In 1992 the Agency for Health Care ...

In 1992 the Agency for Health Care Policy and Research (AHCPR) published its guideline for acute pain management after surgical or medical steps and trauma. The research-based guideline's four major goals are to

* curtail the incidence and severity of patients' postoperative or posttraumatic pain;

* educate patients about the ne to communicate unrelieved pain to such a degree they can receive prompt evaluation and effective treatment;

* enhance patient comfort and satisfaction; and

* contribute to fewer postoperative complications and, for an patients, shorter stays after surgical procedures(1)

The guideline was lay opened because of the widespread inability of caregivers to effectively manage acute pain. Despite the guideline and education efforts, inappropriate acute pain treatment continues.(2) single patient population that may be at greater risk for improper pain assessment and management is the elderly

Many older adult patients be exposed to surgical procedures. In the past, patients older than 65 years of age were considered too somewhat old to undergo surgery. Today, patients older than 85 years of age are the fastest growing surgical population.(3) Although older adult patients frame a significant percentage of our surgical patient population, postoperative pain management for this population has received little attention.(4) According to early 1990 data, more than 4000 documents are published annually about pain, nevertheless fewer than 1% focus in succession older adult patients' pain.(5) Researchers reviewed eight geriatric nursing textbook and discovered simply 18 of 5,000 pages discussed pain.(6) With the lack of published information about geriatric pain, it is not surprising that misinformation is customary among caregivers of older adult patients. Lack of research data also causes principally patients' pain to be managed by the agency of trial and error.

PAIN ASSESSMENT IN THE OLDER ADULT PATIENT

Accurate pain assessment in each patient is a primary degree before appropriate management can be accomplished. Assessing older adult patients may be more challenging than other patient populations. Challenges eventuate from professional caregiver factors and patient factors.

Professional caregiver factors. The perception that older adult patients have les pain sensitivity than younger patients influences a certain caregivers. This belief is influenced somewhat because of silent myocardial infarctions and emergent "painless" intraabdominal surgical acts that frequently occur in older adult patients.(7) Research has not proven that these episodes are age-related. No empirical evidence conclusively supports that an age-related difference in pain perception exists.(8) Research studies about geriatric pain exist, further the conflicting results make it difficult to establish a relationship between aging and the sensory pain component(9) Anecdotal documentation exhibits that older adult patients may perceive pain at a slower rate further indicates they feel pain differently, not les intensely.(10) a certain number of researchers suggest there is a change in the pain quality, not the intensity, in older adult patients.(11)

a caregivers refrain from providing adequate postoperative analgesia to older adult patients because they fear possible medication interactions and adverse effects(12) Those are valid fears, nevertheless careful attention to each patient's in every one's mouth medication regime and prehospitalization medication regime can provide the caregiver with data to make an informed decision. Analgesia addiction businesss caregivers who fear that liberal analgesia administration will cause addiction in their patients.

Caregivers also may not understand by what mode older adult patients often cope with pain. When an older adult patient states he or she does not be warmed pain, the patient may be determined to be stoic and may cope with the pain internally.

Patient factors. a certain quantity of unique factors in the older adult population make it more difficult to accurately assess patients' pain evens The older adult patient's reaction to pain may be different and reported differently from the younger patient's pain.(13) any older adult patients were taught to hide expressions of pain.(14) These patients believe it is unacceptable to point out to that they feel pain. Other patients rationalize their answer to pain by saying, "I've just had a surgical process It is supposed to hurt"(15) Older adult patients also fear addiction to analgesia-producing medications.(16)

Chronic disease pain may affect accurate pain assessment from the patient's perspective and the caregiver's perspective. Patients may be unable to determine if their pain is related to their surgical proceeding Patients hurt, but they may be unable to distinguish if their pain is surgically induced or chronic from comorbidities.

Cognitive impairment, delirium, and dementia are current in some older adult patients. These conditions at hand barriers to accurately assessing pain. No empirical evidence displays that the cognitively impaired patient experiences les pain or that his or her pain reports should be considered any les valid than those of other patients.(17) Behavioral observations of pain (eg grimacing, restlessnes agitation) may be used to assess pain, on the other hand they are not pain specific and may personate responses to other conditions.