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      Chronic pain and geriatric syndromes in community-dwelling patients aged ≥65 years

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          Abstract

          Background

          In growing elderly populations, there is a heavy burden of comorbidity and a high rate of geriatric syndromes (GS) including chronic pain.

          Purpose

          To assess the prevalence of chronic pain among individuals aged ≥65 years in the Southern District of Israel and to evaluate associations between chronic pain and other GS.

          Methods

          A telephone interview was conducted on a sample of older adults who live in the community. The interview included the Brief Pain Inventory and a questionnaire on common geriatric problems.

          Results

          Of 419 elderly individuals who agreed to be interviewed 232 (55.2%) suffered from chronic pain. Of those who reported chronic pain, 136 participants (68.6%) noted that they had very severe or unbearable pain. There were statistically significant associations between the pain itself and decline in patient’s functional status, increased falls, reduced mood, and cognitive decline.

          Conclusion

          The results of this study show that chronic pain is very common in older adults and that it is associated with other GS. There is a need to increase awareness of chronic pain in older adults and to emphasize the important role that it plays in their care.

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          Most cited references 45

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          Chronic pain in Australia: a prevalence study

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            Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group.

            The Eastern Cooperative Oncology Group (ECOG) conducted a groupwide survey to determine the amount of knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated institutions and to determine the methods of pain control being used by these physicians. Survey. A questionnaire was sent to all ECOG physicians with patient care responsibilities (medical oncologists, hematologists, surgeons, and radiation therapists), practicing in university institutions, Community Clinical Oncology Program (CCOP) institutions, and Cooperative Group Outreach Programs (CGOP) institutions. A physician cancer pain questionnaire developed by the Pain Research Group at the University of Wisconsin was used. The questionnaire was designed to assess physicians' estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of cancer pain management, and their report of how they manage pain in their own practice setting. The study analyzed responses to 897 of 1800 surveys. In regard to the use of analgesics for cancer pain in the United States, 86% felt that the majority of patients with pain were undermedicated. Only 51% believed pain control in their own practice setting was good or very good; 31% would wait until the patient's prognosis was 6 months or less before they would start maximal analgesia. Adjuvants and prophylactic side-effect management should have been used more frequently in the treatment plan. Concerns about side-effect management and tolerance were reported as limiting analgesic prescribing. Poor pain assessment was rated by 76% of physicians as the single most important barrier to adequate pain management. Other barriers included patient reluctance to report pain and patient reluctance to take analgesics (both by 62%) as well as physician reluctance to prescribe opioids (61%). Professional education needs to focus on the proper assessment of pain, focus on the management of side effects, and focus on the use of adjuvant medications. A better understanding of the pharmacology of opioid analgesics is also needed. Physicians also need to educate patients to report pain and to effectively use the medications that are prescribed for pain management.
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              Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes.

              To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence. Population-based cohort with a 1-year follow-up. General community. A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews. At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living. At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (chi 2 = 119.8; P < .001) as the number of predisposing factors increased from zero to one to two at least three. Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                19 June 2018
                : 11
                : 1171-1180
                Affiliations
                [1 ]Nursing Department, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva, Israel
                [2 ]Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
                [3 ]Pain Clinic, Clalit Health Services, Beer-Sheva, Israel
                [4 ]Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
                [5 ]Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
                Author notes
                Correspondence: Yan Press, Unit for Comprehensive Geriatric, Assessment, Clalit Health Services, Yassky Clinic, 24 King David Street, Beer-Sheva, Israel, Tel +972 8 640 7738, Fax +972 8 640 7795, Email yanp@ 123456bgu.ac.il
                Article
                jpr-11-1171
                10.2147/JPR.S160847
                6016537
                © 2018 Liberman et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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