A life with pain -- new study examines the experiences of older people

10 jan 2009--It's debilitating, isolating and can lead to severe depression — yet pain is widely accepted as something to be expected and regarded as 'normal' in later life. Now a new study from The University of Nottingham examines older people's experiences of pain and how best Government, the NHS and social care agencies can address the issue.

The report, Pain in older people: reflections and experiences from an older person's perspective, aims to highlight the issue of pain in older people by exploring their experiences of living and coping with persistent pain. Funded by Help the Aged and the British Pain Society, the study saw researchers interview older people about their experiences of pain and how it affected their lives, both physically and psychologically. Literature on pain in older people was also reviewed.

The report — which reveals that nearly five million people over the age of 65 are in some degree of pain and discomfort in the UK — has already led to questions being asked of the Government in the House of Lords.

By interviewing older people, the researchers identified specific themes in the way that they communicate, cope with and experience their pain. These include;

• The stiff upper lip — "I understand my generation very well. We learned our attitude to pain from British society in general and from our families. It was: 'Don't make a fuss'."
  Claire Rayner OBE, 76, journalist.
• Becoming a burden — "Later this year my wife and I will be celebrating our 46th anniversary. We have the opportunity to go to New York for a long weekend with family and friends. However, I simply cannot endure the flight. If I were to sit for an extended period, such as six hours, in a confined space, I would be unable to walk far for the next few days. I feel I would be too much of a burden to the others if I were to go."
  Ben Kelk, 68, retired security guard.
• An isolating experience — "Your life tends to revolve around pain and yet, at the same time, it's not something that's seen as being something you can talk about too much. This is why I use the word 'lonely', and I think pain can make you feel lonely because you feel that you're the only one suffering and can cope with it, and that is a lonely experience."
  Janet Allcock, 73, retired healthcare worker.
• Psychological effects — "I worry a lot about my pain and sometimes I think about what I have done in the past and can no longer do for myself and my family. I know that worrying can bring your health down, but I can't help worrying about it. I find it very difficult to sleep and I am not able to sleep on my side — some nights I cannot sleep at all."
  Nur Uddin, 70, lives with wife and family.
• Response of the medical profession — "Doctors sometimes see you as an illness rather than a whole person."
  Dorothy Bristow, 68, member of BackCare: the charity for Healthier Backs.

  "I feel reluctant to keep going and pestering my doctor about my pain because when you get to my age, and especially if you're a woman, you feel he's going to think I'm being neurotic. And because pain can't be seen, it's probably not easy for him to understand how much pain I'm actually in."
  Janet Allcock, as above.

• Not being able to do 'normal' things — "It's the little things that annoy — not being able to paint one's own toenails, essential with summer sandals! Two walking sticks mean I can't hold my grandchild's hand. Small things — yes — but they matter."
  Dorothy Bristow, as above.

  "Simple tasks like lifting a grandchild from their cot and bringing them downstairs become a cause for concern, as I'm conscious that if my knee goes an accident could easily happen."
  Ben Kelk, as above.

The report raises points for discussion and recommends ways in which agencies dealing with pain in older people — from the Government and policy-makers to the NHS and regulatory bodies — can help address this problem. These include suggestions that primary care trusts should encourage practice nurses and GPs to raise their awareness of the effect of pain in older people, and that Government should fund educational campaigns to do this; specialist pain services need to be tailored to older people and made more accessible; and including standards on pain management on recognised healthcare professional training schemes.

Dr Nick Allcock, Associate Professor in the University's School of Nursing, Midwifery and Physiotherapy and Co-Director of the Nottingham Centre for Evidence Based Nursing and Midwifery, led the study. He said: "Pain in older people is highly prevalent and widely accepted as something to be expected and regarded as 'normal' in later life. Hence, suffering associated with persistent pain in older people often occurs without the appropriate assessment and treatment.

"Ageist and discriminatory attitudes towards older people in pain must be challenged and ended. Pain in older people needs to be seen as a priority. It is not a normal part of ageing. Much more can and must be done to improve help and support.

When questioned in the House of Lords on the subject of pain in older people following the release of the report, Lord Darzi of Denham, Parliamentary Under-Secretary of State in the Department of Health, responded: "As a clinician, I agree that the assessment and management of pain should be at the heart of all good clinical practice. I therefore welcome this report, which sets out the important issues relating to pain in later life and reflects older people's experiences. It will raise awareness of important issues among those responsible for meeting effectively the healthcare needs of their local population.

"It is imperative to understand that no one, irrespective of age, should tolerate pain. I appreciate that awareness in this area is extremely important, because we are living in a century when all of us are getting older and, at the same time, there is a suggestion that pain is a symptom of ageing, which it is not. As far as concerns age discrimination, older people deserve to be treated with dignity and respect in all care settings. This important document will increase awareness among the public and patients. At the same time, it will remind clinicians that they should give higher regard to chronic pain. I take most of the recommendations and could not agree more with some of the other work that has been done in this field."

To download a copy of the full report, Pain in older people: reflections and experiences from an older person's perspective, visit http://policy.helptheaged.org.uk/NR/rdonlyres/D97BB4C1-8A95-4940-91DC-BC8AFD921BFA/0/pain_in_older_people_181108.pdf