34 THE QUEENS COURIER • MARCH 17, 2022 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
Pain, comfort and aging
BY SHELDON ORNSTEIN
ED.D, RN, LNHA
By definition, “comfort is a state of
ease and satisfaction, of bodily freedom
from pain and anxiety.” According
to recent research, “The absence of
physical pain is not always sufficient
to provide comfort. The aged may have
their biologic needs satisfied but still be
emotionally distressed.”
Nurses understand the significance
of the word “comfort” which describes
the goals and outcomes that aid in
determining the nursing measures
needed to administer care. However,
the meaning remains vague and essentially
abstract to the person who is the
recipient of that nursing intervention.
The researcher, Hamilton, studied the
meaning and attributes of comfort from
the point of view of the chronically ill
elderly who is hospitalized in a geriatric
setting. Hamilton’s definition of comfort
is “multidimensional, and means
many things to different people.” The
researcher, McCaffery’s definition of
pain is “whatever the person experiencing
pain says it is.”
Pain, whatever its source, erodes
personality, saps energy and foments
anguish until that cycle is broken. It
is important to realize that an individual
responds in a certain way to
pain. Young and old have been taught
as children that this is “correct and
normal.” Likewise, nurses and caregivers
are likely to respond in a certain
way based on their own pain experiences
and what may have been taught
in their nursing programs and even in
family life. Pain tends to weaken and
interrupt the elderly individual’s idea
of their relationship to self, others and
their environment. In the aged, fear
and anxiety can generate negative effects
that emanate from thoughts that
pain will result in crippling and forced
dependency or that it will be of such
intensity that the ability to cope will be
inadequate.
The elderly are at high risk for pain
inducing situations. The following are
several myths and facts about pain in
the aged.
Myth: Pain is always expected with
aging.
Fact: Pain is not normal with aging.
The presence or absence of pain in the
elderly would however necessitate a
diagnosis and physical assessment to
demonstrate otherwise.
Myth: An elderly person who has
no functional impairment and appears
occupied or distracted from that pain
must not have significant pain to begin
with.
Fact: The elderly may have a variety
of reactions to pain. Many are stoic and
refuse to “give in” to the pain. Over an
extended period of time they may also
mask any outward signs of pain.
Myth: Pain sensitivity and the individual’s
perception decreases with
aging.
Fact: Data regarding age associated
changes in pain perception must be
demonstrated via observation of needless
suffering, proof of under-treatment
and an underlying cause.
In order to better understand the
elderly’s pain, I recommend certain
questions that can be asked in order
to address the underlying causes. By
using these questions, the nurse or
caregiver can obtain a clearer idea of
what the origin of the pain might be.
• Are you concerned about the
pain sensation itself or about
the implications of what the
pain can produce?
• Are you afraid of what the pain
may mean such as a sign of a
serious illness? Can it deprive
you of specific pleasures or a
physical activity you had been
enjoying?
• Do you want to be alone for
fear of showing an unwanted
emotional response that can be
interpreted as a weakness?
• Do you want visitors to “share”
your discomfort or rely on visitors
only as a distraction?
One cold wintry morning I was asked
to visit a resident by the name of John
who wanted to talk about an issue that
was disturbing him. Here then is his
experience with pain and how he was
dealing with it. Case Study: “When in
agonizing pain and you lie at death’s
door, praying to pass through it and it
closes in your face, you realize there
must be some reason you are ignored.
Gathering strength for the struggle
to recover, you find comfort in even
small increments of strength and satisfaction
in the tiniest improvement.”
Unfortunately, John’s pain was caused
by a malignancy that would eventually
end his life. However, in the time he
was with us he was under the care of
a competent hospice staff. As the end
drew near, John expressed his thanks to
everyone for their kindness and excellent
treatment, but most of all, for the
lessening of his pain. The nurses who
Photo via Getty Images
were involved with John’s care were
inf luential and meaningful in their
concern for him.
Although this article does not discuss
the various pain alleviating practices
and interventions, it would be expected
that the doctors, nurses, therapists, etc.
providing care would be expected to
have knowledge of the physiologic aspects
of pain and the practices that are
accepted as treatment by the medical
community. Some examples would be
meditation, transient cutaneous nerve
stimulation (TENS), massage, imagery,
hypnosis, placebo, and pharmacologic
pain control.
Lastly, to those caring for an elderly
individual with intractable pain, you
need not look upon the pain with fear or
trepidation. If the assessment is medically
correct and the individual who is
suffering is listened to, and the case is
handled gently and wisely, the anxiety
can be controlled. The intervention,
whatever it may be, will prove effective
to the resident’s satisfaction, and you
can be further assured that the care you
render will bolster confidence with others
who may also seek your guidance for
that which is causing their discomfort.
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