By Bradley Yee
When your elderly loved one experiences chronic pain
What is chronic pain?
When pain of an injury or illness persists longer than the time of healing or if pain lasts longer than three months, that is chronic pain.
What causes this chronic pain?
As people age, there is increased prevalence of chronic pain. Arthritis is the most common chronic condition older people manage on a daily basis. Approximately 80 percent of older adults have at least one chronic health condition and 50 percent have at least two. Arthritis, hypertension, heart disease, diabetes, and respiratory disorders are some of the leading causes of activity limitations among older people.¹
How chronic pain affects a family’s life
The elderly loved one who experiences chronic pain may lose sleep. Gradually, their muscles and joints may become more rigid. The family caregivers will need to pay more attention to when the care recipient takes their medication. Chronic pain gets your attention, and schedules change and are typically subject to change immediately in response to spikes in chronic pain. The emotional toll of chronic pain is significant. Their energy level can decrease. There is a risk of depression for the one who has chronic pain. There could be more trips to see the doctor or scheduled health professional assistance. There will be more co-payments, transportation costs and time for these health professional appointments. Because of the unpredictable nature of when the chronic pain spikes and the associated rearranging of schedules, social interaction with friends and family is affected. Planning for regular social interaction outside the home is more of a challenge. There may be more need for assistance with Activities of Daily Living.
Ways to help
When your elderly loved one shows signs of experiencing chronic pain, or complains of pain, which lasts over an extended time, be proactive – encourage them to arrange for an assessment of their pain, from a reliable health professional, such as a doctor specializing in pain management and pain medicine.
Next, help your elderly loved one find out the intensity of the pain, and then have the doctor do a thorough assessment (examination.)
The goal of assessment is to: find out what spurred on the pain, how it can be best treated and managed.
The Benefits of evaluation are multi-faceted: chronic pain affects the overall quality of life. Accordingly, a thorough evaluation will determines the elderly’s level of function – how those activities of daily living are carried out, and also it assesses, if needed, the amount of help from caregivers needed for the elderly to function. All this points to the amount of independence an elderly person has.
Assessing the pain often will require a team of health professionals which include but are not limited to: doctor, physical therapist and possibly psychologist or psychiatrist because depression is often experienced by the person experiencing chronic pain. For those with cognitive challenges, the team of health professionals may rely on input from family member caregivers or outside help caregivers working with your elderly loved one – on when the elderly loved one expresses pain, what activity they could be participating in and the duration of expressed pain.
In an article in The Oschner Journal entitled Pain Management in the Elderly Population: A Review, researchers have recommended that the team of health professionals utilize assessment tools for determining the intensity of pain, including the McGill Pain Questionnaire, then having a medical professional perform a thorough examination.² The MicGill Pain Questionnaire has evidence for validity, reliability, and discriminative abilities that are not age-related. The McGill Pain Questionnaire can be used to assess the sensory, affective, evaluative, and miscellaneous components of pain. After assessing the intensity of pain, one should perform a thorough examination. An overview is discussed here:
- Complete history and physical examination, with focus on most pressing pain issues
- Review of location of pain, intensity, exacerbating and/or alleviating factors, and impact on mood and sleep
- A screen for cognitive impairment such as the Folstein mini mental examination
- A screen for depression
- A review of the patient’s ADLs (bathing, dressing, toileting, transfers, feeding, and continence) and instrumental ADLs (use of phone, travel, shopping, food preparation, housework, laundry, taking medicine, handling finances)
- Assessment of gait and balance
- A screen for sensory depression to examine basic visual and auditory function³
There are challenges to assessment and management of chronic pain. These include if the elderly loved one has dementia, has poor memory, has depression or is not reporting pain because of cultural reasons or their mind set that some reoccurring pain is normal with aging. Doctors and the health team can certainly work with these challenges to best assess and manage the chronic pain.
Next steps after assessment:
Display genuine empathy
Experiencing chronic pain can produce stress, which then becomes a vicious cycle. Help to deal with the emotional toll. Be aware that your elderly loved one may have low energy. They may be able to do some things that they normally do, but perhaps only for a short time or their interest in keeping their normal routine may wane. Recognize that chronic pain may not be a short term experience. Be very careful with the words you use towards your elderly loved one. Do not question or minimize their chronic pain. Be very careful with using trite sayings. Perhaps one of the most devastating experiences is for a person experiencing chronic pain to receive unsolicited advice. Instead, use words which can bring encouragement for the moment. Your loved one may be grieving their loss of their former life before their chronic pain. Let your loved one talk about their emotional pain. Gently help them understand the opportunities for growth in the future in new areas of interest, creating new skills, and learn new ways to be productive.
Keep professional health team updated
Family caregivers and outside home care aides are typically the first to notice any changes in developments with chronic pain. Alert the appropriate professional health team members of the time and duration and intensity of the pain that your elderly loved one reports to you. Also, report any new developments, so that the professional health team can best plan to manage the chronic pain.
If your elderly loved one is open to it, invite family, extended family and friends to assist
Your elderly loved one can receive a boost of morale when others provided the needed assistance. You will also benefit from not carrying the full load of assisting with ADLs and the respite can re-energize you. Brief visits from individuals who care for them, can help stave off loneliness that your elderly loved one might be experiencing.
Learn all you can about your loved one’s chronic pain, so you can better assist them.
Research ways to lessen the pain. Help to make their life easier – in practical ways around the house for instance. There are a multitude of products which can help, so that they can continue functioning at a high level. If the doctor prescribes exercise, learn how to encourage your loved one to exercise. Make it enjoyable. Find out about free/low cost exercise programs your city provides for residents. Become an expert at reading visual and verbal signs of pain your elderly loved one expresses, so you can know when their chronic pain is spiking, and what you can do to relieve pain in a quick manner. Research about independent-living products and services which can greatly benefit those in chronic pain.
Join a support group of others who may be experiencing similar type of chronic illness.
Your local library or an internet search will provide resources of which groups are meeting with locations and times. Just knowing that they are not alone in their chronic pain does wonders to boost their morale. Social connectedness is a strong deterrent to social isolation. Be aware that your elderly loved one is experiencing decreased energy as a result of chronic pain, so this will factor in on how much time can be invested in support groups.
Help if you need it
Christian Love Home Care is a licensed Home Care Organization, offering non-medical in-home assistance. Our Home Care Aides will gladly assist your elderly loved one with helping make their life easier, in may ways. Please contact us if we may be of service to you: Tel: 805-238-3500 email: email@example.com
Loverde, Joy (2009) The Complete Eldercare Planner: Where to Start, Which Questions to Ask, And How To Find Help. New York, New York. Three Rivers Press, and imprint of the Crown Publishing Group, a division of Random House, Inc.
Kaye, Alan D., MD, PhD Department of Anesthesiology and Department of Pharmacology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, Amir Baluch, MD, Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL, Jared T. Scott, MD, Department of Anesthesiology, Texas Tech Health Sciences Center, School of Medicine, Lubbock, TX. (2010) Pain Management in the Elderly Population: A Review. The Oschsner Journal 10:179-187, 2010. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/
Seniors and Chronic Pain (2011) from MedlinePlus.gov available here: https://medlineplus.gov/magazine/issues/fall11/articles/fall11pg15.html
Peterson, Kathleen, BSN, RN. Managing Chronic Pain In The Elderly. American Nurse Today. Official Journal of ANA (American Nurses Association). September 2010 Vol. 5 No. 9. Available here: https://www.americannursetoday.com/managing-chronic-pain-in-the-elderly/
The American Geriatrics Society, (2002) The Management of Persistent Pain in Older Persons: AGS Panel on Persistent Pain in Older Persons. Available here: http://www.geriatricpain.org/Content/Resources/CPGuidelines/Documents/AGS%20Panel%20on%20Persistent%20Pain%20in%20Older%20Persons.pdf
¹ Loverde, Joy (2009) The Complete Eldercare Planner: Where to Start, Which Questions to Ask, And How To Find Help. New York, New York. Three Rivers Press, and imprint of the Crown Publishing Group, a division of Random House, Inc. Page 230, this footnote tied to Joy Loverde’s citing this from:
Wan, He, Manisha Sengupta, Victoria A. Velkoff, and Kimberly A. DeBarros, 65+ in the United States: 2005, U.S. Census Bureau, Current Population Reports, P23-209 (Washington, D.C.:US. Government Printing Office, 2005), p.15.
²Kaye, Alan D., MD, PhD Department of Anesthesiology and Department of Pharmacology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, Amir Baluch, MD, Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL, Jared T. Scott, MD, Department of Anesthesiology, Texas Tech Health Sciences Center, School of Medicine, Lubbock, TX. (2010) Pain Management in the Elderly Population: A Review. The Oschsner Journal 10:179-187, 2010 p. 180. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/
Christian Love Home Care, LLC is a non-medical home care agency. Accordingly, information provided in this blog as well as on our website is for informational purposes only. The information is not implied or intended to take the place of professional medical advice, treatment or diagnosis. You are encouraged to always confirm any information from this website with professional medical advice.