The nurse is caring for older patients in a long-term-care facility. The nurse understands that which factors influence pain management in these patients?
Select all that apply.
1. Increased A fiber transmission increases the potential for addiction in older adults.
2. An increased risk of depression in older adults is related to chronic pain.
3. Less reporting of referred pain may mask myocardial infarction in older adults.
4. Assessment of pain in the cognitively impaired older adult is not possible.
5. Delirium should be evaluated as pain.
Correct Answer: 2, 3, 5
In older adults there are decreased fiber transmission, no greater risk for addiction, and an increased risk of depression related to chronic pain. There is also a lower level of reported referred pain, so that the patient may not exhibit classic symptoms of myocardial infarction. Research has shown the numeric rating, verbal descriptor, and FACES rating scales to be effective with older adults. These scales are also effective with cognitively impaired older adults, although the FACES scale is the preferred tool. The older adult may present with manifestations such as delirium rather than subjective reports of pain.
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