Seniors and Chronic Pain: The Home Care Perspective
The National Institutes of Health reports that pain is largely undertreated in the senior population.
More than half of all seniors who live at home are dealing with the challenges of chronic pain, which can lead to a decline in their health and independence. Fortunately, the field of pain research has come a long way in the past few decades. Neurologists and geriatricians are learning more about the mechanisms of pain and have a greater array of treatments to offer than ever before.
One area of study is the relationship between pain and depression. It's common sense that chronic pain can lead to depression—and we now know that depression also heightens the perception of pain. In an all-too-common cycle, pain leads to depression … depression leads to an increase in pain … leading to inactivity and isolation … both of which threaten a senior's independence and good health.
How can seniors escape this pattern? First, it helps to understand what "chronic pain" is. When we cut ourselves on a sharp knife, break an arm or suffer a bout of kidney stones, we experience "acute pain"—pain of limited duration, which ends once the underlying injury or illness abates.
Chronic pain, however, may last a long time. It may be caused by a long list of incurable conditions, including arthritis, osteoporosis, migraine headaches, angina, digestive disorders, multiple sclerosis, fibromyalgia, shingles or diabetes. In some cases, no underlying cause can be found for a patient's pain, and chronic pain often is described as a disease in its own right.
Chronic pain can be challenging to treat. But it can be treated! Many seniors are inclined to "tough it out," but they should know that ignoring chronic pain actually makes it more likely that pain will persist and an intractable pain pattern will be established. It's important to seek help right away.
Pain Management at Home
A senior's battle with pain can have a huge impact on family. Pain affects relationships, and the physical challenges and emotional stress of caring for a loved one who is in pain even may put the health of family caregivers at risk. In some cases, pain management takes place in a nursing home or other supportive living environment. But most people prefer to remain at home, where they feel overall more comfortable. Professional in-home caregivers provide support services to help these seniors stay safe and active. Here are six important facts to consider as a senior, family and professional caregivers develop a pain-control strategy:
Preserving independence fights depression. In-home caregivers assist clients with dressing, bathing, grooming and other personal hygiene tasks. They can provide housekeeping, do laundry and prepare nutritious meals that support all-around good health. The goal is to provide the kind of assistance that supports the client's independence. Many clients quickly discover they can continue to do the activities they have always enjoyed when a professional caregiver helps out. For example, arthritis makes it hard to chop vegetables—but when a home caregiver does that step of the recipe, the client can then make her favorite minestrone soup. A caregiver can help prepare the soil in a raised bed garden so a client can continue to grow his prize-winning tomatoes.
Physical inactivity increases pain and depression. Pain, or the fear of pain, often causes seniors to shy away from the active lifestyle that could lower the risk of pain, depression and a host of illnesses. Exercise is a natural pain reliever, and studies show that all older adults can safely do some form of regular exercise. In-home caregivers provide encouragement and supervision while clients are following the healthcare provider’s suggested exercise program. Caregivers are also mindful to remove clutter and other hazards that could lead to a fall injury.
Medications help control pain, but it's important to take them correctly. Various classes of drugs help reduce pain. These include over-the-counter products such as ibuprofen, aspirin and acetaminophen; opioid drugs such as codeine; antidepressants; muscle relaxants; steroids; and topical medications. Once the doctor has determined the ideal drug or combination of drugs for the patient, the in-home caregiver can provide medication reminders, take the client to the pharmacy or pick up prescriptions, and be alert for negative side effects or interactions with other medications.
When it comes to pain management, persistence is important. Medications are far from the only treatment offered by today's pain specialists. Patients have been helped by physical therapy, meditation techniques, electrostimulation, surgery, innovative treatments based on brain imaging, talk therapy to support depression control, and much more. There may be a trial-and-error period to find the optimal regimen for an individual, and it may take time for the treatments to be effective. It sometimes seems that life is made up of nonstop medical appointments, especially at first! In-home caregivers support the success of the process by helping clients manage their appointments; providing transportation to the doctor, physical therapists and other professionals; and providing reminders and encouragement to follow the healthcare provider's recommendations.
Isolation leads to increased pain and depression. People who are experiencing physical pain tend to withdraw from the company of others. It can seem like too much work to prepare for a visit out, or to tidy the house before visitors arrive. But geriatricians tell us that loneliness has a powerful, negative effect on health. In-home caregivers support an emotionally nourishing social life for clients who are coping with pain. Though it is a professional relationship, in-home care also provides all-important human companionship. And the caregiver can transport the client to visit friends, to their faith community, and to engage in favorite activities that take place among other people. And most of us are much happier to receive guests when our house is clean and in good order!
Dementia complicates pain control. When a person has Alzheimer's disease or a similar condition, physical pain might be the underlying cause of aggression, sleep problems and other common behavior changes associated with the disease. Yet diagnosing and treating pain is more challenging when the patient is unable to clearly communicate information about their discomfort. If family and professional caregivers suspect the patient is in pain, it's important to report it to the healthcare provider, and to learn how to recognize nonverbal signals of pain, such as slower movements, decreased function, irritability or other signs.
Treating chronic pain and related depression can make a huge difference in the quality of life of seniors. Pain management is a team effort involving the patient, family and healthcare providers. As part of this team, in-home caregivers can be a valuable support resource.
Find an overview of pain treatment for seniors in "Pain: You Can Get Help" on the website of the National Institute on Aging.
The National Institute of Neurological Disorders and Stroke offers information about the management of chronic pain.
The American Chronic Pain Association offers resources and support for people who are living with chronic pain, and helpful information for family caregivers.
For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.
Depression is common in seniors who are living with health problems—but did you know that family caregivers also are more susceptible to the effects of this condition? In the December 2013 issue of Caring Right at Home, we will take a look at caregiver depression and ways caregivers can lower their stress load.