Older people in persistent pain: nursing and paramedical staff perceptions and pain management

Persistent pain is a common problem for older people. Knowledge about how nursing and paramedical staff perceive these people and what they do to relieve the pain seems scarce.

To explore nursing and paramedical staff perceptions of older people in persistent pain and their day-to-day management of pain.

Interviews in Swedish with 52 nursing auxiliaries, Registered Nurses, physiotherapists and occupational therapists were collected from February to May 2000. The analysis was based on their stories (n = 150) about older people in persistent pain who received help in their own homes or in special accommodation. A typology of staff perceptions of pain in older people was developed. Activities to manage pain were examined using content analysis.

Respondents perceived the pain as real, exaggerated, trivial, care-related, endured, concealed, self-caused or inarticulate. Older people perceived as exaggerating the pain, those with care-related and self-caused pain evoked frustration in the staff, while those perceived as enduring their pain evoked satisfaction. Various strategies to manage pain were used: no activity, medication, mediating contacts, distracting activities, physical therapies, mobility, work in a gentle way, rest or relieving pressure on body part, and communication concerning pain. The activities differed between the types, as well as between staff with different professional backgrounds.

Care and treatment provided by staff should be based on older people's needs rather than on staff attitudes and preferences. The typology revealed that staff perceived older people in pain as a heterogeneous group and that their perceptions affected the pain-relieving activities that were offered. It seems urgent to address how to handle pain in older people who never complain and those who complain a great deal, as well as how to handle pain in people with impaired communicative ability. Reflective discussions on feelings related to different individuals are needed.