Nurse Practitioner Should Be Able to Recognize these Descriptors and Take Them as Potential Indicators of Pain and Clarify with Further Questioning

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Nurse practitioner should be able to recognize these descriptors and take them as potential indicators of pain and clarify with further questioning. According to Horgas & Miller (2008), older adults with cognitive or physical limitations, have difficulty expressing details about their pain. These include pain location, duration, onset, type, precipitating factors, and relieving factors of pain. Pain is a subjective experience without valid and reliable objective tests to measure it. The existence and intensity of pain are measured by patient self-report. Unfortunately, older populations with cognitive disability may have difficulty expressing pain via verbal or body language. In some cases, it is astounding to know that pain in older population with dementia is very often undertreated. Therefore, variation in patient's ability to communicate verbally can add another layer to effectively manage pain. When pain issue is not resolved, it decreases overall ability to perform daily activities, and it causes serious impacts in most life (Horgas & Miller, 2008). Likewise, older population with cognitive impairment is even more limited to communicate pain symptoms. Therefore, extra care should be provided to observe even the slightest reactions- body movement, changes in activity routines, changes in interpersonal interactions, facial expression, mental status changes, verbalizations, and vocalizations (Bruckenthal, Reid & Reisner, 2009). Additionally, certain patients may have limited movement that makes difficult for practitioners to assess them. When pain is not controlled in patients with cognitive limitation, they express their pain by being violent, angry, or refusing their routine care. There are patients who come more quiet and... ... middle of paper ... ...al management of persistent pain in older persons. (2009). Journal of the American Geriatrics Society, 57(8), 1331-1346. Reid, M., Bennett, D., Chen, W., Eldadah, B., Farrar, J., Ferrell, B., & ... Zacharoff, K. (2011). Improving the pharmacologic management of pain in older adults: identifying the research gaps and methods to address them. Pain Medicine, 12(9), 1336-1357. Somes, J., & Donatelli, N. (2013). Pain assessment in the cognitively impaired or demented older adult. Journal of Emergency Nursing, 39(2), 164-167. Wickremaratchi, M., & Llewelyn, J. (2006). Effects of ageing on touch. Postgraduate Medical Journal, 82(967), 301-304. Zwakhalen, S. G., Jenny T., S., & Najim, M. D. (2012). Which score most Likely represents pain on the observational PAINAD pain scale for patients with dementia?. Journal of the American Medical Directors Association, 13(4), 384

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