The assessment of pain and home environments with the focus on possibilities of falls is important for understanding experiences of older persons and developing appropriate interventions. The purpose of this paper is to provide the results of the interview with an older female regarding her perception of pain. The paper also presents the findings of the home assessment with recommendations regarding the required adjustments.
Part I: Descriptive Information
O. F. is a 72-year-old Caucasian female who lives in Buffalo, New York. O. F. is of the Eastern European origin, and she was raised in the family of immigrants from Poland. Currently, O. F. lives in a two–storey house located in the suburban neighborhood in Buffalo known as the Riverside Park neighborhood. The woman is an owner of this house, and she lives alone as her husband died eight years ago. O. F. occupies only those rooms located downstairs as she has problems with going upstairs because of her joint disease. A social worker assists O. F. on a regular basis and helps with shopping.
Part II: Interview
Interview Narrative
While answering the interview questions, O. F. has stated that she experiences pain almost constantly because of her osteoarthritis. The symptoms of the disease appeared eleven years ago. The intensity and character of pain can change, but it is constant, and it can be reduced only with the help of medications. Some daily activities can contribute to increasing pain, and they include walking, going upstairs, and needlework. Therefore, O. F. limited her walking and chose not to use the rooms located upstairs. O. F. consulted healthcare professionals regarding her condition, and non-steroidal anti-inflammatory drugs and special exercises were prescribed as a therapy to reduce pain.
The woman is satisfied with the treatment although it cannot reduce pain significantly because she believes that such pain is normal for her age. To manage her pain, O. F. follows nurses’ recommendations regarding exercises, and she does them five times per week. O. F. has also stated that she believes that nurses care about her condition and pain because she receives all the required guidelines. She has not ideas regarding what can be done differently to change her experiences because of her age. Furthermore, the provided assistance and treatment can be viewed as adequate.
Student Reflection
The interviewee’s answers to the proposed questions are surprising because O. F. has not focused on any problems related to the support she receives from healthcare providers. To assess pain in older patients, including persons with dementia or cognitive impairment, the following methods can be used: behavioral-observational pain assessment tools and computerized imaging to analyze facial expressions. The use of pain assessment instruments, such as the DOLOPLUS2, the Abbey Pain Scale, and the Pain Assessment in Advanced Dementia among others, is discussed as a traditional approach followed by nurses (Hadjistavropoulos et al., 2014).
Computerized imaging methods are regarded as advanced, and they are used when it is necessary to assess patients with dementia (Hadjistavropoulos et al., 2014). Potential barriers to pain assessment and management in older people are associated with the accuracy of self-reporting because older persons often cannot provide the appropriate information regarding the intensity of pain. As a result, an inefficient assessment can lead to prescribing ineffective medications and therapies (Hadjistavropoulos et al., 2014). Furthermore, older people can refuse reporting pain or taking drugs because of their fears or beliefs, and these situations prevent healthcare providers from managing pain.
The prevalence of pain in adults aged 70 years and older is about 40-79% (Hadjistavropoulos et al., 2014). To become more aware of pain issues related to the older interviewee, it is important to conduct regular assessments and observations to report changes in the state. The researchers propose to use such evidence-based practice interventions as self-management education, programs of physical activity and exercising, healthy nutrition, and injury prevention (Hsu, Tsai, Lin, & Liu, 2015). O. F. does not know how her diet can influence pain and what guidelines to follow while carrying things or walking to reduce the pressure on joints, and this information should be discussed with the patient. The interview has provided a lot of information regarding gaps to cover while communicating with those patients who suffer from chronic pain.
Part III: Home Assessment
The assessment of O. F.’s house has indicated the following problems: the pavement is cracked, there is no outdoor grab near the entrance door, there is a lack of lighting outside and inside the house, there is a cluttered area in the hall, and cabinets in the kitchen are placed too high. In the living-room, bathroom, and bedroom, there are no deficiencies, and the standards to prevent falls are addressed. Thus, additional railings are provided in the bathroom, rugs with a non-skid bottom are used, and electric cords are not observed.
The plan to eliminate deficiencies in O. F.’s house should include measures to reduce intrinsic risks and adjustments to make the environments safe. The measures to address such intrinsic risks as low vision and unstable joints include improvements in lightening outside and inside the house and the use of an outdoor grab. It is also necessary to repair the pavement and re-organize items in the cluttered area. The other adjustments can include adding more cabinets in the kitchen which can be reached easily.
Conclusion
Many representatives of the older population suffer from pain associated with their chronic diseases or age-related changes and other conditions. The causes of the experienced pain can be associated with specifics of home environments in which older people live. The conducted interview and assessment allow for preventing falls and managing pain in the older patient.
References
Hadjistavropoulos, T., Herr, K., Prkachin, K. M., Craig, K. D., Gibson, S. J., & Lukas, A. (2014). Pain assessment in elderly adults with dementia. The Lancet Neurology, 13(12), 1216-1227.
Hsu, K. Y., Tsai, Y. F., Lin, Y. P., & Liu, H. T. (2015). Primary family caregivers’ observations and perceptions of their older relatives’ knee osteoarthritis pain and pain management: A qualitative study. Journal of Advanced Nursing, 71(9), 2119-2128.