BACHELOR OF SCIENCE IN NURSING:

NCMB 314 – CARE OF THE OLDER ADULT

RLE MODULE RLE UNIT WEEK

2 6 7

Pain in Elderly
  Read
 course and
 laboratory unit objectives
 Read study guide prior to class attendance
 Read required learning resources
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. To be able to gain knowledge regarding age-related changes of advancing age.

2. To describe physical changes of the older adult.

Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones &

Bartlett Publishers.610.7365 G31 2010

Eliopoulos (2018). Gerontological Nursing 9 th Edition.Wolters Kluwer

Meiner (2019). Gerontologic Nursing 6th Edition. ELS

Cuison,Roy. Handbook of Lectures on Geriatric Medicine

Pain is the greatest threat to comfort. A definition of pain that was accepted for
decades for decades describes pain as “an unpleasant sensory and emotional experience
associated with actual or potential tissue damage” (American Pain Society, 2003; International
Association for the Study of Pain, 2012).
 It is mostly experienced by the patients with cancer. Prevalence is highest and affected by
cancer in the older population. Understanding of how individual perceived pain assessment and
management especially in older adult.

One of the immense challenges of all health practitioners is assessing pain in older adult because
it is a part of normal aging.

Older adults may experience many different types of pain, and often at the same time.
Because they may have lived with pain over many years, older adults may be reluctant to
report new pain. It is important to assess the type of pain being treated somatic, visceral,
neuropathic, or a combination. The type of pain determines the appropriate medication to be
use.

A systematic approach should be utilized in the treatment of pain. The World Health
Organization recommends a step approach

An oral medication is the route of choice and is well-tolerated in the geriatric population.
However, other routes are acceptable when the patient is unable to swallow at the end of life.
These routes may include sublingual, subcutaneous, intravenous, rectal, or topical, depending
on the medication.

The 5-step approach to pain assessment

Step 1: Self-Report

o Attempt to obtain a self-report of pain from the patient. Use a 0-10 scale if
able.

o If the patient is unable to use a 0-10 scale, attempt a verbal descriptor scale
such as mild, moderate, severe

o Ask the patient if they have pain of if they are hurting

o Ask the patient to squeeze your hand if they are hurting

Step 2: Pathology

o Consider the patient’s physiological condition(s)

 o History of arthritis or chronic pain

o Type of cancer and its potential to cause pain

o Procedures that can cause pain

o Physiologic measures such as heart rate and blood pressure are the least
sensitive indicators of pain but can be elevated in the presence of acute pain

Step 3: Behaviors

o Assess for any patient behaviors that may indicate the presence of pain

o Facial expressions

o Crying or yelling

o Use a nonverbal pain assessment tool if the patient is unable to communicate

Step 4: Caregiver Input

o Ask the caregiver about their perceptions of their loved one’s pain

o Recent change in behavior that indicate pain- withdrawal or agitation

o Actions that indicate the presence of pain

Step 5: Analgesic Trial

o Assume pain present

o If any of the above measures suggest pain, an analgesic trial should be

initiated

o Analgesics should be consistent with pathology of the pain, for example,

opioids should be employed for cancer pain.

Case Scenario:

Jane is an 84-year-old woman diagnosed with breast cancer 2 years ago, now with metastasis to
the bone and lung. She has refused any further active treatment (i.e chemotherapy and radiation) and
has asked her health care representative daughter Patty to help her talk to her oncologist about her
wishes. After this discussion, the patient, daughter, and physician have agreed upon a hospice
evaluation.
 Upon evaluation and subsequent admission to hospice services, the patient’s most pressing need
was adequate pain control. Previously, she had tried scheduled Tylenol without relief-her pain rated at
an 8 on a 0-10 scale. Her oncologist then prescribed Hydrocortisone 7.5/750 mg. 1-2 tabs every 4
hours as needed, which lowered her pain acuity to a 6. At this point, an adjuvant might be considered
for bone pain-possibly Decadron. If Jane experiences shortness of breath related to lung metastasis,
the Morphine and Decadron are both helpful in alleviating this symptom.

1. As the admitting hospice nurse, you recognize that 8 on the pain scale greatly impair Jane’s
quality of life. Using the WHO step approach, what would be your plan on intervention?
2. Knowing that Jane probably has two types of pain due to the metastasis, what adjuvant might
you consider for the bone pain?
3. Looking to the future, what other comfort issues might Jane face as her metastasis impacts her
life?
4. How could you keep Jane reach her goal of selected activities (e.g. shopping, lunch, church?)
5. Make a drug study on the medications given to Jane.
6. Make a pain and comforting cycle for your patient using this diagram:
Crying Grimacing Favoring body part Depression Decrease function complaints

______________________________________________________________________________________________________

Identify symptoms of distress

Symptoms Symptoms

Function Evaluate level of Assess level of Function

Comfort and discomfort comfort and discomfort

Self-rating Self-rating

history History

Provide comforting Interventions

Comforting strategies Medications Complementary and alternatives therapies

Date Completed:

Date Submitted:
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones &

Bartlett Publishers.610.7365 G31 2010

Eliopoulos (2018). Gerontological Nursing 9 th Edition.Wolters Kluwer

Meiner (2019). Gerontologic Nursing 6th Edition. ELS

Cuison,Roy. Handbook of Lectures on Geriatric Medicine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996586/