City of Hope Pain & Palliative Care Resource Center

V.    Special Populations
        B.   Pain 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.      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.

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

3.      Ferrell, B. A., Ferrell, B. R., & Rivera, L. M. (1995). Pain in cognitively impaired nursing home patients.  Journal of Pain and Symptom Management, 10(8), 591-598.

4.      Ferrell, B.A. (1991). Pain management in elderly people.  Journal of the American Geriatrics Society, 39, 64-73.

5.      McCaffery, M., & Ferrell, B. R. (1991). Patient age - Does it affect your pain control decisions.  Nursing, 21(9), 44-48.
 

       Recommended Publications

1.       Gerontological Nursing & Healthy Aging, 3rd Edition
          -     Ebersole, P., Hess, P., Touhy, T., & Jett, K. (2009). MO: Elsevier Mosby. ISBN #: 0323057012.

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

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

4.       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.

5.     Essentials of Gerontological Nursing
          -      Wallace, M. (2007). NY: Springer Publishing Company. ISBN #: 0826120520.

6.       Working with Toxic Older Adults
          -      Davenport, G. (2006). NY: Springer Publishing Company. ISBN #: 0826102751.

7.       Pain in Older Persons
          -    Gibson, S. J. & Weiner, D. W. (2005). IASP Press.     

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

9.       Gerontologic Palliative Care Nursing
          -        Matzo, M. L. & Sherman, D. W. (2003). PA: Mosby, Inc.  ISBN #: 0323019900

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

11.     Pain in the Elderly 
          -     Ferrell, B. R., & Ferrell, B. (1996).  WA: IASP Press. ISBN #: 0931092159.

12.     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.
             

        Educational Materials/Curriculum

1.       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.

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

3.    Pain Care Fast Facts: 5-Minute Clinical Inservice – UW Health, Madison, WI  
          -     Assessing Pain in the Nonverbal or Cognitively Impaired
          -     Establishing Pain Relief Goals
          -    Insomnia Assessment and Treatment

4.      Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care – California HealthCare Foundation
         -         This report describes some of the online and  mobile platforms and applications that can assist patients in managing their health care -- not only at home, but almost anywhere else outside their clinician's office.

5.       PERT Program - Palliative Care Education Resource Team (PERT) for Nursing Homes. 
          -     PERT Advisor is an online forum for questions about providing end-of-life care.  The PERT Program locates appropriate clinical experts to thoroughly address each question received.

        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. 

      Position Statements/Standards

1.      American Society of Pain Management Nurses (ASPMN)
        -     Pain Assessment in the Non-verbal Patient