Studies on pain in older adults (age 65 and older) have demonstrated that 25% to 45% of community-dwelling older people have chronic pain. Fortyfive percent to 85% of nursing home residents also report pain that often is left untreated. Although there is minimal research that strictly focuses on pain in older adults, studies with younger participants have elucidated associations between pain and depression. Increased pain has further resulted in decreased socialization, impaired ambulation, and increased health care utilization and costs. Older adults are reluctant to report pain: therefore, nurses need to be proactive in screening for and assessing pain.
No objective measure or biological marker of pain exists. Simply worded questions and tools, which can be easily understood, are the most effective because older adults frequently encounter numerous factors, including sensory deficits and cognitive impairments. Subjective tools such as Visual Analogue Scales (VAS) and the Faces Scale are highly effective for assessing pain in older adults. The VAS is a straight horizontal 100 mm line anchored with "no pain" on the left and "worst possible pain" or "pain as bad as it could possibly be" on the right. Older adults are simply asked to choose a position on the Une that represents their pain. The Faces Scale depicts facial expressions on a scale of 0 to 6, with 0 = smile and 6 = crying grimace. Older patients should choose a face that represents how the pain makes them feel.
Both the VAS and Faces Scale are used with older adults. Studies have shown that 86% of nursing home residents could complete at least one of these pain scales.
Source for scales: Reprinted from Pain, Vol. 41, No. 2, pp. 1391-50, with permission from Elsevier Science.
Studies, which have compared simple pain intensity measures, have demonstrated high reliability and validity using the VAS and Faces Scale with older adults.
STRENGTHS AND LIMITATIONS
These simple, yet effective, pain assessment tools are easy to administer and provide a method to evaluate not only the presence of pain but also the effectiveness of treatment. However, these assessment tools should not replace extensive medical history taking and physical examinations, which may lead to the determination of etiologies of pain.
MORE ON THE TOPIC
American Geriatrics Society. (1998). The management of chronic pain in older penóos- Journal of the American Geriatria Society, 46, 635-651.
Closs, J. (19%). Pain and elderly patients: A survey of nurses' knowledge and experiences. Journal of Advanced Nursing, 23, 237-242.
Herr, ILA-, 8c Mobility, RR. (1993). Comparison of selected pain assessment tools for use with the elderly. Applied Nursing Research, 6, 39-46.
The following tool represents an effective quantitative method to gather information on pain in older adults. We invite nurses to duplicate the tool and encourage staff to carry it for reference.