Mar 15, 2018

Aged Care – Are Residents in Pain?

The most significant reason people move into aged care is due to a decline in health. In most cases, they need extra support, beyond what their loved ones can offer and because they are no longer able to live independently.

During 2015-16, more than 2 in 3 people who began using aged care services specifically moved into residential aged care facilities.

The expectation for residents and their loved ones when they move into care is that every effort will be made to ensure they will be comfortable and well cared for.

Despite being well cared for many aged care residents live with chronic pain.

In instances where residents are unable to communicate their pain, there is an expectation that aged care facilities will have trained staff to monitor and assess their needs.

It is the responsibility of aged care facilities to deliver a standard of care to all of their residents.

The Aged Care Act 1997 set guidelines to support aged care facilities in how they manage and care for residents. In terms of pain management, the goals are that ‘all care recipients are as free as possible from pain’.

And for palliative care, the aims include “the comfort and dignity of terminally ill care recipients is maintained” and the “core components of palliative care is the relief of pain and other distressing symptoms”.

As many residents will have multiple conditions that can cause pain, and with one quarter of all deaths in Australia occurring in aged care facilities, these standards of care need particular focus.

Different studies have estimated that between 45% and 80% of residents in aged care facilities have substantial pain that is undertreated.

An Australian study found that while the vast majority (90.7%) of residents were prescribed an analgesic, there is still room for improvement.

Pain management was often suboptimal; there was high use of anti-anxiety medication in combination with opioid analgesics, and indicators that pain management was suboptimal in patients with dementia.

The high prevalence of dementia, sensory impairments and disability make pain assessment and management challenging in this population.

It is important that staff at aged care facilities aim to address this challenge and make their facility a pain-vigilant facility.

Pain management goes beyond the drug therapies that people may assume is standard for pain – rather it includes the process of recognition and reporting of pain too. Pain management in aged care is often multimodal, which can include a combination of pharmaceutical and non pharmaceutical therapies.

The inadequate treatment of pain has clinical consequences. It is associated with functional impairment, a higher risk of falls, mood changes such as depression and anxiety, disturbed sleep, lower levels of socialisation and behaviour changes such as agitation and aggression.

When aged care residents are in pain, it’s the responsibility of the aged care facilities to make sure their residents are “as free as possible from pain”.

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