Frances Patmon, PhD, RN Heather Martin, DNP, RN,
concludes people with late-stage
dementia and other forms of
cognitive impairment have altered
responses to pain, with many
conditions associated with increased
– not decreased – pain sensitivity.
Someone who looks relaxed may
truly be in terrible pain.
Older Adults Don’t Want
“Older adult patients can withdraw when suffering from pain,”
Patmon said. “Also, a myth held by older adults is that if they
complain about their pain, they will be seen as a bother, and
most don’t want that reputation.”
Patmon believes seniors will either not report pain or report a
lower level of pain than what they truly experience. So to get
to the truth, clinicians must spend time with patients. And that
is not always an option in the ED.
“Managing pain in both children and adults requires a more
intensive assessment, reviewing all different modalities that
have or have not worked in the past, and that time
commitment is difficult to achieve and sometimes not feasible
in the ED,” Patmon said.
The Painful Conclusion
Experts concur the difficult-to-treat
nature of pain in both pediatric and
geriatric groups underscores the
need for further research to better
understand pain’s development and
evolution, as well as to identify
physiologic and genetic
mechanisms. Studies suggest
children may benefit from a
multimodal treatment approach with medical, physical,
psychological and behavioral components. Similarly, older
adult patients require a unique mix of treatments: cognitive
behavioral therapy, self-management programs, rehabilitation
and exercise programs, in addition to medication. But all this
can’t be done in the ED alone.
“For chronic pain, refer a patient to a healthcare professional
specializing in pain management,” said Patmon. “In the short
term, we can do more than just ask patients to rate their pain
on a standard number rating scale. I know this is hard to do,
but it is truly what’s best for our patients.”n
By Carrie Farella, MA, RN, CHPPN
ENA Connection Contributor
n 15. 21 Contact Hours n 17 Interactive Modules n Geriatric Evidence-based Research
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