Recent years have seen alarming and shameful reports of elder abuse in Australian homes and residential aged care facilities. While it is arguably of the utmost importance to delve into the many reasons for these worrying stories of neglect, lack of funding, staffing shortages and inadequate training to name a few, one key aspect of adequate care remains absent from the conversation: appropriate pain management.
Among the many sad stories aired, untreated or poorly managed and mistreated pain is a common thread. Pain continues to be treated as a one-dimensional medical condition, something often solely treated with medication.
We now know indisputably that there is more to effective pain management than simply treating the symptoms. This is especially true for chronic pain, and all the more important to remember as chronic conditions become increasingly prevalent as people age.
These are the statistics we know:
· Almost 91% of aged care residents are prescribed analgesics.
· Of those, 28% are taking opioids regularly.
· The concurrent use of sedatives is high, with 48.4% of those taking regular opioids also taking an anxiolytic/hypnotic.
· In one study, pain was detected in just 31.5% of cognitively impaired residents compared to 61% of cognitively intact residents, despite both groups being equally afflicted with potentially painful disease.
· As many as 80 percent of residents are living with chronic pain, commonly arthritis, bone and joint disorders, cancer and other long-term illnesses.
· More than half of the residents (52%) in aged care facilities in Australia have a diagnosis of dementia while two in three (67%) require high-level care to manage behaviour.
These figures add up to a reality which sees many aged care residents over medicated and suffering adverse side-effects. These figures demonstrate the lack of understanding of proper pain management skills.
Of particular concern is the prevalence of acute and chronic pain in people with cognitive decline, who are often unable to communicate their discomfort. Pain is now being recognised as a significant factor in behavioural and psychological symptoms of dementia (BPSD). When you consider that people living with dementia account for nearly 50% of those living in residential aged care facilities, it is easy to see how untreated chronic pain can result in BPSD, which can further lead to inappropriate use of chemical and physical restraints and other forms of elder abuse.
It is good to see the aged care sector step up to the challenge of addressing pain proactively like The Dementia Centre and Hammond Care who have developed a number of short, instructive videos. The three-part series details what pain signs and symptoms to look for in people with reduced communication skills, like so many in aged care facilities. The catch-cry is “if you observe a change, consider pain” which should be front of mind for every worker in aged care – as well as residents’ friends, families and carers.
For every painful story shared, there remain countless more endured in silence – through the inability to communicate, or by being misbelieved and ignored. As a nation, we must do more to care for and support the generations that have raised us.
It is my hope that this Royal Commission will see a drastic improvement in pain assessment and management protocols in all aged care facilities and industry guidelines, including quality standards, vastly improved to ensure quality care.
In the interim, we can only hope the aged care sector is listening to and ready to hear the myriad of voices urging them to take proactive steps to address the gaps. Pain must be one of these areas that is addressed as a matter of urgency. We have a generational opportunity to create an aged care environment that affords dignity to the older and frail- some of the most vulnerable people in our society. Appropriate pain management in aged care will go a long way towards providing that dignity.