City of Hope Pain & Palliative Care Resource Center

V.    Special Populations
        B.   Pain Management, Palliative, and Long-Term Care in the Elderly

This section includes Clinical Practice Guidelines on the Management of Pain in the Elderly from the American Geriatric Society and the American Medical Directors Association. 

       City of Hope Publications

1.      Dale, W., Mohile, S., Eldatah, B., Trimble, E., Schilsky, R., Cohen, H., Muss, H., Schmader, K., Ferrell, B. R., Extermann, M., Nayfield, S., & Hurria, A. (2012). Biological, clinical, and psychosocial correlates at the Interface of Cancer and Aging Research. The Journal of the National Cancer Institute, 104(8), 581-589. doi: 10.1093/jnci/djs145.

2.      Wittenberg-Lyles, E., Demiris, G., Ferrellm B. R. & Shaunfield, S. (2012). Volunteers as facilitators of communication about pain: A feasibility study. Research on Aging, 34(2), 246-253. doi: 10.1177/0164027511426879.

3.      Kelly, K., Thrane, S., Virani, R., Malloy, P., & Ferrell, B. R. (2011). Expanding palliative care nursing education in California: The ELNEC geriatric project. International Journal of Palliative Nursing, 17(4), 188-194.

4.     Kelly, K., Ersek, M., Virani, R., Malloy, P., & Ferrell, B. R. (2008). End-of-life nursing education consortium geriatric training program: Improving palliative care in community geriatric care settings. Journal of Gerontological Nursing, 34(5), 28-35.

5.      Ersek, M., & Ferrell, B. R.  (2005). Palliative care nursing education: opportunities for gerontological nurses. Journal of Gerontological Nursing, 31(7), 1-7.

6.     Ersek, M., Grant, M. M., Kraybill, B. M. (2005). Enhancing end-of-life care in nursing homes: Palliative care educational resource team (PERT) program. Journal of Palliative Medicine, 8(3), 556-566.

       Recommended Publications

1.       Jablonski, A. M., DuPen, A. R., & Ersek, M (2011). The use of algorithms in assessing and managing persistent pain in
          older adults, American Journal of Nursing, 111(3), 34-43. doi: 10.1097/10.1097/01.NAJ.0000395239.60981.2f.

2.      Strohbuecker, B., Eisenmann, Y., Galushko, M., Montage, T., & Voltz, R. (2011). Palliative care needs of chronically ill
          nursing home residents in Germany: Focusing on living, not dying. International Journal of Palliative Nursing, 17(1), 27-34.

3.      McCleane, G. (2010). Pain management in older people. Reviews in Clinical Gerontology, 20, p. 183-192.
         doi: 10.1017/S0959259810000146.

4.      Ersek, M., Herr, K., Neradilek, M. B., Buck, H. G., & Black, B. (2010). Comparing the psychometric properties of the
         Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment of Advanced Dementia (PAIN-AD) instruments.
         Pain Medicine, 11(3), p. 395-404.  doi:  10.1111/j.1526-4637.2009.00787.x.

5.      Herr, K., Bursch, H., Ersek, M., Miller, L. L., & Swafford, K. (2010). Use of pain-behavioral assessment tools in the nursing
         home: Expert consensus recommendations for practice.  Journal of Gerontological Nursing, 36(3), 18-31.
         doi: 10.3928/00989134-20100108-04.

6.      Coker, E., Papaioannou, A., Kaasalainen, S., Dolovich, L., Turpie, I., & Taniguchi, A. (2010). Nurses’ perceived barriers to
         optimal pain management in older adults on acute medical units. Applied Nursing Research, 23, 139-146.
         doi: 10.1016/j.apnr.2008.07.003.

7.     Kaye, A. D., Baluch, A., & Scott, J. T. (2010). Pain management in the elderly population: A review. The Ochsner Journal,
         10(3), 179-187.

8.     Arnstein, P. (2010). Balancing analgesic efficacy with safety concerns in the older patient. Pain Management Nursing, 11(2),
         Suppl 1), S11-S22. doi:  10.1016/j.pmn.2010.03.003.

9.     Herr, K. (2010). Pain in the older adult: An imperative across all health care settings. Pain Management Nursing, 11(2), S1-
         S10. doi: 10.1016/j.pmn.2010.03.005.

10.    Bruckenthal, P. (2010). Integrating nonpharmacologic and alternative strategies into a comprehensive management
         approach for older adults with pain. Pain Management Nursing, 11(2). P. S23-S31. doi: 10.1016/j.pmn.2010.03.004.

11.     Wood, B. M., Nicholas, M. K., Blyth, F., Asghari, A., & Gibson, S. (2010). Assessing pain in older people with persistent
          pain: The NRS is valued but only provides part of the picture. The Journal of Pain, 11(12), p. 1259-1266.
          doi: 10.1016/j.jpain.2010.02.025.

12.    Takai, Y., Yamamoto-Mitani, N., Okamoto, Y., Koyama, K., & Honda, A. (2010). Literature review of pain prevalence among
         older residents of nursing homes. Pain Management Nursing, 11(4), p. 209-223. doi: 10.1016/j.pmn.2010.08.006.

13.    Gianni, W., Ceci, M., Bustacchini, S., Corsonello, A., Abbatecola, A. M., Brancati, A. M., et al. (2009). Opioids for the
         treatment of chronic non-cancer pain in older people. Drugs & Aging, 26 (Suppl 1), 63-73.
         doi: 10.2165/11534670-000000000-00000.

14.    McKendrick, M. W., Ogan, P., & Care, C. C. (2009). A 9 year follow up of post herpetic neuralgia and predisposing factors
          in elderly patients following herpes zoster. The British Infection Society, 59, 416-421. doi: 10.1016/j.jinf.2009.09.008.

15.     American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons (2009).
          Pharmacological management of persistent pain in older persons. Journal of American Geriatrics Society, 57, 1331-1346.
          doi: 10.1111/j.1532-5415.2009.02376.x.

16.     D’Arcy, Y. (2008). Pain in the older adult. The Nurse Practitioner, 33(3), p. 18-24.
          doi:  10.1097/01.NPR.0000312997.00834.ce.

17.     Blyth, F. M., Rochat, S., Cumming, R. G., Creasey, H., Handelsman, D. J. Le Couteur, D. G., et al. (2008). Pain, frailty and
          comorbidity on older men: The CHAMP study. Pain, 140, 224-230. doi: 10.1016/j.pain.2008.08.011.

18.     Cann, P. (2008). Pain in older adults should not be seen as part of ageing. British Journal of Community Nursing, 13(12), 
          574-576.

19.     Pain in Older People
          -     Crome, P., Lally, F., & Main, C. J. (2008).  Oxford University Press. ISBN: 0199212619.

20.    Pain Management for Older Adults, A Self Help Guide
          -      Hadjistavropoulos, T., & Hadjistavropoulos, H. D. (2008). WA: IASP Press.  ISBN: 931092701.

21.     Evidence-Based Geriatric Nursing Protocols for Best Practice, 3rd Edition
          -       Capezuti, E. Zwicker, D., Mezey, M., Fulmer, T., Gray-Miceli, D. & Kluger, M. (2007). NY: Springer Publishing
         Company. ISBN: 0826111033.

22.     Herr, K., Coyne, P., Manworren, R., McCaffery, M., Merkel, S., Pelosi-Kelly, J. & Wild, L. (2006). Pain assessment in the
          nonverbal patient: Position statement with clinical practice recommendations. Pain Management Nursing, 7(2), 44-52.

23.     Bjoro, K., & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-
          science review. Journal of Pain & Symptom Management, 31(2), 170-191. doi: 10.1016/j.jpainsymman.2005.07.001.

24.    Pain in Older Persons
          -    Gibson, S. J. & Weiner, D. W. (2005). IASP Press. ISBN: 13: 978-0-931092-59-6    

25.     Geriatric Palliative Care
          -      Morrison, R. S., & Meier, D., Capello, C. (2003).  UK: Oxford University Press. ISBN: 0195141911.

26.    Improving Nursing Home Care of the Dying: A Training Manual for Nursing Home Staff
          -      Henderson, M. L., Hanson, L. C., & Reynolds, K. S. (2003). NY: Springer Publishing Company. ISBN: 0-8261-1925-5.

27.     Persistent Pain in Older Adults - An Interdisciplinary Guide for Treatment  
          -     Weiner, D., Herr, K., & Rudy, T. (2003).  NY: Springer Publishing Company. ISBN: 0826138357. 

28.     Gloth, F. M. III, Scheve, A. A., Stober, C. V., Chow, S., Prosser, J.  (2001). The Functional Pain Scale: reliability, validity and
          responsiveness in an elderly population.  Journal of the American Medical Directors Association, 2(3), 110-114.  
          doi: 10.1016/S1525-8610(04)70176-0. 

             

        Educational Materials/Curriculum

1.       Cancer Pain in Older People – International Association for the Study of Pain: Global Year Against Cancer Pain

2.       Detecting Discomfort in Dementia: Focus on Behaviors – Alliance of State Pain Initiatives (ASPI), Madison, WI
          -    An educational video toolkit to help nursing assistants understand their role in providing good care for cognitively impaired residents in pain.  Includes a 13 minute educational video (VHS or DVD) and a booklet Tools for Inservice Education.                  

3.       Pain Care Fast Facts: 5-Minute Clinical Inservice – UW Health, Madison, WI  
          -     Assessing Pain in the Nonverbal or Cognitively Impaired, 3rd Edition                   

        Guidelines/Clinical Pathways

1.       Acute Pain Management in the Elderly 
          -     This web-based instruction program is designed to provide nurses and physicians with current, research-based information on acute pain management for older adults. Key areas of focus include assessment of pain in older adults, pharmacological and non-pharmacological approaches to managing pain in older adults, and approaches to teaching older patients and their families about management of acute pain.  

2.       Clinical Practice Guideline: Pain Management in the Long Term Care Setting
          -     Published by the American Medical Directors Association (AMDA).  The guideline is directed toward the entire interdisciplinary team - as well as patients and their families - in order to achieve effective pain management.  

3.       Improving Pain Management in Long Term Care Facilities   
          -     Published from the Medical College of Wisconsin as a resource guide for institutional change. Designed to assist staff member of facilities to improve pain management strategies for their residents.  

4.       The Management of Persistent Pain in Older Persons 
          -     Clinical Practice Guidelines from the American Geriatrics Society. 

5.       State of the Art Review of Tools for Assessment of Pain in Nonverbal Older Adults  (New Tools Added)
          -      Overview  
          -      Criteria for Evaluation
          -      Comparison Grid
          -      Comparison of Tool Items
          -      Review References
          -      Detailed Information or Brief Summaries
         Tools:
          -      Abbey Pain Scale (Abbey, J., et al.)
          -      Assessment of Discomfort in Dementia (ADD) Protocol, (Kovach, C.R., et al.)
          -      Certified Nurse Assistant Pain Assessment Tool (CPAT) (Cervo, F., et al.)
          -      Checklist of Nonverbal Pain Indicators (CNPI), (Feldt, K.)
          -      Disability Distress Assessment Tool (Dis DAT) (Regnard, D., et al.)
          -      Discomfort Behavior Scale (DBS) (Stevenson, K.)
          -      Discomfort Scale-Dementia of the Alzheimer’s Type (DS-DAT), (Hurley, A., et al.)
          -      Doloplus 2, (Wary, B.)
          -      Elderly Pain Caring Assessment 2 (EPCA-2) (Morello, R., et al.)
          -      Face, Legs, Activity, Cry and Consolability Pain Assessment Tool (the FLACC), (Merkel, S.I., et al.)
          -      Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID) (Husebo, B.S., et al.)
          -      Nursing Assistant-Administered Instrument to Assess Pain in Demented Individuals (NOPPAIN), (Snow, A.L., et al.)
          -      Pain Assessment in Advanced Dementia (PAINAD) Scale, (Warden, V., et al.)
          -      Pain Assessment for the Dementing Elderly (PADE), (Villaneuva, M.R., et al.)
          -      Pain Assessment in Noncommunicative Elderly Persons (PAINE) (Cohen-Mansfield, J., et al.)
          -      Pain Assessment Scale for Seniors with Severe Dementia (PACSLAC), (Fuchs-Lacelle, S.K., et al.)                
          -      Pain Behavior for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE) (Tsai, P., et al.)

        Other Organizational Links

         
       Key References

1.      Herr, K., Bjoro, K., & Decker, S.  (2006). Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review. Journal of Pain and Symptom Management, 31(2), 170-192.

2.     Herr, K. (2002). Pain assessment in cognitively impaired older adults.  American Journal of Nursing, 102(12), 65-68.