Complex Care

Pain in older people

Pain in older people has been found to be under-recognised, under-assessed, and poorly managed especially if the person has cognitive impairment¹. In residential aged care it is estimated that between 26% to 86% of residents experience pain on a regular basis². The presence of pain has a significant impact on the quality of life for the older person and it is essential that comprehensive pain assessments are undertaken. A comprehensive assessment of pain should be prompted by any of the following:

• an observed change in behaviour e.g. decreased mobility, agitation, reluctance to participate in previous activities
• an event such as a fall
• the person complains of pain- remembering that older people may under represent the extent of their pain
• part of a regular screening process.

 

For further details on how best to assess and manage pain please carefully review the following two documents:

• Pain in residential aged care facilities: management strategies
• PMG Kit for Aged Care

In aged care it is everyone’s job to look out for signs of discomfort and pain in residents and ensure that it is managed effectively.

 

Muscle deconditioning

Muscle deconditioning is the term used to describe a decrease in muscle mass that results from immobility or ageing or both and contributes to an overall weakness. This overall weakness in turn results in functional decline of the person impacting on their capacity to undertake everyday activities such as getting out of a chair unaided.

Kortebein et al⁴ found that bed rest significantly impacted on the overall condition of healthy older adults. In the study Kortebein et al discovered healthy participants had substantial loss of strength in lower limbs after just 10 days as well as a reduction in cardiovascular capacity⁴.

The importance of supporting older people to maintain muscle strength is paramount as it can help avoid unnecessary dependency on others to undertake simple tasks and assists in maintaining their quality of life.

 

Collaborative practice

Effective collaborative practice is essential to ensure that each resident receives safe quality care. The World Health Organisation has recognised the importance of collaborative or interprofessional practice as a key practice competency⁵. Effective collaborative practice recognises each team member’s professional skills, expertise and capacity to perform different functions to ensure the best outcomes for the client⁶.

A wide variety of professionals, both frontline and behind the scenes, are required in Aged Care to ensure residents receive optimum quality care. Think about the various people you have seen involved in the care of Mrs Collins – do you know what their roles were?

 

Guess Who Quiz

Take the Guess Who test to help you reflect on the range of people/employees in Aged Care.

Watch the short film clips here and see if you can match the profession to the right person.

 

 

 

 

References

1. Australian and New Zealand Society for Geriatric Medicine: Position Statement No. 21: Pain in Older People [Internet] 2012 [cited 2014 Mar 19]; Available from here.
2. Australian Government Department of Health and Ageing. The PMG Kit for Aged Care: An implementation kit to accompany The Australian Pain Society’s Pain in Residential Aged Care Facilities: Management Strategies. [Internet] 2007 [cited 2014 Apr 8]; Available from here.
3. Australian Pain Society. Pain in residential aged care facilities: Management strategies [Internet] 2005 [cited 2014 Mar 28]; Available from here.
4. Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronse O, Protas E, et al. Functional impact of 10 days of bed rest in health older adults. Journal of Gerontology [Internet]. 2008 [cited 2014 Apr 8]; 63A(10):1076-81. Available from Australian and New Zealand Society for Geriatric Medicine: Position Statement No. 21: Pain in Older People [Internet] 2012 [cited 2014 Mar 19]; Available from here.
5. World Health Organisation. Framework for action on interprofessional education and collaborative practice [Internet] 2010 [cited 2014 Apr 10] Available from here.
6. Barr B. Effective interprofessional education: argument, assumption, and evidence. Oxford: Blackwell Publishing; 2005.