Pain Management and Opioid Free Treatment Order Sets: An Evolving Role for Pharmacists

2020 ◽  
Vol 35 (10) ◽  
pp. 406-407
Author(s):  
Lacey Davis
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Vital Sign ◽  
The United States ◽  
Free Treatment ◽  
Assessment And Treatment ◽  
Prevalence Of Pain ◽  
Patients Experience ◽  
Treatment Order

Over the past twenty five years, significant changes to the assessment and treatment of pain have occurred. In the 1990s, the identification of "pain as the fifth vital sign" impacted how providers assessed and treated pain. Now, with the opioid epidemic and recommendations from multiple organizations to remove pain as the fifth vital sign, the practice of pain management is changing again. Despite these changes, pain is still a common condition many patients experience. It is estimated about 50% of older adults in the community report daily pain, and there is an increased prevalence of pain in the facility setting, with 45-80% of residents reporting chronic pain impacting their quality of life. With the growing number of older adults in the United States, pharmacists working with geriatric patients need to be familiar with the treatment of pain and new approaches that are being utilized.

Pain Management and Opioid Free Treatment Order Sets: An Evolving Role for Pharmacists

2020 ◽  
Vol 35 (10) ◽  
pp. 406-407
Author(s):  
Lacey Davis
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Vital Sign ◽  
The United States ◽  
Free Treatment ◽  
Assessment And Treatment ◽  
Prevalence Of Pain ◽  
Patients Experience ◽  
Treatment Order

Over the past twenty five years, significant changes to the assessment and treatment of pain have occurred. In the 1990s, the identification of "pain as the fifth vital sign" impacted how providers assessed and treated pain. Now, with the opioid epidemic and recommendations from multiple organizations to remove pain as the fifth vital sign, the practice of pain management is changing again. Despite these changes, pain is still a common condition many patients experience. It is estimated about 50% of older adults in the community report daily pain, and there is an increased prevalence of pain in the facility setting, with 45-80% of residents reporting chronic pain impacting their quality of life. With the growing number of older adults in the United States, pharmacists working with geriatric patients need to be familiar with the treatment of pain and new approaches that are being utilized.

Pain in Older Patients

2019 ◽  
pp. 319-338
Author(s):  
Staja Q. Booker ◽  
Keela A. Herr
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Older Patients ◽  
Best Practice ◽  
Management Plan ◽  
High Risk Population ◽  
Patient Centered ◽  
Assessment And Treatment ◽  
Centered Care

Chapter 19 discusses the complexities of pain assessment and treatment in older adults and provides best practice recommendations for comprehensive pain management. Pain in older patients is a common, yet significant quality-of-life issue necessitating accurate assessment and safe multimodal treatment. The assessment and treatment of older adults in pain pose distinct challenges and unique opportunities to provide proactive and patient-centered care for a high-risk population with complex health needs. Thus, it is important that providers are prepared to identify these challenges and implement an effective and safe pain management plan.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

scholarly journals Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
Person Centered Care ◽  
Centered Care ◽  
The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

Detecting and Managing the Untreated Pain in Dementia

2020 ◽  
pp. 342-356
Author(s):  
Anne Corbett
Keyword(s):  
Pain Management ◽  
Current Evidence ◽  
Public Health Issue ◽  
Care Needs ◽  
People With Dementia ◽  
Dementia Syndrome ◽  
Assessment And Treatment ◽  
Person Centered Approach ◽  
Established Treatment

Dementia affects more than 30 million people worldwide and is a major public health issue because of the complex treatment and care needs of these older patients. Pain is very common in people with dementia and is closely linked to key clinical outcomes, including mobility and falls, behavioral symptoms, mental health, and quality of life. Effective pain management is therefore essential to provide a good quality of care for these individuals. Pain assessment and treatment can be challenging in dementia because of loss of communication and insight as the condition progresses. There are also indications that the dementia syndrome itself affects the experience of pain and response to established treatment approaches. Guiding principles for pain management are therefore focused on a person-centered approach, with careful monitoring to avoid the risk for polypharmacy and treatment sensitivity that is common in people with dementia. This chapter outlines the current evidence pertaining to pain in people with dementia and sets out recommendations for both assessment and treatment of pain in this patient group.

Patient Versus Informal Caregiver Proxy Reports of Pain Interference in Persons With Dementia

2020 ◽  
pp. 073346482090263 ◽  
Author(s):  
Amber B. Amspoker ◽  
A. Lynn Snow ◽  
Brenna N. Renn ◽  
Phoebe Block ◽  
Sabrina Pickens ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Informal Caregiver ◽  
Pain Interference ◽  
Severe Dementia ◽  
Proxy Reports ◽  
High Prevalence ◽  
Assessment And Treatment ◽  
Prevalence Of Pain ◽  
Caregiver Report

Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To better understand reports of pain interference, we examined ratings made by PWDs, as well as corresponding ratings about PWDs, as reported by the caregiver. We aimed to assess alignment between and predictors of caregiver and PWD report of pain interference. Methods: The sample consisted of 203 veterans with pain and mild to moderately severe dementia and an informal caregiver. Results: Most PWDs and their caregivers reported at least some pain interference and similar levels of pain interference. PWDs with greater cognitive impairment reported less pain interference, whereas caregivers who perceived the PWD to have greater depression reported more pain interference. Conclusions: PWD and caregiver characteristics were differentially associated with PWD versus caregiver report of pain interference. Results suggest the importance of caregiver reports to inform assessment, as well as factors complicating assessment. Pain in Dementia As one ages, the risk of developing both dementia and pain increases substantially (Scherder et al., 2009). It is estimated that 30% to 50% of persons with dementia (PWDs) experience persistent pain, a complex multifactor problem (Corbett et al., 2014). Despite the high prevalence of pain among older adults with dementia, and major advances in pain management, pain often remains unrecognized or undertreated (Hodgson et al., 2014).

scholarly journals Adaptability and Resilience in Aging Adults (ARIAA): A Pilot and Feasibility Study in Chronic Low Back Pain

2020 ◽  
Author(s):  
Paige E Lysne ◽  
Shreela Palit ◽  
Calia A Morais ◽  
Lucas C DeMonte ◽  
Maria Lakdawala ◽  
...  
Keyword(s):  
Older Adults ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Management ◽  
Chronic Low Back Pain ◽  
The United States ◽  
Primary Study ◽  
Low Back ◽  
Positive Health ◽  
Aging Adults

Abstract Background: Chronic low back pain (cLBP) is the leading cause of disability among older adults and one of the top reasons for seeking healthcare, resulting in significant decrements in physical functioning. Because older adults are among the fastest growing cohorts in the United States, both the incidence and burden of cLBP are expected to increase considerably, rendering geriatric pain management a top health priority. Resilience is defined as a process allowing individuals to adapt and recover from adverse and stressful conditions and it has been highlighted as a crucial factor in positive health-related functioning. While a growing body of literature supports the use of resilience-based interventions in chronic pain, research examining their effectiveness in older adults with cLBP remains limited.Methods: In this article, we describe the rationale and design of the Adaptability and Resilience in Aging Adults (ARIAA) study, a single-arm intervention in which 50 participants (ages >60 years) with cLBP will be recruited to participate in a 7-week group-based program aimed at enhancing psychological resilience. Intervention sessions will target positive psychology concepts (e.g., positive affect, pain acceptance, hopeful thinking, pain self-efficacy) and cognitive-behavioral techniques that have established benefits in pain management. Primary study outcomes include intervention feasibility and acceptability as measured by treatment engagement, intervention credibility and satisfaction, ability to meet recruitment and retention metrics, and the feasibility of questionnaire and home activity completion. Outcomes will be assessed at baseline, immediately at post-treatment, and at the 3-month follow-up period. Discussion: This study will establish the feasibility and acceptability of a novel intervention aimed at enhancing positive, psychological functioning and resilience in older adults with cLBP. Achievement of these aims will provide a rich platform for future intervention research targeting improvements in pain and disability among geriatric populations and will serve as a foundation for a fully powered trial to examine treatment efficacy of the proposed intervention.Trial Registration: Clinicaltrials.gov, identifier NCT04068922. Registered 28 August 2019, https://clinicaltrials.gov/ct2/show/NCT04068922

scholarly journals Pain in Nursing Homes Residents With and Without Cognitive Impairment. Results From Five Consecutive Multicenter Cross-sectional Surveys Carried Out Between 2014 and 2018 in Germany

2020 ◽  
Author(s):  
Rainer Centmayer ◽  
Manfred Leiske ◽  
Nils Axel Lahmann
Keyword(s):  
Cognitive Impairment ◽  
Pain Management ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Self Report ◽  
Cross Sectional ◽  
Intensive Training ◽  
Prevalence Of Pain ◽  
Significant Deficit

Abstract Background: There is evidence that knowledge about the prevalence of pain and quality of pain management particularly in nursing home residents (NHR) with severe cognitive impairment (CI) is poor.Methods: The multicenter cross-sectional surveys explored the prevalence of pain of NHR with or without CI from nursing homes in Germany. Actual pain intensity in rest and stress were documented. NHR were asked about their daily restrictions due to pain. Data about the pain management were collected and analyzed.Results: A total of 3437 residents were interviewed with respect to feeling pain, including one third each with mild and severe CI. The prevalence of actual pain was 31,8%. Women reported pain more often. Prevalence of NHR without CI or with self-report on pain was significantly higher than NHR with severe CI or with external report on pain. About 20% of all NHR were dependent on external pain-recording. Nearly 10% of all NHR with pain confirmed pain in stress above 5 on a scale of 0 - 10. 85% of all NHR with pain reported that they had pain for longer than 3 months. Residents with severe CI are 0.55 times less likely to take painkillers than NHR without CI.Conclusion: The study points out a significant deficit in pain management in German NHR with severe CI. Intensive training in pain management for employees in nursing homes is recommended.

scholarly journals The Impact of COVID-19 Across Nursing Homes That Disproportionally Serve Minority Residents

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 241-241
Author(s):  
Amit Kumar ◽  
Indrakshi Roy ◽  
Amol Karmarkar ◽  
Kimberly Erler ◽  
James Rudolph ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Homes ◽  
The United States ◽  
Structural Racism ◽  
High Quality ◽  
Total Death ◽  
The Life Course ◽  
The Impact ◽  
Related Mortality

Abstract The Coronavirus-2019 (COVID-19) pandemic has disproportionally affected communities of color and older adults in the United States. Nursing homes (NHs) have reported over 130,000 COVID-19 deaths (or one-fourth of all US deaths) circa March 2021, a high share of the nation’s total death count (CMS COVID-19 NH Data). These inequities partially driven by barriers to care, segregation and structural racism have resulted in the unequal impact of COVID-19 across NHs (Li et al., 2020). In this presentation, I will describe NHs that disproportionally care for minority residents and the effect of NH composition on COVID-19-related mortality and outcomes. In 2020, minority older adults were less likely to have access to high quality facilities. From June – August, NHs with a high proportion of minority residents reported higher COVID-19 mortality rates per 1000 residents. Equal access to high quality of care across the life-course among racial and ethnic groups is needed.

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