Nurse practitioner should be able to recognize these descriptors and take them as potential indicators of pain and clarify with further questioning.
According to Horgas & Miller (2008), older adults with cognitive or physical limitations, have difficulty expressing details about their pain. These include pain location, duration, onset, type, precipitating factors, and relieving factors of pain. Pain is a subjective experience without valid and reliable objective tests to measure it. The existence and intensity of pain are measured by patient self-report. Unfortunately, older populations with cognitive disability may have difficulty expressing pain via verbal or body language. In some cases, it is astounding to know that pain in older population with dementia is very often undertreated. Therefore, variation in patient's ability to communicate verbally can add another layer to effectively manage pain. When pain issue is not resolved, it decreases overall ability to perform daily activities, and it causes serious impacts in most life (Horgas & Miller, 2008). Likewise, older population with cognitive impairment is even more limited to communicate pain symptoms. Therefore, extra care should be provided to observe even the slightest reactions- body movement, changes in activity routines, changes in interpersonal interactions, facial expression, mental status changes, verbalizations, and vocalizations (Bruckenthal, Reid & Reisner, 2009). Additionally, certain patients may have limited movement that makes difficult for practitioners to assess them. When pain is not controlled in patients with cognitive limitation, they express their pain by being violent, angry, or refusing their routine care. There are patients who come more quiet and weak when they have pain, but also there are patients who become more troublemaking or have unsuitable behaviors in public settings (Somes& Donatelli, 2013). Furthermore, health care providers should pay extra attention on any type of sudden fluctuations in activity of daily life of older adults, since it can be a warning sign of pain. According to Somes & Donatelli (2013), “refusing food, changes in appetite, increases or decreases in the length of rest periods, increased wandering, or ceasing to do routine activities” can be signs of possible pain, and patients need further assessments. Especially, “crying, increased confusion, apparent distress, or irritability” can reflect pain of patients who cannot express their pain (Somes & Donatelli, 2013). There are four different pain scales for older adults with limited cognitive or physical ability to express their pain. The details will be explained after discussing one more barriers to pain management.
Barrier 3: interruption in communicating with health care provider
Older adults have difficulty communicating about their pain condition when they are interrupted. Practitioners should assess every aspect of behavior to optimize pain outcomes for older populations. However,...