Thursday, 21 August 2003
This presentation is part of : Thursday Poster Sessions

PD-031 Psychological Well Being in the Elderly Suffering Chronic Pain

Lepa Bosko Jovanovic, Department for Research and Methodology, Department for Research and Methodology, Institute of Gerontology, Home Treatment and Care Belgrade, Belgrade, Yugoslavia

Objective:For many elderly people chronic pain is associated with negative images like drug-siking behavior, functional disability, and longstanding physiologic, psychiatric and social problems. The numerous consequences of persistent pain: depression, anxiety, decreased socialization, sleep disturbance, impaired ambulation have a great influence on subjective well-being. Subjective well-being can be represented by a balance or regulation of emotional reactions.

Design:Research question was to assess influence of chronic pain in elderly, considering its intensity and quality on psychological well being within overall health status, functional ability and psychosocial context. Epidemiological approach: descriptive, cohort study. Cohort consists of elderly living in Belgrade, treated in their homes, by medical professionals from Institute of Gerontology, Home Treatment and Care Belgrade from 2001. All of them live alone, functionally disabled, with pronounced polimorbidity and high-level mortality. Selection Criteria was: 1. age 65 and over, 2. both sex, 3. chronic pain (6 month and more), 4. presence of musculo-sceletal and/or neurological and/or cancer diseases. The data was collecting during six-month period (July 2002 – December 2002).

Materials and Methods:In direct interweaving we applied a questionnaire consisted of: McGill Pain Questionnaire, Functional Status Index, Circumplex Model: Positive and Negative Affect and additional original questions. The emotional relationship can be best represented by a distinction between positive (PA) and negative affect (NA) according to diagnostic test “Circumplex Model”. High levels of NA characterize both depression and anxiety. Additional presence of the PA component differentiates depression. That completed, data has been analysed on a PC (using EXCEL) and presented in absolute and relative numbers (%).

Results:In the population of elderly which has been treated in their homes from 2001(N=646), 57,89% patients had musculo-sceletal, neurological and cancer diseases (N=374). High mortality limited the study population on N=124 patients. During study time 19 patients died and 22 withdrawn alive. The results was obtained on N=102 (76f/26m) patients, 58-94 years old, 1/3 without pain and 68,63% with intermittent or permanent pain lasting more than 6 months. All of them were functionally disabled, more than half lived alone, others with spouse unable to take care. They had moderate, strong or the most intense pain. Appearance of pain caused feelings of sadness (1/3), fear (1/4) and anger. Suffering patients felt unhappy, distressed and fearful. According to Cicumplex model, 48,54% patients was anxious, 1/5 in depression. Only 16,5% patients with good social support (spouse and child, relatives, friends, ect.) felt energetic, happy and satisfied. Everyone in the study group was on analgesic drugs and has never had psychotherapy, but many was satisfied with their pain management.

Conclusion:Health care professionals need to understand that this frail population is substantially different from younger adults, with multiple medical problems, unique psychology, sociology and cognitive impairment, which may be a substantial barrier to pain management. Despite these barriers, pharmacology and nondrug strategies have to provide comfort and effective pain control for these patients.

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