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Geriatric Population. Pain and Palliative Care for the Older (Geriatric) Adult

Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher

During your journey through this slide deck of Geriatric Populations, Pain and Palliative Care for the Older (Geriatric) Adult, you will experience: the assessment of pain; pain management strategies; and learn more about Palliative Care services.

As a health care consumer it is important to recognize and be aware of the quality of life benefits of good pain and symptom control. This begins with a good assessment of the factors contributing to the pain. Pain is a multifaceted experience. There are many barriers to achieving effective pain control in the elderly (geriatric population). Health care providers need to be aware of personal biases surrounding pain for proper pain management. There are also many health care provider misconceptions regarding Palliative Care especially in the geriatric population.

To enrich your geriatric understanding, at the end of this slide deck we discuss Palliative Care: the relief you need when you are experiencing serious medical illness.

Learn it-Live it-Love it-Your path for a more informed life!

Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher

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Geriatric Population. Pain and Palliative Care for the Older (Geriatric) Adult

  1. 1. LET’S DISCUSS Pain assessment Pain management Palliative care
  2. 2. PAIN IS… Physiologic Psychologic Behavioral Social Cultural Religious A Multifaceted Experience
  3. 3. Pain in the Elderly Ability to cope may change Losses Significant other, friends, pets Finances Transportation Driving Multiple chronic illnesses Unwanted relocation
  4. 4. Elderly Pain Barriers Myth that pain is normal aging Underestimation by clinicians Overestimation of addiction rate Overestimation of depressed respiration Lack of clinician education
  5. 5. Elderly Pain Barriers Hearing, visual deficits Cognitive impairment, depression Financial constraints, accessibility Underused pharmaceutical agents Fears of addiction What other’s might think Adverse side effects
  6. 6. Acute Pain Unpleasant sensory or emotion Whatever they say it is Acute Pain identified with: An event A beginning and end “Looks sick” May present with changes in vitals, symptoms
  7. 7. Chronic Pain Often exhausting experience Physically, functionally, psychologically Pain becomes focus of treatment Underlying condition chronic, rarely resolved
  8. 8. Somatic Pain Identified with: Direct stimulation, receptors, muscles, bones Usually localized Soft tissue, bone pain: Sharp, throbbing, aching Muscle pain: Cramping, gripping, clenching
  9. 9. Visceral Pain Identified with: Direct stimulation of intact receptors in deep visceral organs like heart and lungs Difficult to localize Deep aching, cramping, pressure or colicky
  10. 10. Neuropathic Pain Identified with: Disordered function, Direct damage to nerves, Difficult to treat effectively Peripheral Pain: Burning, Shooting Spinal Cord Pain: Constant, Dull aching with neurologic deficits Central Nervous System Pain: Changes in vital signs, nausea, vomiting, increased intracranial pressure
  11. 11. Pain Assessment  Location, Onset, Duration  Quality, Intensity  Relationship to Activity & Position  Precipitating & Alleviating  Associated Findings  Life-style Factors: Function, Appetite, Sleep, Socialization
  12. 12. Assessment of Pain Standardized Pain Assessment Subjective Report Severity, Intensity Desired Outcome Instruments: Numerical or Verbal Descriptor, Visual Analog, Vertical or Horizontal, Pictorial Facial Expressions
  13. 13. Pain Management Goals: Prevention of acute pain Control of chronic pain Optimizing function Improving quality of life Interdisciplinary team
  14. 14. Effective Management Requires the health care providers to be aware of personal biases surrounding pain and its management
  15. 15. Non Pharmacological Consider prior to pharmacological Enhances management Physical or Occupational Therapy Transcutaneous electrical nerve stim Biofeedback Visual imagery
  16. 16. Non Pharmacological Relaxation Yoga Counter Irritation Hydrotherapy Psychotherapy Magnetic Therapy Nerve Blocks Prayer Meditation Music Activities Heat Cold Massage
  17. 17. Pharmacological World Health Organization Stepwise Analgesic Ladder Focus on Proper selection, dosing, titration, and administration of analgesics Five concepts: by mouth, by the clock, by the ladder, for the individual, with attention to detail
  18. 18. Step 1 Mild pain 1 - 3 on a 10 point scale Analgesics include: Aspirin Acetaminophen (Tylenol) Nonsteroidal anti-inflammatory drugs (Elderly need to be cautious) Coanalgesics
  19. 19. Step 2 Moderate pain 4 - 6 on 10 point scale Analgesics include: Codeine Hydrocodone Oxycodone Nonopioid analgesic Coanalgesics
  20. 20. Step 3 Severe Pain 7 - 10 on a 10 point scale Analgesics include: Morphine Oxycodone Hydromorphone Fentanyl Nonopioid analgesics Coanalgesics
  21. 21. The relief you need when you are experiencing serious medical illness PALLIATIVE CARE
  22. 22. Patient & Family Centered Care Patient Population Comprehensive Care Inter- disciplinary Team Attention to relief of suffering Timing Quality Improve- ment Communi- cation Continuity of care across settings Equitable Access Addressing regulatory barriers Palliative Components
  23. 23. Palliative Care Team Clinical Team: Physician Nurse Practitioner Physician Assistant Nurse Therapists, Dietician Pharmacist Psychosocial Team: Social Worker Case Manager Psychologist Chaplain Grief Counselor Child Life Specialist
  24. 24. Who Uses Palliative Care People of all ages… Life threatening illness Limiting injuries from accidents or other trauma  Congenital injuries  Dependent on life- sustaining treatments  Serious, life- threatening illness  Progressive chronic conditions
  25. 25. Palliative Care Indications Uncontrolled symptoms Goals of care Cardiac arrest Advanced cancer Multi-organ failure Ventilation support Hospice eligibility Prolonged hospitalization Multiple hospitalizations Family distress
  26. 26. Reduce physical, emotional symptoms Improve function and reduce disability Integrating complimentary therapies Coordinate with specialists, resources Assist in making informed decisions Palliation of suffering along with continued treatment (no requirement to stop care) Palliative Care Goals
  27. 27.  Pain and symptom control  Avoid inappropriate prolongation of the dying process  Achieve a sense of control  Relieve burdens on family  Strengthen relationships with loved ones Singer, et al. (1999). The Patient’s Perspective What Do Palliative Care patients want?
  28. 28. References Brown, J. B.; Bedford, N. K.; White, S. J. (1999). Gerontological Protocols for Nurse Practitioners. Bruera, E. & Ahmed E. (2008). The MD Anderson Supportive and Palliative Care Handbook. End of Life Palliative/ Education Resource center: www.eperc.mcw.edu/EPERC www.hartfordign.org www.ConsultGeriRN.org Singer, et al. JAMA 1999;281(2):163-168.

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