form of cognitive impairment, there are tools for evaluation of behavioral responses through observation (Table 11). Pain-relieving medication, such as acetaminophen, has been shown to be a safe product to help alleviate and augment pain. NSAIDs have potential to address chronic pain from specific conditions, such as arthritis, but should be topical to avoid long-term use of NSAIDs. Long-term use of those drugs has been known to increase blood pressure, increase rates of kidney disease, worsen congestive heart failure, and exacerbate gastric ulcers. For older adults, using opioids for chronic pain is specific, temporary, and should be used after trying nonopioid medications. Opioid use should be spared but may be needed temporarily to help patients return to functional independence after an incident, accident, or medical procedure. A deprescribing plan for opioids should be in place prior to medication disbursement. Table 11: Pain Assessment Tools for Older Adults Tool Interpretation Self-reported numeric rating scale Observational response Visual analogue scale Observational response Facial recognition Observational response Brief Pain Inventory Observational response Abbey Pain Scale Observational and behavioral response Pain Assessment in Advance Dementia Scale (PAINAD) Observational and behavioral response Dolophus-2 scale Observational and behavioral response WOMAC Osteoarthritis Index Observational and behavioral response Oswestry Disability Index Observational and behavioral response Disabilities of the Arm, Shoulder, and Hand questionnaire Observational and behavioral response (Ong & Thian, 2022) al. (2023), with these variables impacting pregnancy, it is to be expected that there will be an increase in medication use. This increase has made pregnant women potentially more vulnerable to polypharmacy as well as the occurrence of drug-drug interactions (DDIs). At this time, the rate of polypharmacy in pregnant women is not known; however, there is an increase in medication utilization during pregnancy. Historically, the use of multiple medications during pregnancy would occur with women who had mental health issues or epilepsy; however, this is no longer the case. There is a concern for pregnant women who have polypharmacy while carrying a child. Some challenges can include: ● Drug pharmacokinetics are altered when a woman is expecting ● Plasma volume is an example as it increases during this physiological change, and this would impact distribution of certain drugs ● Increased hepatic and renal clearance can dilute medications and lead to subtherapeutic drug concentrations
Chronic pain is one of the most common conditions globally and frequently is concurrent with other conditions and diseases. Chronic pain is pain that persists for at least three months or well beyond a normal time for healing; it is different from acute pain, which is typically a localized discomfort or sensation. In the United States, chronic pain costs exceed $600 billion per year, often due to losses incurred by patients who are unable to function normally due to unusual suffering and increased healthcare costs (Domenicello & Ramsden, 2019). Addressing chronic pain with prescription medication has not been particularly effective in older adults and the aspects of polypharmacy potentially causing side effects that can be precipitous for additional illness and dysfunction. Many residents of skilled nursing facilities and nursing homes are treated for chronic pain. An estimated 80% of nursing home residents report feeling perpetual pain symptoms (Tinerello et al 2021). Approximately 50% of older people in the community report regular pain symptoms. For those older adults living in facilities pain of correlated to
(Tinerello et al 2021): ● Reduced mobility ● Depression
● Cognitive impairment ● Disturbances from sleep ● Social isolation ● Musculoskeletal conditions ● Rheumatological challenges ● Neuropathic issues
Managing pain experienced by residents of a nursing home is a balancing act. In addition to age-related challenges, there are the limitations of living in a healthcare facility. Staffing issues, limited ability to be outside, lack of daily independence, lack of privacy, and complete reliance on other people may increase feelings of sadness and isolation that precede depression. Multimorbidity is typical, as is polypharmacy; additionally there may be sensory deficits that also impact sensations of pain. The result is that pain management for older adults in this environment is challenging to address. Pain assessment is standard of care when examining older adults. To ensure that examination is appropriate when addressing older adults who may have dementia or some Polypharmacy and pregnancy It is well established that polypharmacy is a public health issue throughout the world for older adults. With the easy access to purchase over-the-counter medications and the availability of prescription drugs, anyone who is undergoing a physical change that requires clinical oversight should be aware of the challenges of taking multiple medications. For women who become pregnant, they may find themselves in need of medications to manage symptoms confronted throughout that period of time. Any medication taken during pregnancy should have the approval of the physician. Medications commonly used during this time include those addressing (Anand et al., 2023): ● Nausea ● Vomiting ● Pre-existing maternal health conditions ● Pregnancy-related complication There has been an increase in the use of medications by pregnant women in recent decades. There has also been an increase in maternal comorbidities, as well as an increased age of pregnant women. According to Anand et
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