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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
More inWhite Papers  

a senior person imageMarch 27 2018

Health professionals are being asked to consider that older people may try to downplay pain when being assessed. 

New guidelines have been published to support health professionals in recognising and assessing pain levels in older people, and to address under-reporting of pain. In addition to ‘stoicism’ shown by older people about their pain, the guidelines also reflect that:

  • there is a perception that increasing pain is a natural part of ageing;
  • 10 minute consultations in UK general practice often limits older adults from engaging in meaningful conversation about their pain;
  • pain in nursing home residents often goes undetected.

The guidelines have been published in the scientific journal Age and Ageing. They were developed by the British Geriatrics Society, the British Pain Society, the Royal College of Nursing, in collaboration with researchers at Teesside University, Anglia Ruskin University, University of Bournemouth, Centre for Ageing Better, and the Centre for Positive Ageing.

Among the recommendations are to encourage patient self-reporting as it is considered the most reliable and accurate measure of pain, even when cognitive impairment is present. “The guidelines also recommend that although older people often deny pain, the use of related terms, such as soreness, aching or discomfort may provoke a positive response,” said the BPS.

“Re-wording questions to elicit the presence of pain such as ‘Do you hurt anywhere?’ or ‘What is stopping you from doing what you want to do?’ can substantiate the presence or absence of pain.”

In addition, the guidelines call for better staff education and training to recognise pain: “It is advised that healthcare professionals be aware of the wide variety of pain measures available and have a solid understanding of how and when to use them.”

Professor Patricia Schofield, Deputy Dean for the Faculty of Health, Social Care and Education at Anglia Ruskin University and lead contributor to the Age and Ageing paper, said: “Pain in the older population has been largely neglected in the past, with the assumption that it is expected as you get older.

“This document sets out guidelines for the fundamental first step in the process, which is how we identify and measure pain in this population. Hopefully health and social care professionals will take on board the recommendations and we can move towards more effective pain management in the future.”

Links:
BPS announcement     
P Schofield. ‘The Assessment of Pain in Older People: UK National Guidelines’. Age and Ageing. March 2018. 47 (suppl. 1): i1–i22.            

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