Paper
Thursday, 20 July 2006
This presentation is part of : Chronic Care Initiatives
Holistic Assessment: The Effective Approach in Assessing Chronic Pain Among Older Adults
Susan A. Ruzicka, RN, PhD, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Learning Objective #1: The learner will be able to identify and implement important domains in assessing older adults experiencing chronic pain to optimize effective care planning.
Learning Objective #2: The learner will be able to discuss relationships among seven dimensions of chronic pain and the distinct patterns that emerge from holistic assessment.
Background: Older adults experience the highest prevalence of pain and predominantly ineffective pain management. Chronic disease is the leading cause of unwanted pain experienced by 80% U.S. elders. Studies and interventions examine one or two dimensions of pain, few studies have examined chronic pain as holistically experienced, a complex experience of many dimensions.
Purpose: To identify patterns and examine associations in the experience of chronic pain, (using seven dimensions of pain assessment) among chronically-ill older adults.
Methods: 150 cognitively intact subjects age 65 and older with three different etiologies of chronic pain: 1)Cancer with hope for recovery (n=50), 2)Arthritis (n=50), and 3)Terminal cancer with prognosis<6 months (n=50). Subjects were recruited from a Veterans Hospital and home hospice settings. Seven pain dimensions were assessed: Physiological , Behavioral , Sensory, Affective, Cognitive, Socio-cultural and Spiritual.
Results: 150 subjects. Mean age of 73.5. 82.6% male,70% White, 23% Hispanic, 6% Black, 1% Asian. Mean education level was 11 years. Mean number of chronic illnesses was 4. 66% arthritis, 59% cancer, 44% hypertension, 40% heart disease, 33% visual impairment, 33% orthopedic impairment. Factor analysis using orthogonal transformation matrix, yielded three distinct factors: 1) Physiological, Sensory and Cognitive; 2) Behavioral, Affective and Socio-cultural; 3) Spiritual dimension. Cluster analysis yielded 13 clusters. Two major clusters of pain experience comprised 85% subjects. The two clusters were compared and the Behavioral, Affective and Socio-cultural dimensions were significantly different (p>.0001). Eleven clusters defined pain experiences for 15% of the sample. Spiritual dimension was significant as identified through factor analysis.
 Conclusions: Major findings in this study: 1) Self-perceived functional status significantly influences chronic pain experiences. 2) Spiritual assessment is significant in evaluating chronic pain. 3) Holistic assessment is essential for a better understanding and management for an elder's chronic pain, facilitating the provision of comfort among all settings.

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