Chronic pain management: a qualitative study of elderly people's preferred coping strategies and barriers to management

Although the majority of pain complaints, in Australia, are among the elderly population, the focus of treatment is not on this age group. In order to achieve effective management of elderly people's chronic pain, their perspective of pain and coping strategies used needs to be understood. This qualitative study explored the preferred strategies of elderly people and the barriers they encountered in trying to manage their pain. Elderly people (n = 72) with chronic pain, over 65 years of age and living in the community, were interviewed for the study. Data were collected using six focus group and 12 in-depth interviews and a biographical questionnaire. Preferred coping strategies were those that could be self-administered and included both physical and cognitive elements. Elderly people wished to be active in their treatment, make informed choices and were willing to try new methods. Least-preferred strategies were the conventional treatments of medications, exercise and physiotherapy. Many barriers have to be overcome to achieve relief for their pain such as cost, access to health care, related disorders, attitudes of health professionals, lack of communication and fear of losing independence. Health professionals need to be aware of elderly people's perspective of pain and their preferred strategies and reasons for these choices. Health services must meet their specific needs.     

Principles of pain management in older people.

The management of chronic pain should be a priority in geriatric care. Pain is a common problem that has tremendous potential to influence the physical function and quality of life of elderly people during their remaining years. Much research and education is still needed to further our understanding of pain and its management among elderly people. Existing pain management strategies should be tailored for the special needs of the geriatric population. Applications of "high tech" pain management strategies, such as morphine pumps and chronic spinal infusions, need to be clarified for older people. Finally, family and caregiver considerations should be included in chronic pain management strategies.     

The nursing management of elderly patients with pain in the community: study and recommendations

This study is designed to identify factors which influence quality of life for elderly people suffering from painful conditions. It is based upon a theoretical model of control in which mood state is used as the indicator of coping. One hundred and ninety elderly patients took part in semi-structured interviews about their pain and coping experiences, and data were also collected from their nurses in the community. Multivariate statistical analysis revealed that the key determinants of mood were having regrets about the past, being occupied, perceived level of pain control, additional personal problems (notably bereavement) and feeling informed about the painful condition. Active personal coping strategies were identified as more therapeutic than passive strategies. Nurses' data revealed that pain complaints were associated with perceived exaggeration. Few nurses used formal pain assessment. Recommendations for the management of persistent pain in the community are given.     

上海市社区老年人的慢性疼痛认知与应对方式的研究

目的 了解上海市社区老年人对于老年慢性疼痛的认知和应对方式。方法 选取上海市13个社区99名老年人进行问卷调查,内容主要包括一般情况、慢性疼痛应对策略问卷和面部疼痛表情(FPS-R)量表。结果 据调查老年人最近一段时间疼痛程度为(4.78±2.32)分,疼痛程度与应对策略问卷中寻求支持(r=0.51)、忽视疼痛(r=0.26)、行动解决(r=0.28)、限定活动(r=0.53)、消极心态(r=0.61)这五个维度相关性较大。结论 上海社区老年人的疼痛程度处于中重度,其疼痛程度与应对策略相关,医护人员应重视社区老年慢性疼痛的患者,重视疼痛教育与管理,采取相应措施提高患者的应对策略,减轻慢性疼痛对生活带来的影响。     

Chronic pain coping experiences of institutionalized elderly

While pain is a common problem among the elderly, a group that has grown significantly as a percentage of population in recent decades, few studies have been done to describe their chronic pain coping experiences. The aim of this qualitative study was to enhance understanding of chronic pain coping strategies adopted by elderly residents of long-term care facilities. Eighteen elderly residents were interviewed, with Lincoln and Guba's trustworthiness criteria utilized to evaluate methodological rigor. Colaizzi's phenomenological approach was used to analyze chronic pain coping data. Three themes that emerged in findings included: use of multiple pain relief strategies, use of passive pain endurance and learning to live with chronic pain. The author hopes that results of this study will provide better insight on approaches taken by the elderly to personal pain management and help guide the development of nursing guidelines for chronic pain management. Recommendations highlighted in this study include increasing chronic pain education and continued research in support of developing a Chinese version chronic pain assessment tool for the elderly.     

Coping with multiple chronic conditions: An integrative review

There is a paucity of summarized evidence concerning coping with multiple chronic conditions. An integrative review approach was used to synthesize current evidence on: (i) coping in forms of perceptions and strategies, (ii) relationship between coping and health‐related outcomes, and (iii) factors related to coping. Five electronic databases were searched without time limitation. Thirty‐two studies met inclusion criteria and were included for full‐text review: 24 qualitative, seven quantitative, and one mixed‐methods study. Studies were assessed for quality using an appraisal system of rigor and relevance. A constant comparison method was used to synthesize findings from eligible studies. This review synthesized perceptions of multiple chronic conditions involving negative moods and physical limitations, and strategies of coping with multiple chronic conditions including problem‐ and emotion‐focused strategies. Findings suggested that coping is a promising path to manage multiple chronic conditions and emphasized that appropriate coping might have positive impacts on health‐related outcomes. Five impact factors including age, gender, clusters of multiple chronic conditions, social support, and ethnicity and culture were associated with people's coping. Future healthcare plans should address the physical and psychological needs of people with multiple chronic conditions and highlight the importance of modifying their illness perceptions and enhancing appropriate coping strategies.     

The relationship of locus of control to pain coping strategies and psychological distress in chronic pain patients

Although behavioral scientists have long been interested in how an individual's locus of control relates to coping and adjustment, basic information remains to be gathered on the relevance of locus of control to adaptation to persistent pain. This study examined the relationship of locus of control orientation to pain coping strategies and psychological distress in chronic pain patients. Subjects were 62 chronic pain patients. All patients were administered: (1) the Multidimensional Health Locus of Control Scales to assess locus of control, (2) the Coping Strategies Questionnaire to evaluate pain coping strategies, and (3) the Symptom Checklist-90 Revised to assess psychological distress. Correlational analyses revealed that patients who viewed outcomes as controlled by chance factors such as fate or luck tended to rely on maladaptive pain coping strategies and rated their abilities to control and decrease pain as poor. They also exhibited greater psychological distress. Regression analyses indicated that patients having a chance orientation toward locus of control were more likely to report depression, anxiety, and obsessive-compulsive symptoms and to have higher overall levels of psychological distress. Chance locus of control also predicted greater reliance on diverting attention and praying/hoping in dealing with their pain. In addition, patients high on chance locus of control reported feeling helpless to deal effectively with their pain problem. Clinicians evaluating chronic pain patients need to be aware that patients who view outcomes as controlled by external factors such as chance may have deficits in pain coping strategies and may report greater psychological distress than patients who do not have this locus of control orientation.     

Teaching program for elderly women who care for elderly relatives in their home: report of experience

This is a report of experience about the development of a program designed especially for the orientation of elderly people who care for elderly relatives at home. It was carried out by the coordinators of the Group of Attention for Elderly People's Health (GRASI), of the Campinas State University's Clinics Hospital. This program was developed based on the needs reported by elderly caregivers who take part in the activities of the GRASI. The participants reported that the program made coping with the difficulties related to caregiving better; that there had been an improvement in the understanding of the changes brought by the aging process; and that it made possible the development of procedures that make easier the daily relationship with the elderly that is being cared for.     

Nursing care of elderly people at home and ethical implications: an experience from Istanbul

Elderly people are a particularly vulnerable group in society and have special health problems. The world population of older people is increasing. People who are 65 years or older constitute 6% of the Turkish population, 90% of whom have chronic health problems. In Turkey, there is a high possibility that elderly people's requirements are not met by today's health care system in the way they would wish. They prefer not to be hospitalized when they have health problems. From a wider perspective, various countries are still seeking how to provide the best care for elderly people. Our goal was to characterize home-based care for elderly people using an ethical approach as an area of interest for nurses and other health care professionals now and in the future, both for Turkey specifically and from a global perspective. We studied four case histories and then prepared a composite scenario and a short questionnaire for elderly people living in a specific district of Istanbul to evaluate their expectations from the health care system. We compared our findings with situations in other countries and have proposed some practical solutions. The results showed that these older people preferred to receive nursing care at home instead of in hospital in Turkey, and also in many other countries. In this article we discuss our findings, comparing them with those in the literature, and suggest that there should be nursing care at home with insurance coverage while using a proper ethical approach.     

Assessment and management of chronic pain in elderly people

The ageing process can bring with it an increased incidence of conditions which give rise to chronic pain. Persistent musculoskeletal and/or neuropathic pain due to conditions such as back pain, arthritis, osteoporosis and diabetes in elderly people can lead to a marked deterioration in their quality of life. Pain assessment can be complicated by concomitant disorientation, confusion and communication deficits, leading to the undertreatment of pain in this client group. Pain management can be difficult due to the existence of multiple medical problems and the increased incidence of side-effects related to the treatment. This article aims to update nurses on the assessment and management of pain in the older adult, and will provide a broad overview of pain management strategies suitable for elderly patients.     

Coping or acceptance: what to do about chronic pain?

Research and treatment of chronic pain over the past 20 or more years have tended to focus on patient coping as the primary behavioral contribution to adjustment. The purpose of the present study was to compare a coping approach to chronic pain with a different behavioral approach referred to as acceptance of chronic pain. These approaches were compared in terms of their ability to predict distress and disability in a sample of patients seeking treatment for chronic pain. Subjects were 230 adults assessed at a university pain management center. All patients completed the coping strategies questionnaire and the chronic pain acceptance questionnaire among other standard measures. Results showed that coping variables were relatively weakly related to acceptance of pain and relatively unreliably related to pain adjustment variables. On the other hand, acceptance of chronic pain was associated with less pain, disability, depression and pain-related anxiety, higher daily uptime, and better work status. Regression analyses examined the independent contributions of coping and acceptance to key adjustment indicators in relation to chronic pain. Results from these analyses demonstrated that acceptance of pain repeatedly accounted for more variance than coping variables.     

Cultural diversity in heart failure management: findings from the DISCOVER study (Part 2)

Self-management is a critical dimension in managing chronic conditions, particularly in heart failure (HF). Knowledge, attitudes and beliefs, relating to both illness and wellness, are strongly influenced by culture and ethnicity, impacting upon an individual's capacity to engage in self-care behaviours. Effective management of HF is largely dependent on facilitation of culturally informed, self-care behaviours to increase adherence to both pharmacological and non-pharmacological strategies. The Understanding the cultural experiences of individuals with chronic heart failure (CHF) in South East Health (DISCOVER) study is an exploratory, observational study investigating health patterns, information needs and the adjustment process for overseas-born people with HF living in Australia. An integrative literature review was augmented by qualitative data derived from key informant interviews, focus groups and individual interviews. A key finding of this study is that culture provides an important context to aid interpretations of attitudes, values, beliefs and behaviours, not only in illness but in health. While individual differences in attitudes and beliefs were observed among participants, common themes and issues were identified across cultural groups. Data from the DISCOVER study revealed the primacy of family and kinship ties. These relationships were important in making decisions about treatment choices and care plans. Participants also revealed the critical role of the 'family doctor' in assisting people and their families in brokering the health care system. In this study, heart disease was considered to be a significant condition but cancer was the condition that people both feared and dreaded the most, despite the high mortality rates of HF. This sample reported that religious and traditional beliefs became more important as people aged and considered their mortality. As HF is predominately a condition of ageing, the information derived from this study will assist clinicians to tailor health care service delivery for older people with HF, across multiple ethnic backgrounds.     

Pain management of older people in care homes: a pilot study

This article presents the findings of a pilot study conducted within six care homes within a district of the UK. This is stage one of a programme of funded research designed to explore issues surrounding pain and older people living in care homes. The aim of the study was to determine the residents' perceptions of pain and identify their preferred pain management strategies. Staff working in the care homes were interviewed to identify their level of pain knowledge, and the problems perceived by them, as preventing their role in the management of pain within this group. A number of important issues were identified as barriers to reporting pain among the residents, along with important concerns for staff about communication and education. A serendipitous finding demonstrated some age-related differences in perceptions of pain. Recommendations are made for further research in this area.     

老年耳鸣患者的心理体验及应对方式的质性研究

目的探索我国文化背景下,老年耳鸣患者在症状发生时的真实体验。方法 2015年6月至2016年7月,采用现象学的研究方法对22例确诊为耳鸣的老年患者进行深入访谈,了解老年耳鸣患者的症状体验,采用内容分析法对访谈资料进行分析,归纳主题。结果老年耳鸣患者症状体验的三大主题为认知调整、情绪体验以及应对行为改变。结论大部分老年耳鸣患者在心理体验方面有着一定的相似性,除了需要家人、医护人员以及社会的支持,还应从健康教育、情绪调节以及应对积极性等方面着手,以提高老年耳鸣患者的生活质量。     

Elders adapting to a chronic diagnosis within a nursing refuge

PROBLEM: The increasing numbers of people seeking care for chronic disease has placed unparalleled demands on nurses who journey with them as they grasp the meaning of their altered health status. The complexity of the newly diagnosed chronic disease can be overwhelming. Newly diagnosed elder patients need a refuge in which to explore the uncertainties and challenges in managing a chronic illness. Reactions to a new diagnosis are uniquely shaped by the elder person's culture, age, life circumstances, and previous coping strategies. Six dichotomous response pairs are posed: relief versus devastation, courage versus cowardice, disease obsession versus disease aversion, rational thinking versus intuition, reawakening versus stuck, and self-reliance versus dependence. Nurses can create a sanctuary for elderly patients with protected space, presence, partnership, past to future orientation, and perspective on life. Nurses who embrace this mission may find themselves returning to the reasons they sought a nursing career, to support and strengthen elderly people in the most vulnerable moments of their lives.     

Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment

Recent studies suggest that coping strategies play an important role in adjustment to chronic pain. Identification of factors that influence coping could potentially help clinicians facilitate the use of adaptive coping strategies by pain patients. According to social learning theory, self-efficacy beliefs (judgments regarding one's capabilities) and outcome expectancies (judgments regarding the consequences of behaviors) are significant determinants of coping behavior. This study tested hypotheses derived from social learning theory by examining the contributions of these beliefs to the prediction of coping behavior in chronic pain patients. One hundred and fourteen chronic pain patients completed measures of health-related dysfunction, pain severity, use of 8 coping strategies, and outcome and self-efficacy expectancies regarding these coping strategies. In support of social learning theory, and consistent with research in other areas, the patients' beliefs regarding their capabilities were strongly related to reported coping efforts. Beliefs about the consequences of coping efforts and their interaction with beliefs about capabilities were generally unrelated to coping. These results suggest that treatment should emphasize the actual practice and use of adaptive coping strategies over education about their outcome.     

Perceptions of health and self-care learning needs of outpatients with HIV/AIDS

Health promotion increases healthy behaviors, enhances health status, and decreases health care costs of chronically ill persons. As HIV has become a chronic illness, many HIV-positive persons may have health learning needs that affect their behaviors, health status, and health care costs. Health learning needs may be general or HIV specific. Social stigma may affect learning resource usage. We used Pender's Health Promotion Model and community-based health promotion principles as theoretical underpinnings for an exploratory study of perceived health and self-care learning needs, barriers, and preferred learning modalities of outpatients with HIV/AIDS. A nonrandom sample of 151 adults completed a researcher-designed self-report survey. Most (97%) expressed interest in health and self-care. Many identified multiple topics, learning barriers, and preferred learning modalities. A statistically significant difference (p=.027) was noted in communication needs of participants diagnosed with HIV versus AIDS. Findings have led to practice changes, health promotion activities, and further research.