit between health services, and community and social care providers. These transition episodes place elders at increased risk of adverse incidents due to poor communication of information. Integrated multi‐professional models of care built on enhanced communication have been widely promoted as a strategy to improve transitional care for older people. However, a range of findings exist in the literature to guide service providers and researchers. Design. Comprehensive literature search and review strategies were employed to identify, describe and synthesise relevant studies. Ten databases were searched in addition to Google Scholar. Conclusions. Specified discharge worker roles, multi‐professional care coordination teams, and information technology systems promote better service satisfaction and subjective quality of life for older people when compared with standard hospital discharge. Improved multi‐professional communication reduces rates of re‐admission and length of stay indicating greater cost effectiveness and efficiency for the health and social care systems. Systems of care emphasizing information exchange, education and negotiation between stakeholders facilitate communication in transitional care contexts for older adults. Conversely, lack of dialogue and lack of understanding of others’ roles are barriers to communication in transitional care. Implications for practice. Enhanced multi‐professional communication, transitional pathways, and role clarity are required to improve the quality, sustainability and responsiveness of aged care into the future. Recommendations for further research include: (i) Investigation of pathways promoting person‐centred care planning including the older person, their family and relevant practitioners; (ii) Development of interventions aimed at improving multi‐professional communication and transitional aged care with marginalised and socially disadvantaged elders on indicators of equity and access; (iii) Investigation of changing roles for practitioners in multi‐professional teams with a focus on community‐based teams including nurses specialising in aged care and general practice.     

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.