Question

HOMEWORK # 4                               Pain/Comfort   

A. How does assessment of pain differ in cognitively impaired older people?

B. What evidence-based instruments may be used for Pain Assessments?

C. Describe assessment process of evidence-based instruments for the cognitively impaired.

D. Describe at least two non- pharmalogical treatment for pain in order adults

Answer 1

A. Pain assessment in Older People with cognitive impairment

• VERBAL COMMUNICATION BARRIERS:- older cognitive impaird patients will give less subjective. data regarding pain.they cannot state what they are feeling because of inabiliy to remember or communicate.

also some older adults choose not bother family members or health care workers even if they are aware of methods communicating pain.

• BODY LANGUAGE CHANGES:- the patients with less cognitive abilities may also present wiith body languade changes or inability to peform voluntary movements(like in Alzhimers disease or Parkinsons disease)
• INABILITY TO RECALL:- if the patient is experienced pain at any other time (nighttime),may be due to cognitive impairement he cannot recall it.
• MOOD SWINGS:- Mood changes in older people will be higher and they may chose to not cooperate with pain assessment or don't want treatment.

there are also many differences in geriatric pain assessment of people with cognitve impairement like they may refer pain with any other words they recalls.also some of them have difficulty in responding to the assessment methods.etc.

B.

• ​​​BEHAVIORAL PAIN SCALE:- using bevioural changes and objective data for pain rating
• abbey pain scale:- used for patients with late stage dementia
• Critical care pain observation tool:- used in critical care units where verbal response impossible
• PAIN algorithm
• Non verbal pain assessment tool: it uses objective datas of patient.

C. In BPS or bahavioural pain asessment process includes rating patient's face expression(like tense,frowning,frightened),movement of hands,and if any life supports connected with patient,then patients compliance with it.no pain is score3 and maximum pain is score 12.

in Abbey's pain rating scale,the assessment process is like,

• vocalization of patient like cry or wispers
• facial expression
• body language(guarding)
• physiologic factors including vital signs
• physical changes

​​​​​​​D.

1. COGNITIVE BEHAVIORAL THERAPY:- it aims at helping the person to alter his perception of pain.it includes relaxation therapy(like music therapy),shift of focus,etc
2. Use of thermal pads,hot water bags,transcutaneous electrical nerve stimulation,etc.