Pain assessment in a geriatric psychiatry program.

Background: The assessment of pain in older persons with psychiatric illness is particularly challenging for health care professionals. There are few well-tested pain assessment tools for this population.

Objectives: A study was conducted to explore pain assessment and management issues in geriatric psychiatry.

Methods: Seventy-four staff members of a geriatric psychiatry service at Regional Mental Health Care London, St Joseph's Health Care London, London, Ontario completed a survey to assess current pain assessment and management practice for geriatric psychiatry patients, and to identify indicators used to assess pain in this population. The results of the survey were later shared with members of the program's pain management team in a focus group discussion to explore opportunities on how to transfer these findings into clinical practice.

Results: The majority of survey respondents (91.8%) agreed that pain assessment and management could be improved for patients; only 14.9% reported that there was a consistent approach to pain management. Misconceptions and attitudes about pain, lack of easily administered pain tools, inconsistent monitoring of pain, and lack of documentation of pain symptoms and indicators were identified as significant barriers to optimal pain management for their patients. A number of behaviours indicative of pain were identified but emphasis was placed on recognition of changes from usual behaviour.

Conclusions: The findings of the present study highlight the need for a comprehensive, practical and consistent approach to pain assessment and management, and provide insight into the critical components, including behavioural indicators, that could be incorporated into a pain protocol to be used with this population.