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

Abstract. Summary: Background: This pilot study was set up to examine the effects of a continuous postoperative wound infusion system with a local anaesthetic on perioperative pain and the consumption of analgesics. Patients and methods: We included 42 patients in this prospective observational pilot study. Patients were divided into two groups. One group was treated in accordance with the WHO standard pain management protocol and in addition to that received a continuous local wound infusion treatment (Group 1). Group 2 was treated with analgesics in accordance with the WHO standard pain management protocol, exclusively. Results: The study demonstrated a significantly reduced postoperative VAS score for stump pain in Group 1 for the first 5 days. Furthermore, the intake of opiates was significantly reduced in Group 1 (day 1, Group 1: 42.1 vs. Group 2: 73.5, p = 0.010; day 2, Group 1: 27.7 vs. Group 2: 52.5, p = 0.012; day 3, Group 1: 23.9 vs. Group 2: 53.5, p = 0.002; day 4, Group 1: 15.7 vs. Group 2: 48.3, p = 0.003; day 5, Group 1 13.3 vs. Group 2: 49.9, p = 0.001). There were no significant differences between the two groups, neither in phantom pain intensity at discharge nor postoperative complications and death. Conclusions: Continuous postoperative wound infusion with a local anaesthetic in combination with a standard pain management protocol can reduce both stump pain and opiate intake in patients who have undergone transfemoral amputation. Phantom pain was not significantly affected.

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Bilateral Continuous Erector Spinae Blocks for Post-Sternotomy Pain Management: A Pilot Study

Case Medical Research ◽

10.31525/ct1-nct03936387 ◽

2019 ◽

Author(s):

Keyword(s):

Pain Management ◽

Pilot Study ◽

Erector Spinae

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83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

Age and Ageing ◽

10.1093/ageing/afab030.44 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C Yang ◽

Z Hui ◽

S Zhu ◽

X Wang ◽

G Tang ◽

...

Keyword(s):

Medication Adherence ◽

Pilot Study ◽

Older People ◽

Intervention Group ◽

Self Management ◽

Control Group ◽

Medication Knowledge ◽

Management Intervention ◽

Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

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Using crystallization to understand loneliness in later life: integrating social science and creative narratives in sensitive qualitative research

Qualitative Research ◽

10.1177/14687941211005943 ◽

2021 ◽

pp. 146879412110059

Author(s):

Barbara Barbosa Neves ◽

Josephine Wilson ◽

Alexandra Sanders ◽

Renata Kokanović

Keyword(s):

Qualitative Research ◽

Creative Writing ◽

Social Science ◽

Older People ◽

Case Studies ◽

Vulnerable Populations ◽

Lived Experiences ◽

Later Life ◽

Care Homes ◽

Social Phenomena

This article draws on crystallization, a qualitative framework developed by Laurel Richardson and Laura Ellingson, to show the potential of using sociological narratives and creative writing to better analyze and represent the lived experiences of loneliness among older people living in Australian care homes. Crystallization uses a multi-genre approach to study and present social phenomena. At its core is a concern for the ethics of representation, which is critical when engaging with vulnerable populations. We use two case studies from research on loneliness to illustrate an application of crystallization through different narrative types. To supplement our sociological narratives, we invited author Josephine Wilson to write creative narratives based on the case studies. Josephine was awarded the prestigious Miles Franklin Literary Award in 2017 for Extinctions, a novel exploring themes such as later life and loneliness. By contrasting the two approaches—sociological and creative narratives—we discuss the implications of crystallization for qualitative research.

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Preferences for everyday living inventory (PELI): study protocol for piloting a culture-sensitive and setting-specific translated instrument in German care settings (PELI-D)

BMJ Open ◽

10.1136/bmjopen-2019-030268 ◽

2020 ◽

Vol 10 (1) ◽

pp. e030268

Author(s):

Tobias Ingo Stacke ◽

Johannes Michael Bergmann ◽

Armin Michael Ströbel ◽

René Müller-Widmer ◽

Daniel Purwins ◽

...

Keyword(s):

Pilot Study ◽

Older People ◽

Study Protocol ◽

Personal Information ◽

Care Process ◽

Internal Quality ◽

Care Practice ◽

Individual Preferences ◽

Need Of Care ◽

Everyday Living

IntroductionRegardless of the healthcare setting, person-centred care and its implementation in caring for older people are a central issue for those who are responsible as professional caregivers and for those in need of care within the care process. Both aspects encompass the possibility of recognising personal preferences. To provide person-centred care, professional caregivers need to know about the individual preferences of the persons being cared for. Therefore, the PELI (an acronym for ‘Preferences for Everyday Living Inventory’) instrument was developed at the Polisher Research Institute (USA) for the systematic recording of individual preferences of older people in need of care. There is currently no comparable instrument available in the German language.MethodsAs part of the proposed project PELI-D, all versions of the original PELI instrument (nursing home version) were (1) culture-sensitively translated into German and will be (2) examined in a pilot study for their reliability, feasibility and practicability. For the project PELI-D, we worked together with our practice partners in Germany (Diaconia and Caritas in North Rhine-Westphalia) and collaborated with our partners in the USA who developed the PELI instrument. This study protocol focuses on the pilot study, which will be conducted by the German Center for Neurodegenerative Diseases (DZNE) (site Witten).Ethics and disseminationThis study was approved by the internal quality control committee of the DZNE (ID number: WI029 PELI-D) and by the ethics committee of the German Society of Nursing Science Duisburg branch office (ID number: 18-010). All personal information will be deidentified with a specific identification code and stored in a secured location apart from the rest of the study data. Only qualified and study-related staff will be allowed access to the data. The results of the study will be distributed nationally and internationally through peer-reviewed journals, conferences and journals for nursing care practice.

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The ‘regulated death’: a documentary analysis of the regulation and inspection of dying and death in English care homes for older people

Ageing and Society ◽

10.1017/s0144686x06005460 ◽

2007 ◽

Vol 27 (2) ◽

pp. 233-247 ◽

Cited By ~ 9

Author(s):

KATHERINE FROGGATT

Keyword(s):

Older People ◽

Best Practice ◽

Quality Care ◽

Care Homes ◽

National Standard ◽

Good Death ◽

Term Care ◽

Documentary Analysis ◽

Death Event ◽

Inspection Process

In England, processes of regulation and inspection have been established to ensure that older people living in long-term care settings receive quality care. This paper describes how dying and death in care homes for older people is regulated and inspected. A documentary analysis was undertaken of the standard that addresses dying and death in the 2001 Care Homes for Older People: National Minimum Standards. Present in the standard is a ‘good death’ template drawn from constructions of best practice in palliative care. The way in which this national standard is enacted in the inspection process is described using a content analysis of the inspection reports from 226 care homes for older people. These present a narrow focus on dying and death, one that emphasises the older person's wishes and the degree of adherence to policies and procedures concerned with the dying and death event. A regulated death attenuates the ‘good death’ template and reflects both the inspection process and capabilities of the residents of care homes. If the regulation and inspection process is to integrate dying with living, a broader conception and regime of inspection is required. Only then will end-of-life care be provided that meets the diverse needs of older people who live in care homes.

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