Managing chronic pain in older people

Managing chronic pain in older people

Pain management needs to be tailored for older people. The British Pain Society and British Geriatric Society produced guidelines specifically for this client group

This link is to a page summarizing an article from the professional journal Nursing Times. The article lists five key points:

  1. Pain is a risk factor for falls in older people
  2. It is thought that 50% of older adults living in the community, and 80% of those living in care homes, experience chronic pain
  3. Few studies look at the effects of pharmacological interventions specifically on older people
  4. Combination therapy using different classes of analgesics may be more effective with fewer side-effects, compared with higher doses of a single medicine
  5. Further research is needed on psychological treatments for pain in older people

You can see the entire two-page article by clicking on the link for the PDF file under “Related Files” in the middle of the page.

In the Doctor’s Office, a Neglected Resource

In the Doctor’s Office, a Neglected Resource – NYTimes.com

When it comes to providing health care for an aging nation, the bad news is no longer news. We already lack sufficient numbers of geriatricians and other professionals — nurses, social workers, pharmacists, aides — trained to care for the elderly, and the shortage is projected to increase.

The good news, confirmed by a study in the Journal of the American Geriatrics Society, is that nurse practitioners can markedly improve the quality of care for older patients.

This article in The New York Times‘s health section “The New Old Age” reports on a recent study revealing that nurse practitioners can, in many cases, dramatically improve the quality of patient care.

Researchers from UCLA examined medical visits involving four common conditions among older patients: urinary incontinence, falls, depression and dementia:

When it came to treating depression, patients seeing a doctor and a nurse practitioner received about the same care as those treated by doctors alone. In both groups, patients received 60 percent to 63 percent of recommended care.

But when patients showed up with one of the other three conditions, the addition of nurse practitioners meant much higher scores. Patients who saw a nurse practitioner along with a doctor received 80 percent of the recommended assessments and treatments for falls (compared with 34 percent for those who only saw a doctor), 59 percent for dementia (versus 38 percent) and 66 percent for incontinence (versus a particularly dismal 19 percent).

Dr. David Reuben, director of geriatrics at the University of California, Los Angeles and lead author of the study, explains the benefits of a team approach to medical management that uses both doctors and nurse practitioners:

“There are certain things doctors do well, certain things they don’t do well, certain things nurse practitioners do better,” he said. He added that he sympathized with primary care doctors working with elderly patients who have many chronic conditions: “The job is too big. It’s too complicated. There’s too much to do.”

 

Dementia’s Signs May Come Early – NYTimes.com

Dementia’s Signs May Come Early – NYTimes.com

Studies presented Wednesday at an Alzheimer’s Association conference in Boston showed that people with some types of cognitive concerns were more likely to have Alzheimer’s pathology in their brains, and to develop dementia later. Research presented by Dr. Amariglio, for example, found that people with more concerns about memory and organizing ability were more likely to have amyloid, a key Alzheimer’s-related protein, in their brains.

And, in a significant shift highlighted at the conference, leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.

This article reports on a new interest in Alzheimer’s research, the subjective reports of aging patients, known as “the worried well,” who sense their cognitive abilities changing before standard testing procedures reveal definite signs of dementia:

leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.

However, it’s important to note that:

Some memory decline reflects normal aging, they say, and some concerns reflect psychological angst. People who forget what they wanted in the kitchen or the names of relatively unfamiliar people are probably aging normally. People who forget important details of recent events, get lost in familiar places or lose track of book or television plots may not be, especially if they have more problems than others their age.

European studies find dementia rate down sharply | Nation & World | The Seattle Times

Finally, a bit of good news:

European studies find dementia rate down sharply | Nation & World | The Seattle Times

A new study has found dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend researchers say is likely occurring across developed countries and that could have major social and economic implications for families and societies.Another recent study, in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who reached their 90s a decade earlier.

 

Retiring later may stave off dementia | Nation & World | The Seattle Times

Retiring later may stave off dementia | Nation & World | The Seattle Times

Baby boomers, take note: For every year you put off retirement, your chances of developing Alzheimer’s disease or other types of dementia are cut by 3 percent.

The findings are the result of a massive French study, which looked at the records of 429,000 workers. The scientists presented their results Monday at the Alzheimer’s Association International Conference in Boston.

. . .

The findings underpin the often-repeated advice to prevent mental decline: “Use it or lose it.” Doctors have said that keeping the brain mentally challenged is one way to prevent dementia and related diseases.