By definition, “comfort is a state of ease and satisfaction, of bodily freedom from pain and anxiety.” According to recent research, “The absence of physical pain is not always sufficient to provide comfort. The aged may have their biologic needs satisfied but still be emotionally distressed.”
Nurses understand the significance of the word “comfort” which describes the goals and outcomes that aid in determining the nursing measures needed to administer care. However, the meaning remains vague and essentially abstract to the person who is the recipient of that nursing intervention. The researcher, Hamilton, studied the meaning and attributes of comfort from the point of view of the chronically ill elderly who is hospitalized in a geriatric setting. Hamilton’s definition of comfort is “multidimensional, and means many things to different people.” The researcher, McCaffery’s definition of pain is “whatever the person experiencing pain says it is.”
Pain, whatever its source, erodes personality, saps energy and foments anguish until that cycle is broken. It is important to realize that an individual responds in a certain way to pain. Young and old have been taught as children that this is “correct and normal.” Likewise, nurses and caregivers are likely to respond in a certain way based on their own pain experiences and what may have been taught in their nursing programs and even in family life. Pain tends to weaken and interrupt the elderly individual’s idea of their relationship to self, others and their environment. In the aged, fear and anxiety can generate negative effects that emanate from thoughts that pain will result in crippling and forced dependency or that it will be of such intensity that the ability to cope will be inadequate.
The elderly are at high risk for pain inducing situations. The following are several myths and facts about pain in the aged.
Myth: Pain is always expected with aging.
Fact: Pain is not normal with aging. The presence or absence of pain in the elderly would however necessitate a diagnosis and physical assessment to demonstrate otherwise.
Myth: An elderly person who has no functional impairment and appears occupied or distracted from that pain must not have significant pain to begin with.
Fact: The elderly may have a variety of reactions to pain. Many are stoic and refuse to “give in” to the pain. Over an extended period of time they may also mask any outward signs of pain.
Myth: Pain sensitivity and the individual’s perception decreases with aging.
Fact: Data regarding age associated changes in pain perception must be demonstrated via observation of needless suffering, proof of under-treatment and an underlying cause.
In order to better understand the elderly’s pain, I recommend certain questions that can be asked in order to address the underlying causes. By using these questions, the nurse or caregiver can obtain a clearer idea of what the origin of the pain might be.
- Are you concerned about the pain sensation itself or about the implications of what the pain can produce?
- Are you afraid of what the pain may mean such as a sign of a serious illness? Can it deprive you of specific pleasures or a physical activity you had been enjoying?
- Do you want to be alone for fear of showing an unwanted emotional response that can be interpreted as a weakness?
- Do you want visitors to “share” your discomfort or rely on visitors only as a distraction?
One cold wintry morning I was asked to visit a resident by the name of John who wanted to talk about an issue that was disturbing him. Here then is his experience with pain and how he was dealing with it. Case Study: “When in agonizing pain and you lie at death’s door, praying to pass through it and it closes in your face, you realize there must be some reason you are ignored. Gathering strength for the struggle to recover, you find comfort in even small increments of strength and satisfaction in the tiniest improvement.” Unfortunately, John’s pain was caused by a malignancy that would eventually end his life. However, in the time he was with us he was under the care of a competent hospice staff. As the end drew near, John expressed his thanks to everyone for their kindness and excellent treatment, but most of all, for the lessening of his pain. The nurses who were involved with John’s care were influential and meaningful in their concern for him.
Although this article does not discuss the various pain alleviating practices and interventions, it would be expected that the doctors, nurses, therapists, etc. providing care would be expected to have knowledge of the physiologic aspects of pain and the practices that are accepted as treatment by the medical community. Some examples would be meditation, transient cutaneous nerve stimulation (TENS), massage, imagery, hypnosis, placebo, and pharmacologic pain control.
Lastly, to those caring for an elderly individual with intractable pain, you need not look upon the pain with fear or trepidation. If the assessment is medically correct and the individual who is suffering is listened to, and the case is handled gently and wisely, the anxiety can be controlled. The intervention, whatever it may be, will prove effective to the resident’s satisfaction, and you can be further assured that the care you render will bolster confidence with others who may also seek your guidance for that which is causing their discomfort.
Quotable Quote: “One act of kindness can change the world.”