The effectiveness of physical exercise training in pain, mobility, and psychological well-being of older persons living in nursing homes.

Pain is common in the aging population, particularly among older residents of nursing homes. It has been found that 50% of older people living in the community have been experiencing chronic pain, and the number increased to 80% for older residents of nursing homes. Exercise is an effective non-pharmacological intervention that can reduce pain and improve physical and psychological functions. A quasi-experimental study with a pretest-posttest control group designed was conducted to evaluate the effects of a physical exercise program (PEP) on older residents of nursing homes who have chronic pain. Three-hundred-ninety-six older residents with chronic pain were recruited from 10 nursing homes run by non-governmental organizations in Hong Kong. The average age of the older residents was 85.44 ± 6.29. Five nursing homes were randomized to the experimental group with PEP (n = 225, age = 85.45 ± 6.25); the other five nursing homes were randomized to the control group without the PEP (n = 171, age = 85.44 ± 6.35). PEP was an eight-week training program given by a physiotherapist and nurses once a week. It consisted of warm-up exercises, muscle strengthening, stretching, balancing, and self-administered massage to acupressure points. At the end of each PEP session, pamphlets with pictures illustrating the "exercise of the day" were given to the older residents of nursing homes as a tool to enhance their self-management skills. The control group received no training during the eight weeks. Upon completion of the PEP, the experimental group experienced a significantly greater reduction in pain intensity from 4.19 ± 2.25 (on an 11 point scale) to 2.67 ± 2.08, as compared to the control group (p < .05). In addition, the psychological well-being (happiness, loneliness, life satisfaction, and depression) of the experimental group was significantly improved (p < .05).

Health-related profile and quality of life among nursing home residents: does pain matter?

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents' demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents' physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents' pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.

Pain and pain-related situations surrounding community-dwelling older persons.

AIMS AND OBJECTIVES: To examine the pain prevalence in community-dwelling older adults and to explore the relationships between pain and physical and psychological parameters. BACKGROUND: Uncontrolled chronic pain is one of the barriers preventing older people from achieving active ageing. Effective pain management can enhance their mobility, increasing the happiness level and thus the quality of life. DESIGN: Exploratory cross-sectional study. METHOD: Cognitively intact community-dwelling older persons aged over 60 in Hong Kong were invited for a 20-25-minute interview. RESULTS: A total of 173 participants were recruited, with a mean age of 73.2. The average pain intensity was 3.97 ± 1.80. Oral analgesic drugs were used by 47.1% of participants, and 86.0% used nonpharmacological methods to relieve pain. Compared with participants free of chronic pain, participants with pain had lower happiness levels (p < 0.05). In addition, levels of mobility (p < 0.05) and physical quality of life (p < 0.05) were lower for older people with pain. Pain intensity was negatively correlated with physical quality of life (p < 0.05) and self-efficacy (p < 0.05), and positively correlated with mystery (p < 0.05), permanence (p < 0.05) and self-blame (p < 0.05) in pain belief. CONCLUSION: It was noted that nonpharmacological methods were commonly used by older persons as pain relief and that older persons with pain were less happy, less mobile and had a poorer quality of life as compared to their counterparts without pain. RELEVANCE TO CLINICAL PRACTICE: It is important to educate community-dwelling older persons on methods of pain management and to maintain their physical and psychological well-being in order to engage them in the community and lead a healthy and happy ageing.

Physical exercise: does it help in relieving pain and increasing mobility among older adults with chronic pain?

AIM: To provide a physical exercise programme for older adults living in nursing homes. BACKGROUND: Pain is common among older persons and for those already in long-term care and having difficulty in coping with pain will be at risk of further reducing their optimal independent function. DESIGN: A quasi-experimental single group pretest-posttest design. METHOD: Older persons from a nursing home were invited to join an eight-week physical exercise programme. Each session lasted an hour and sessions were conducted once a week by physiotherapist and nurses. Physical exercise programme consisted of stretching, strengthening, balancing, towel dancing and self-administered massage to various acupressure points. On completion of each session, older persons were given a pamphlet with pictures to illustrate the exercise of the day and they were encouraged to practise these exercises by themselves. Outcome measures including pain intensity, range of movement, activities of daily living and mobility were collected before and after the physical exercise programme. RESULTS: There were 75 older adult participants (57 female and 18 male, mean age 85.14 SD 5.30). Seventy-three percent (n = 55) of them had pain in the previous three months and were referred as pain group, while 25% (n = 20) were no pain group. Pain scores of 4.89 (on a 10-point scale) indicated medium pain intensity before the intervention for the pain group; the location of pain was mainly in the knee, back and shoulder. On completion of the physical exercise programme, there was a significant decrease in pain intensity to 2.89 (SD 2.14) (p < 0.01). There was a significant increase in range of movement in the neck, shoulder, back, hip and knee rotation, flex and abduction (p < 0.01). Mobility level was significantly increased post intervention, yet activities of daily living remained unchanged. CONCLUSIONS: The present study demonstrated the effectiveness of a physical exercise programme in relieving pain and enhancing functional mobility for older persons. Relevance to clinical practice. It is important to educate older persons, especially those living in nursing homes, on the importance of engaging in regular physical exercise and maintaining mobility.