Osteoarthritis in canines part 1: geriatric pain management

Osteoarthritis is a developmental disease that progresses as the canine ages. While incurable, there are ways to help mitigate the severity of the disease. Geriatric patients often have pain, lowered mobility, and decreased quality of life. Utilisation of clinical metrology instruments (CMIs), published pain management guidelines, multimodal medications, published quality of life scales, and the use of physical rehabilitation modalities/techniques enable the dog to live a full life. The dog's advancing age does not have to cause abrupt cessation of activities that all family members enjoy. Environmental modification and client education allow dogs to enjoy their entire life with their families.

Pain measurement in the older people: evaluation of the psychometric properties of the Geriatric Pain Measure (GPM-24) – polish version

Background Chronic pain in older people is of particular importance not only with regard to negative subjective experience but also as an indicator of the quality of medical care. Brief scales to assess pain may help health professionals with early recognition and treatment to avoid patient suffering. However, these scales should be adapted to the cultural context to provide valid assessments. The aim of this study was to evaluate the psychometric properties of the Polish translation of the Geriatric Pain Measure – 24 (GPM-24) in older people. Methods The study was conducted among 181 people aged 65 and over with chronic (noncancer) pain of varying intensity lasting more than 6 months. Construct validity was assessed using the principal component analysis (PCA) method with oblimin rotation. Criterion validity was evaluated by correlating the scores of the GPM-24 with the scores of the McGill-Melzack questionnaire (MPQ). The reliability of the GPM-24 was estimated in terms of internal consistency using Cronbach’s alpha coefficients. Results The PCA revealed a 6- component structure of the set of items that constituted the GPM-24. Most of these components were defined by items included in the same subscale, similar to the result obtained by the original scale’s authors. There were significant correlations between the GPM-24 and some dimensions of MPQ: affective (rho = 0.25, p = 0.001), present pain intensity (rho = 0.44, p < 0.001), pain rating index total (rho = 0.31, p < 0.001), and number of words chosen (rho = 0.26, p < 0.001). The value of the standardized Cronbach’s alpha equalled 0.89 and thus confirmed the high reliability of the GPM-24. Conclusions The Geriatric Pain Measure − 24 is a reliable and valid tool that is recommended for the monitoring and multidimensional assessment of chronic pain in older people in daily practice as well as in clinical trials. Trial registration Statutory research “Chronic pain in people over 65 years of age” K/ZDS/005733, conducted in 2015–2018.

Pain Management in Older Persons

Pain is a common symptom in the elderly and it is problematic and distressful especially if the polder person is dependent on a caregiver. Pain keeps the sufferer uncomfortable and can affect the person from carrying out daily activities and tasks especially activities of daily living. Pain in the older person may be acute or chronic. Some of the causes of pain in the elderly are neuralgia, musculoskeletal dysfunction especially osteoarthritis, emotional and mental problems, cancer and several other causes. The assessment of pain in the elderly is done using validated pain assessment tools such as the visual analogue scale, verbal rating scales, numeric rating scales, McGill pain assessment questionnaire, pain attitudes, brief pain inventory, and geriatric pain measure. Management of pain in older persons involves non-pharmacological and pharmacological methods. There are some barriers and challenges of pain management in the elderly and also consequences when pain is not properly managed or not managed at all in an older person.

Evaluation of Chronic Pain and Affecting Factors in the Elderly

Objective: Diseases are more seen in the elderly population, therefore pain also gains a severe probleme in this situation. It is well known that pain impairs significantly the quality of life and gives raise to an increase use of drugs. The aim of our study is to determine the severity of chronic pain in the eldely and to evaluate the conditions affecting chronic pain. Methods: We included 456 elderly patients in our study. The mean age was 71.19±6.27 (min: 65; max: 93). Patient’s sociodemografic information, diseases, use of medications, presence of chronic pain, affecting conditions and treatment applied for chronic pain, and Geriatric Pain Scale were evaluated. Results: The females integrated in tis study were 272 with a rate of 59.6 %. Regarding the geiatric pain scale 61.2 % (n: 279) had a mild pain while the other 18.6% (n: 85) had severe pain. The 87.7% were in medication of analgesics for their chronic pain. The patient’s knowledge of the used of medications was with a rate of 43.9% (n: 200). We founded a statistically significant relationship between the chronic pain and femele gender (p<0.001), older age (p=0.012), smoking users (p=0.01), nonsteroidal antiinflamatory drug users (p=0.003) and inidviduals with higher mass body index (p=0.016). Conclusion: Chronic pain in the elderly is a common complaint. The presence of pain disrupts the quality of life and puts additional burdens on the healthcare system. Detecting preventable situations that cause pain and increases severity, giving importance to non-drug treatments, increasing health literacy about the drugs used, implementing effective policies against diseases will reduce the severity of chronic pain, increasing the quality of life and significantly reducing health costs.

Qualidade de vida e prevalência de sintomas depressivos em idosas com dor crônica

Este estudo buscou avaliar a qualidade de vida e a prevalência de sintomas depressivos em idosas com dor crônica. Tratou-se de um estudo quantitativo de cunho transversal, descritivo e comparativo em que foram comparadas 65 idosas com dor crônica (grupo dor – GD) e sem dor crônica (grupo sem dor crônica - GSD) de um município da região norte do Rio Grande do Sul, Brasil. Como instrumentos foram utilizados um questionário socioeconômico e de saúde, a escala de Medida de Dor Geriátrica (Geriatric Pain Measure - GPM), a escala de Depressão Geriátrica (GDS-15) e a escala de qualidade de vida WHOQOL-Bref. A prevalência de dor crônica foi de 52,3% e para estas idosas houve prevalência sintomas depressivos em 18,4%, já no grupo sem dor crônica 9,2% tiveram esses sintomas, mas não houve diferença estatisticamente significativa entre os grupos. Entretanto, pode-se concluir que por mais que a prevalência de sintomas depressivos seja baixa, as idosas com dor apresentaram menor satisfação com a qualidade de vida comparadas com as sem dor.

IS THERE A RELATIONSHIP BETWEEN PAIN AND FEAR OF FALLING IN OLDER ADULTS LIVING IN LONG-TERM CARE FACILITIES?

Fear of falling is common in older adults and it is associated with multiple factors such as gait and balance issues, difficulties in activities of daily living, visual impairment, and frailty. Unfortunately, fear of falls increases the risk of falls as opposed to protect from falls. Pain can impair mobility, affects activities of daily living, and may also be associated with fear of falling but no studies have evaluated this potential association. The objectives of this study were to evaluate if there was an association between pain and fear of falling in older adults living in long-term care facilities. One hundred and eight older adults living in long-term care facilities participated in the study. The mean age was 79±7 years, and 65% of the participants were women. The participants completed the Geriatric Pain Measure (GPM) questionnaire for multidimensional pain assessment (scores range from 0 to 42), and the Falls Efficacy Scale International (FES-I) for fear of falling assessment (scores range from 16 to 64). The data was analyzed using multiple linear regression. Forty-five percent of the participants had chronic pain (≥3 months) and 18% had acute pain (&lt;3 months). Pain scores were 29±31. Pain was associated with an increase of 3 to 7 points (out of 64 max) in the FES-I. The prevalence of pain in long-term care residents was high, and pain was associated with increased fear of falling.

Preoperative frailty and its association with postsurgical pain in an older patient cohort

Background and objectivesChronic postsurgical pain in patients over 65 negatively impacts recovery, quality of life and physical functioning. In the community setting, chronic pain has been shown to be related to frailty, a syndrome more commonly seen in older adults and characterized by limited physiologic reserve and ability to withstand stressors. While frailty is an important preoperative risk factor for poor surgical outcomes in older adults, the relationship between frailty and postsurgical pain in this population has not been investigated. We hypothesized that preoperative frailty would be associated with greater odds of postsurgical chronic pain.MethodsWe conducted a prospective cohort study of 116 patients older than 65 years old who underwent major elective non-cardiac surgery. Patients were assessed for frailty within 30 days prior to surgery using the FRAIL Scale assessment and pain was evaluated before surgery and at 3 months after surgery using the Geriatric Pain Measure.ResultsAfter adjusting for baseline characteristics, we found that frail patients were almost five times more likely to have intrusive postsurgical pain compared with patients who were not frail (OR 4.73, 95% CI 1.24 to 18.09). Intrusive preoperative pain and spine surgery were also associated with increased postsurgical pain (OR 10.13, 95% CI 2.81 to 36.57 and OR 4.02, 95% CI 1.22 to 13.17, respectively).ConclusionAlthough future studies are needed to establish a causal relationship between preoperative frailty and postsurgical pain, our findings suggest that older patients should have preoperative frailty assessments and frail older adults may need additional resources to improve postsurgical pain outcomes.Trial registration numberNCT02650687