[Pain situation among older adults in need of care in the outpatient care setting and cognitively or physically unable to respond : Challenges and recommendations].

Abstract

BACKGROUND\nSelf-reporting is the gold standard in pain assessment. However, this is not possible among adults who are unable to respond. Thus, the method of choice is to observe behavior in order to assess pain. Nurses rarely conduct pain observations because they do not feel educated enough to use such tools in vulnerable groups. The aim of the study is to analyze the pain situation among older adults (≥65\xa0years) in need of care who are cognitively or physically unable to respond in the outpatient care setting.\n\n\nMATERIALS AND METHODS\nOur cross-sectional study is based on data from ACHE, a\xa0study on pain in outpatient older adults in need of care. Of 355 care-dependent older adults with chronic pain, 81 (22.8%) who were unable to respond received a\xa0pain assessment with the Pain Assessment in Advanced Dementia (PAINAD, German: Beurteilung von Schmerz bei Demenz [BESD]) scale.\n\n\nRESULTS\nThe study population (n\u202f=\u200981) was very old (mean age\u202f=\u200984.2 years), female (77.8%), and widowed (50.0%). We observed pain-related behavior among 61.7% of older adults in need of care. The mean BESD score was 2.8\u202f±\u20092.5 (range 0-8). We identified a\xa0significant difference in the BESD score observed calmly (mean\u202f=\u20091.7\u202f±\u20092.5) and under mobilization (mean\u202f=\u20093.4\u202f±\u20092.3, p\u202f=\u20090.001). Moreover, only\xa021 older adults in need of care received a\xa0pain assessment 4\xa0weeks prior to our study.\n\n\nCONCLUSION\nOur findings indicate a\xa0deficit in regularly conducted pain assessment among older adults who are unable to respond and are in need of care in the outpatient care setting. An observation tool in that setting is urgently needed and would be a\xa0first step in optimizing pain assessment. We recommend conducting observations during regular nursing mobilization.