Email your comments

In October 2006 the International Association for the Study of Pain launched a year to promote awareness worldwide of pain in the older people. It is recognised that the number of people over 65 years of age in the developed world will increase from 17.5% to 35% by 2050, and the number of people over 80 years will treble in that time.

Pain has a devastating effect on the quality of life of the older person, is often not recognised and remains under-treated. There are many reasons for this, stoicism, fear of addiction to drugs, unwanted side effects, the lack of recognition of the existence of pain by healthcare professionals, and an unwillingness to provide appropriate treatment, through lack of time, uncertainty and a fear of prescribing strong analgesics.

At a recent conference, interested professionals explored some of these barriers to the management of pain in older people, and looked at some new assessment tools, especially those that can be used for the cognitively impaired.

These discussions are summarised below:

• For older people living in the community, pain should be measured by GPs (make this a mandatory part of the QOF), nurses, carers and advocates. Awareness of the tools available to measure pain should be promoted. The system should react to findings and treat every case as an individual with treatment adpated to the individual’s needs. There should be “shared care cards” to pass on information to relevant parties and a “record in a bottle” approach should be adopted, as promoted by “Help the Aged”.
• For older people living in the community with a carer, carers should be trained and supported, given medication information, telephone support, and an emergency number to call, and aids should be provided (social services).

The conference recommended increased funding to support carers, who save the NHS an estimated £57 billion per annum and that care packages should be individualised (one package does not fit all).

• For older people in residential care/rest homes, there should be education and guidelines at an appropriate level for non-qualified staff to understand, translated into different languages. National minimum standards should include pain as the fifth vital sign which has to be measured. A link person from the PCT should be provided to advise on pain management. Relatives should be encouraged to ask for improvements in pain management. Examples of good practice should be promoted and links should be developed between voluntary groups and the British Pain Society.
• For older people in nursing homes, ensure adequate education for GPs, nurses, care staff and other carers. The National Minimum Standards of Care in nursing homes should include pain as the fifth vital sign, and should include management guidelines. There should be an information pack for assessment and management of pain in nursing homes. Private nursing homes should have access to and market specialist advice on pain management (this point did not gain approval of the whole group).
• For older People in Hospitals
  It is important that information about medication, including analgesia should come to hospital with the patient. e.g. repeat prescriptions or a memory stick.

Assessment of pain to be improved by all staff.

Introduce pain as the fifth vital sign into routine assessment. Make this part of the QOF for GPs.

Reassess pain

Assess other aspects e.g. depression

Improve communications between primary and secondary care so that advice about pain management is put into action in a timely fashion e.g. email/ telephone follow up

Improve education about pain for doctors and nurses, especially in foundation years for doctors

Conclusions: Action points

• Introduce pain as the fifth vital sign in hospital, residential care, nursing homes and community. Make the measurement of pain part of the QOF for GPs.
• Improve the assessment and re-assessment of pain by introducing a toolkit and teaching all carers how to use it
• Write simple guidelines on pain and its management for nursing homes and rest homes, and for patients and their carers
• Insist that pain assessment and management becomes a part of the National Minimum Standards for Nursing Homes
• Educate doctors, nurses and other healthcare professionals, carers and patients in the understanding of chronic pain and its management.
• Care for the carers
• Treat patients as individuals
• Improve communications between primary and secondary care
• Encourage all older people to keep basic medical information either in written form or on a memory stick.
  

Dr Joan Hester
President of the British Pain Society