Pain experiences of older adults in Chinese nursing homes

Li, Qin; Yan, Wenjun; Zhang, Jingyi; Wang, Manli; Du, Wei; Zhu, Ying; Yan, Wenjing

doi:10.37689/acta-ape/2025AO001152

Abstract

Objective: To explore the current status of pain and its management in elderly residents in nursing homes institutions in China and analyze the existing problems.

Methods: This study assessed the current status of pain and its management in elderly care institutions in the main urban area of Xuzhou, China. Data collection occurred from June to October 2023. Qualitative semistructured interviews were conducted with 20 elderly residents of nursing homes, exploring their experiences of pain, the impact of pain on their daily lives, and their perspectives on pain management. Data were analyzed using Colaizzi’s phenomenological method.

Results: Three main themes emerged from the analysis. The elderly described their pain as sufferings, significantly impacting their daily activities and overall well-being. They identified several barriers to effective pain management, including distrust of healthcare professionals, apprehension about surgical interventions, and lack of financial resources. Participants expressed a need for comprehensive and accessible pain management strategies, including appropriate medication and education on alternative methods.

Conclusion: The study highlights the significant burden of pain experienced by elderly individuals in nursing homes. Barriers to effective pain management need to be addressed through improved communication, education, and financial support. Additionally, healthcare providers should work with older adults to develop individualized pain management plans that meet their specific needs and preferences.

Resumo

Objetivo: Explorar a condição atual da dor e seu manejo em idosos residentes em instituições de longa permanência para idosos na China e analisar os problemas existentes.

Métodos: Este estudo avaliou a condição atual da dor e seu manejo em instituições de longa permanência para idosos na principal área urbana de Xuzhou, China. A coleta de dados ocorreu de junho a outubro de 2023. Entrevistas semiestruturadas qualitativas foram conduzidas com 20 idosos residentes em instituições de longa permanência para idosos, explorando suas experiências de dor, o impacto da dor em suas vidas diárias e suas perspectivas sobre o manejo da dor. Os dados foram analisados usando o método fenomenológico de Colaizzi.

Resultados: Três temas principais emergiram da análise. Os idosos descreveram sua dor como sofrimento, com impacto significativo em suas atividades diárias e bem-estar geral. Eles identificaram várias barreiras ao manejo eficaz da dor, incluindo falta de confiança em profissionais de saúde, apreensão sobre intervenções cirúrgicas e falta de recursos financeiros. Os participantes expressaram a necessidade de estratégias abrangentes e acessíveis de manejo da dor, incluindo medicação apropriada e educação sobre métodos alternativos.

Conclusão: O estudo destaca a carga significativa de dor vivenciada por idosos em instituições de longa permanência para idosos. As barreiras para o manejo eficaz da dor precisam ser abordadas com o aprimoramento da comunicação, educação e suporte financeiro. Além disso, os provedores de saúde devem trabalhar com idosos para desenvolver planos individualizados de manejo da dor que atendam às necessidades e preferências específicas dessa população.

Descritores
Dor; Manejo da dor; Idoso; Casas de saúde; Instituição de longa permanência para idosos

Resumen

Objetivo: Estudiar la condición actual del dolor y su manejo en personas mayores residentes en instituciones de larga estadía para ancianos en China y analizar los problemas existentes.

Métodos: Este estudio evaluó la condición actual del dolor y su manejo en instituciones de larga estadía para ancianos en el área urbana principal de Xuzhou, China. La recopilación de datos se llevó a cabo de junio a octubre de 2023. Se realizaron entrevistas semiestructuradas cualitativas con 20 personas mayores residentes en instituciones de larga estadía para ancianos, donde se analizó la experiencia del dolor, el impacto del dolor en su vida diaria y sus perspectivas sobre el manejo del dolor. Los datos fueron analizados con el método fenomenológico de Colaizzi.

Resultados: Surgieron tres temas principales del análisis. Las personas mayores describieron el dolor como sufrimiento, con un impacto significativo en las actividades diarias y en el bienestar general. Identificaron varios obstáculos para el manejo eficaz del dolor, que incluyeron la falta de confianza en profesionales de la salud, el miedo a intervenciones quirúrgicas y la falta de recursos financieros. Los participantes expresaron la necesidad de estrategias amplias y accesibles de manejo del dolor, que incluyen medicación adecuada y educación sobre métodos alternativos.

Conclusión: El estudio resalta la carga significativa de dolor que sufren las personas mayores en instituciones de larga estadía para ancianos. Los obstáculos para el manejo eficaz del dolor deben ser abordados con una mejora de la comunicación, educación y apoyo financiero. Además, los prestadores de salud deben trabajar con las personas mayores para elaborar planes personalizados de manejo del dolor que atiendan las necesidades y preferencias específicas de estas personas.

Descriptores
Dolor; Manejo da dolor; Anciano; Casas de salud; Hogares para ancianos

Introduction

The world’s population is experiencing a rapid aging process, with projections indicating a tripling of individuals aged 80 or above by 2050.(¹) This demographic shift poses significant challenges for global healthcare systems, as evidenced by over 40% of elderly individuals aged 65 or older residing in nursing homes, underscoring the scale of this issue.(²) Regrettably, residents of these facilities often endure a higher prevalence of diseases and poorer physical conditions, such as arthritis, rheumatism, and nerve lesions, which can result in chronic pain and dysfunction.(³) Additionally, heightened pain intensity and a greater number of pain sites correlate with poorer clinical outcomes, particularly among nursing home residents. Addressing these challenges is paramount to safeguarding the well-being and enhancing the quality of life for the elderly population in aged care facilities.(⁴)

Chronic pain is defined as pain lasting more than 3 or 6 months. For the elderly with chronic disease, pain not only brought pain, but also affected their quality of life and even affected their treatment effect. Surveys were conducted among the elderly in nursing homes showed that 1/4 of the elderly complain of moderate to unbearable pain while resting, and nearly 45% complain of moderate to unbearable pain during activities.(⁵) The elderly often experienced pain when standing up, sitting, lying in bed or walking. Many residents experience pain in several body parts. Studies had shown that pain could limit patients’ daily activities, affect their family relationships, degrade social functions, and cause a series of psychological disorders, such as anxiety and depression.(⁶) The prevalence of pain was even higher among residents of nursing homes, at 48-55%.(²) Nursing home residents in Germany were also deeply affected by pain problems, with an estimated pain prevalence of between 49% and 80% in this population.(⁷) Studies had also reported very high pain prevalence among nursing home residents,40%-85% of nursing home residents reported pain.(⁸,⁹)

Pain was inherently a complex entity that needed to be assessed and treated. Effective pain management was both a clinical and a public health challenge, as undertreatment could lead to disability, overtreatment could lead to functional decline, and potentially contributed to the opioid crisis.(¹⁰) Pain was a common symptom of older adults in longterm care facilities. More than a third of residents complained of severe pain symptoms. At the same time, the condition remained largely undertreated, with 34% of residents not receiving any pain relief despite complaining of severe/frequent symptoms.(¹¹)

Also included false beliefs such as the belief that pain was an expected part of aging and that pain was tolerable without seeking medical treatment. To make matters worse, most oral analgesics were written on an “as needed” basis, and older adults needed to ask a nurse for pain relief. Given that older adults perceived pain as part of aging and had a low expectation of pain relief, they might be hesitant to report pain to a nurse and request analgesics.(¹⁰) Based on available evidence, the issue of pain management in older adults was particularly important.

In China, a study of 2,323 elderly individuals with physical functional limitations found that the incidence of pain was as high as 46.1%.(¹²) Another study conducted in six nursing homes in Hong Kong revealed a high prevalence of pain, with 67.9% of the elderly residents reporting pain experiences in the past three months.(¹³) These findings indicate a high prevalence of pain among elderly individuals in nursing homes. However, what are the perspectives of older people in Chinese nursing homes regarding their pain experiences and management? This gap in understanding underscores the need for further investigation in this area. Therefore, this study aimed to explore the current status of pain and its management in elderly residents in nursing home institutions in China and analyze the existing problems. By doing so, targeted strategies can be proposed to reduce the pain level of the elderly, relieve their suffering, and improve their quality of life.

Methods

This study employed a qualitative research approach to assess the current status of pain management in elderly care institutions in the main urban area of Xuzhou, China. The research adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to ensure transparency and completeness in reporting qualitative findings. Ethical approval for the study involving human subjects was granted by the Ethics Committee of Xuzhou Medical University (XZHMU-2023622). All participants provided written informed consent prior to participation.

Guided by the principle of data saturation, a purposive sampling method was used to select and interview 20 elderly individuals residing in these institutions. The inclusion criteria for participation were as follows: (1) age 60 years or older; (2) ability to self-express pain experiences; (3) residency in a nursing home for at least 6 months with plans for long-term stay; (4) consciousness and willingness to participate in the study, as evidenced by written informed consent. Exclusion criteria included: (1) mental disabilities, impaired understanding, or communication disorders; (2) estimated life expectancy of 3 months or less; (3) receipt of palliative treatment; (4) diagnosis of dementia or current diagnosis of cancer; (5) unwillingness to participate in the study. Participation was voluntary, and participants had the right to withdraw from the study at any time without penalty or loss of any benefits to which they were entitled.

This study assembled a research team of four researchers with diverse expertise relevant to the research purpose. The team comprised a chronic disease management expert, a nursing home nurse, a pain care specialist nurse, and a nursing graduate student. Informed by a review of existing literature and the collective insights of the research team, interview questions were developed. The interview outline was further refined based on the results of pre-interviews conducted with two elderly individuals. During interviews, the numerical rating scale (NRS) was employed to assess the pain status of elderly participants. This 11-point scale, ranging from 0 (no pain) to 10 (worst imaginable pain), enabled participants to quantify their pain intensity. Higher scores indicated greater pain severity, providing valuable insights into the pain experiences of elderly individuals.

Data collection occurred from June to October 2023. Prior to each interview, participants were informed about the study’s purpose and significance and assured of confidentiality, and interviews were conducted anonymously and audio-recorded. To ensure participant comfort, interviews were held in quiet, private, and relaxed settings. Participants were encouraged to freely express their thoughts without interruption. Interviews typically lasted 30-40 minutes. iFlytek H1 Pro voice recorder (Tianjin iFlytek Intelligent Technology Co., Ltd., China) was used to record the interviews in this research. The audio recordings were transcribed verbatim into a word document using the iFLYTEK app (Tianjin Science and Technology Co., Ltd., China). The transcripts were checked during the interviews, and the intonation, pauses, facial expressions, and body language during the interviews were annotated. Incoherent and ambiguous language during the interviews was translated into clear and fluent written text to improve readability. Two researchers then independently proofread and revised the transcripts. Subsequently, the transcribed documents were submitted to the interviewees for verification, guaranteeing the authenticity of the recorded information.

The interview recordings were transcribed verbatim within 24 hours of each interview and analyzed using Colaizzi’s phenomenological analysis method.(¹⁴) Rooted in the philosophical tradition of phenomenology, this method aims to understand individuals’ lived experiences by exploring their subjective perceptions and interpretations of reality. Colaizzi’s approach emphasizes bracketing researcher bias, immersing oneself in the participants’ world, and understanding their experiences from their perspective. The analysis involved a systematic process of repeated transcript reviews, coding of recurring viewpoints, and organizing codes into themes and subthemes through iterative discussions with experienced qualitative researchers. This iterative process allowed for a deeper understanding of the participants’ experiences and the emergence of meaningful patterns and insights.

In this study, the researchers meticulously reviewed each transcript, identifying and coding key words and sentences relevant to the research questions. These coded meaning units were then carefully examined, reflected upon, and synthesized to gradually develop a preliminary thematic framework. Each preliminary theme was clearly defined and described. Subsequently, through repeated comparison and analysis of similar preliminary themes, commonalities and overarching concepts were identified and extracted, leading to a concise and deeply meaningful thematic vocabulary. Finally, all thematic structures were presented to the research participants for verification, ensuring that the analysis accurately reflected their pain experiences and maintaining the credibility of the research findings. The analysis process in this study was conducted entirely manually, with the research team prioritizing the rigor and depth of the analysis.

Results

The study included 20 elderly residents of nursing homes, ranging in age from 76 to 91 years (mean age: 85). The majority were female (85%). Participants had diverse educational backgrounds, with illiteracy (n = 4), junior high school (n = 7), senior high school (n = 6), and university (n = 1) being represented. Most participants were widowed (n = 14), while four were married. Their length of stay in the nursing home varied, with five residing there for less than a year, nine for 1-3 years, two for 3-5 years, and four for over five years. Regarding perceived pain levels, six participants reported severe pain, seven reported moderate pain, and seven reported extreme pain.

Tormenting experience

Tormenting experience means that the elderly endured profound suffering. From the analysis of interview data, three sub-themes emerged under this overarching theme: chronic sufferings, impact on daily activities, and an endless pain.

“Chronic suffering” was prevalent among the elderly residing in nursing homes, characterized by enduring pain from various sources over extended periods. Interview findings revealed that pain was highly prevalent among elderly individuals in such facilities, with frequent complaints including lower back pain, leg pain, and headaches. The severity of pain typically ranged from moderate to severe, persisting for several years, often spanning more than a decade or even decades. Hence, our study underscores the chronic nature of suffering experienced by elderly residents in nursing homes.

Both the legs and waist ache, relatively speaking, the back pain is severe. It has been more than 20 years, with a degree of around 10 points. It is sore, and whenever it rains, it becomes sore. (Int 5)

I have had pain in my legs for decades, and it hurts every day. It is really like a needle in it. Now I still have a headache. I have a headache for 24 hours. I also have a lumbar disc herniation, and my waist is also painful! (Int 11)

“Impact on daily activities” revealed how pain significantly restricted the lives of the elderly participants. Pain limited their physical activities, causing mobility limitations, particularly impacting their ability to walk due to prevalent lower back and leg pain. Additionally, pain experienced at night often disrupted sleep, leading to sleep disorders and even necessitating the use of sleeping pills to induce sleep. Nearly all participants reported the detrimental impact of pain on their daily routines, underscoring its pervasive influence on their lives.

When it hurts, I can’t hold the bowl. I feel weak when walking. I cannot roll over while sleeping. (Int 19)

I usually sleep flat and cannot roll over. I can’t move my waist in the morning. It affects walking, so I need to use a walking aid now to walk as smoothly as possible. (Int 20)

The sub-theme “an endless pain” highlighted the persistent nature of pain experienced by the elderly residents, creating a sense of hopelessness and resignation. Participants described a feeling of being trapped in an unending cycle of pain, with no hope for relief. They had adopted strategies of endurance and acceptance, often believing that their pain was an inevitable consequence of aging and accepting that there were no readily available solutions. Their narratives also revealed emotional responses to their chronic pain, including crying, fear, and a sense of helplessness and powerlessness.

Anyway, I don’t think it can be cured anymore, just endure it. As people get older, the pain is like this, and you can only endure it yourself, there’s no way. (Int 3)

I cry when it hurts, I just cry, I can only cry, otherwise what else can I do. It will be fine when I die. (Int 14)

Barriers to pain management

Barriers to pain management refers to the factors and reasons that impede effective pain management for elderly individuals. From the analysis of interview results, three sub-themes emerged: (1) distrust, (2) apprehension with surgery, and (3) lack of financial resources.

The elderly in the study expressed significant distrust in the healthcare system’s ability to address their chronic pain effectively. They perceived that hospitals and doctors were unable to provide adequate solutions or cures for their conditions. Participants reported feeling that their pain was not being properly managed or treated, leading to a sense of hopelessness and distrust. They stated that seeking medical attention did not result in effective solutions, and some even stated that they no longer sought professional help due to a lack of faith in its efficacy.

They don’t have any good solutions either. I’m not the only one, there are several people who can’t cure leg and back pain. (Int 6)

Doctors and nurses, they don’t have any advice, and I don’t seek them either. (Int 4)

In the interviews, some elderly people expressed significant “apprehension with surgery” for their pain conditions. Concerns about potential complications, particularly the risk of paralysis, were prevalent among participants. They cited cases of patients experiencing paralysis after surgery as a deterrent to seeking surgical treatment. Additionally, some participants expressed concerns about their age and perceived increased surgical risks associated with being elderly.

The femoral bone is painful on both sides, and it has worn out...requiring joint replacement. But I still don’t want to do it, I’m afraid there may be complications. (Int 2)

My lumbar intervertebral disc is protruding and the pain is severe, and I dare not operate because I am afraid of paralysis. (Int 6)

Older people in the study highlighted the significant “lack of financial resources” associated with managing their chronic pain. Many expressed concerns about the high cost of medications, treatments, and devices, which limited their access to adequate pain relief. They also expressed concerns about the affordability of alternative therapies, such as acupuncture and massage, and the high cost of effective pain relief patches. They reported that financial constraints often forced them to limit their use of these treatments or opt for cheaper options that may be less effective or cause allergic reactions.

Whether it’s taking traditional Chinese medicine or western medicine, it costs a lot of money, and I can’t bear to take too many drugs...and medical insurance reimbursement is less. (Int 5)

The physical therapy device is a bit effective, but buying one costs over 10000 RMB, which is too expensive for me to afford. (Int 20)

Pain management improvement

Improving pain management entails medical staff implementing enhanced measures to optimize pain relief for elderly individuals. From the analysis of interview results, two sub-themes emerged: (1) use of medication and (2) limited awareness of alternative methods.

Our interviews unveiled that certain elderly individuals may resort to taking painkillers; however, they exhibit a limited comprehension of the appropriate “use of medication”. Additionally, certain elderly individuals harbor a fear of medication, apprehensive of potentially adverse side effects, despite being uncertain about the specific nature of these effects. This trepidation contributes to a casual and inconsistent approach to medication intake. Moreover, a subset of elderly individuals exhibits a reluctance to take medication, even in the presence of severe pain, actively resisting its use. Conversely, some elderly individuals are inclined to experiment with any medication that holds the promise of relief, regardless of its potential repercussions. These observations collectively suggest that elderly individuals experiencing pain often navigate a complex and uncertain landscape of medication usage.

I haven’t taken any medication, I haven’t taken painkillers, and I heard that taking medication has side effects. (Int 3).

When the pain was severe, I took celecoxib capsules. I took them the day before yesterday, but I didn’t take them yesterday. I didn’t dare to eat too much, afraid of any side effects. (Int 7)

“Limited knowledge on alternative methods” revealed a significant gap in awareness among elderly residents regarding pain relief options beyond traditional medication. Research participants demonstrated limited knowledge and, in some cases, skepticism towards alternative pain management approaches such as acupuncture, moxibustion, and plaster application. Despite exploring these treatments, many reported underwhelming results. While some elders experienced temporary relief from plasters, prolonged use often resulted in allergic reactions. Furthermore, some expressed dissatisfaction with instrument-assisted techniques used alongside acupuncture and moxibustion, finding them ineffective. These experiences collectively highlight the potential limitations of alternative methods in effectively addressing chronic pain in the elderly population.

I only pasted it once for several days, once used too much, it itches and my legs turn into this color (reddish brown). Acupuncture and moxibustion doesn’t work either. (Int 1)

Applying plaster can temporarily relieve pain, but after applying it, it cannot be applied continuously as it has been applied for a long time and can cause allergies. (Int 6)

Discussion

This research has revealed the prevalence and impact of pain among elderly nursing home residents. Pain is described as chronic and unrelenting, disrupting daily activities and overall well-being. Barriers to effective pain management include distrust of healthcare professionals, apprehension about surgical interventions, and lack of financial resources. Residents emphasize the need for comprehensive and accessible pain management strategies, including appropriate medication and education on alternative methods. These findings underscore the urgent need for interventions and compassionate care to alleviate suffering and enhance the quality of life for elderly nursing home residents.

In this study, the overarching theme of “tormenting experiences” emerged, comprising three distinct sub-themes. Elderly individuals residing in nursing homes endured prolonged “chronic sufferings”, with pain manifesting from various sources over extended periods. Research indicated that the mean duration of this pain was 10.26 years, ranging from a minimum of 4 months to a maximum of 30 years.(¹⁵) A significant portion (20.7%) of elderly individuals in southern Brazil grappled with chronic back pain, correlating with c health awareness, compromised quality of life, and depressive symptoms.(¹⁶) An examination of persistent pain among the elderly revealed prevalent conditions such as osteoarthritis and back pain, notably affecting the lower back or neck (65%) and musculoskeletal regions (40%).(¹⁷) This enduring pain severely restricted physical activities, imposing significant limitations on mobility and exerting a profound “impact on daily activities”. Findings from the University of Michigan National Poll on Healthy Aging highlighted that approximately half of those experiencing joint pain reported some degree of limitation in their usual activities (49%), while over a third (36%) noted interference with their daily routines.(¹⁸) These pain-induced restrictions permeated various aspects of daily life, contributing to heightened dependence, lowered mood, and increased feelings of loneliness, ultimately fostering social isolation.(³,¹⁹) Research also indicated that elderly individuals with chronic pain exhibited markedly lower levels of physical activity compared to their painfree counterparts, with persistent pain precipitating notable declines in physical function and overall well-being over a span of 7 years,(²⁰) which is aligning with the present study’s findings. Furthermore, enduring relentless pain could precipitate deteriorating mental health among elderly individuals, which was expressed as “an endless pain”. The pervasive and accepted notion of being unable to escape from pain engendered a sense of psychological vulnerability, compounded by feelings of fragility, loneliness, despair, and apprehension towards an uncertain future.(²¹) Studies have elucidated a prevalent co-occurrence of chronic pain and depression among older adults, suggesting a bidirectional relationship between these phenomena.(²²) Thus, it is posited that elderly individuals in nursing homes are subjected to enduring chronic suffering. With the progressive decline in physiological functions, the incidence of degenerative and chronic ailments among the elderly, such as osteoporosis, osteoarthritis, and digestive disorders, has been on the rise. These conditions, affecting 20% to 36% of the elderly population, commonly present with pain as a predominant symptom, exerting a profound impact on their quality of life.(²³) An interview outcome corroborated these findings, with nearly all elderly participants recounting experiences of chronic pain, particularly prevalent among those grappling with lower back and leg pain. Consequently, the repercussions on physical activity primarily manifested as walking difficulties, exacerbated by the omnipresence of pain, which curtailed their customary physical endeavors. Moreover, elderly individuals afflicted by pain often expressed feelings of helplessness, pervasive negativity, and, in some instances, despair due to the perceived lack of prospects for effective pain management.

“Barriers to pain management” encompass various factors and reasons impeding effective pain alleviation for elderly individuals. Our investigation delineated three primary barriers: “distrust” towards healthcare professionals, “apprehension with surgery”, and “lack of financial resources”. Research underscores the prevalence of untreated or inadequately managed chronic pain within elderly care facilities, partly attributable to ingrained distrust towards healthcare providers among seniors.(²⁴) Studies indicate that inadequate pain treatment in the elderly correlates with a perception that pain is an unavoidable aspect of aging, dissuading them from seeking medical assistance.(²⁵) Moreover, elderly individuals often feel dismissed by healthcare professionals when articulating their pain and seeking its root causes, possibly stemming from a prevailing notion, both among seniors and healthcare providers, that pain is an inevitable consequence of aging.(³) Nurses, particularly in home healthcare settings, may overlook pain expression, exacerbating the overall deficiency in pain management within aged care settings.(²⁶) Consequently, mistrust fosters a loss of confidence in staff and treatments among older individuals residing in care homes. “Apprehension with surgery” emerges as another significant barrier, as elderly nursing home residents often harbor apprehensions and are averse to surgical interventions due to perceived risks. Despite this reluctance, the absence of alternative pain relief methods compels the elderly to endure pain more passively. While surgery poses risks, avoidance solely based on fear may not be optimal; enhancing communication between medical professionals and the elderly could mitigate such apprehensions. Direct communication, avoiding age-centric terminologies, and a comprehensive discussion of risks versus benefits could enable more informed decisions regarding surgical interventions for pain relief.(²⁷) Notably, total knee arthroplasty has been deemed safe and effective even in patients aged ≥80 years, albeit with longer hospital stays and potential complications.(²⁸) Additionally, financial constraints pose a substantial obstacle to pain management, as many non-drug treatment options are not covered by medical insurance. The financial burden of pain management, be it medication or non-medication approaches, further exacerbates the challenges faced by economically disadvantaged elderly individuals in care facilities. Despite having medical insurance, the exclusion of many non-drug therapies from coverage limits access to comprehensive pain management.(²⁹) Addressing these barriers necessitates healthcare institutions to enhance reimbursement for elderly pain treatments and prioritize research on effective pain treatment, management, and prevention to alleviate the economic burden associated with pain.

Proposing “Improvement in pain management” is crucial for enhancing pain relief among elderly individuals. Employing medication judiciously is pivotal in pain control, necessitating careful consideration of dosage, duration, and potential side effects. Concerns about drug addiction are prevalent among some elderly individuals, complicating medication-based pain management significantly.(²⁵) Unfortunately, many elderly individuals’ pain treatments are overlooked by healthcare professionals, leading to a lack of standardized medication guidance and autonomous medication in most cases.(³⁰) Elderly individuals with chronic pain and opioid use disorders face complex management decisions in primary healthcare.(³¹) Additionally, “Limited knowledge on alternative methods” in nursing homes, where little is known about pain relief measures beyond medication treatment, is another concerning issue. Non-pharmacological measures are deemed particularly important for elderly patients due to their lower incidence of adverse reactions compared to pharmacological methods. When combined with pharmacological strategies, their benefits are usually enhanced.(³²,³³) Influenced by traditional Chinese medicine, many elderly individuals in this study opted for physical therapy methods to alleviate pain. However, due to limited knowledge, their options were also limited. Presently, emerging pain intervention methods, such as pain neural education, have proven effective for chronic pain in the elderly.(³⁴) In addition, Brazilian nursing homes and hospices often carry out activities such as bringing animals to visit hospitalized elderly people and monthly music performances, which are effective ways to relieve pain in patients.(³⁵) For people with religious beliefs, religious spiritual intervention is also effective in intervening pain in the elderly.(³⁶) In this study, the majority of participants reported ineffective pain management strategies, as they continued to experience pain in their daily lives. Elderly individuals require necessary knowledge and information to manage their chronic pain. In daily work, healthcare professionals could assess and devise personalized non-drug pain treatment strategies based on the physical condition and preferences of the elderly, while adding more humane collective activities to relieve the pain experience of the elderly, rather than letting them decide which methods to use.

This study, while offering valuable insights into pain experiences and management in Xuzhou nursing homes, is limited by its focus on resident perspectives alone. The absence of healthcare professional insights restricts a comprehensive understanding of pain management practices. Furthermore, relying solely on self-reported pain experiences may underestimate the true prevalence and severity of pain due to cognitive impairment or communication difficulties common among older adults. The study’s geographical confinement to Xuzhou, a specific urban area, also limits the generalizability of its findings to other contexts. Despite these limitations, this study significantly contributes to the field by highlighting the critical need for effective pain management in elderly care institutions. The findings underscore the importance of tailoring nursing practices to address the unique health needs of aging populations, prioritizing pain assessment and management within their care frameworks. This research serves as a crucial step towards improving the quality of life and well-being of elderly residents in nursing homes.

Conclusion

In conclusion, this study underscores the profound impact of chronic pain on the lives of elderly individuals residing in nursing homes. The findings illuminate the pervasive nature of pain experiences, revealing its detrimental effects on daily functioning and overall well-being. Moreover, the identification of barriers to effective pain management emphasizes the urgent need for targeted interventions and support mechanisms. Moving forward, it is imperative for healthcare providers and institutions to prioritize pain management in elderly care settings, fostering improved communication, education, and access to resources. By tailoring interventions to individual needs and preferences, healthcare professionals can enhance the quality of life for elderly residents, mitigating the burden of pain and promoting holistic well-being in this vulnerable population.

Acknowlegdments

This work was supported by Philosophy and social sciences fund project of Jiangsu Provincial Department of Education (NO. 2021SJA1074).

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¹⁶ Silveira Barezani AL, de Figueiredo Feital AM, Gonçalves BM, Christo PP, Scalzo PL. Low back pain in Parkinson’s disease: A cross-sectional study of its prevalence, and implications on functional capacity and quality of life. Clin Neurol Neurosurg. 2020;194:105787.
¹⁷ Dagnino AP, Campos MM. Campos MMJFiHN. Chronic pain in the elderly: mechanisms and perspectives. Front Hum Neurosci. 2022;16:736688.
¹⁸ Malani P, Kullgren J, Solway E, Wallace B, Singer D, Kirch M, et al. Arthritis and joint pain. Institute for Healthcare Policy & Innovation (IHPI, National Poll on Healthy Aging; 2022.
¹⁹ D’Ippolito M, Purgato A, Buzzi MG. Buzzi MGJJopr. Pain and evil: from local nociception to misery following social harm. J Pain Res. 2020;13:1139–54.
²⁰ Ritchie CS, Patel K, Boscardin J, Miaskowski C, Vranceanu AM, Whitlock E, et al. Impact of persistent pain on function, cognition, and well-being of older adults. J Am Geriatr Soc. 2023;71(1):26–35.
²¹ Puto G, Repka I, Brzyski P. Pain measurement in the older people: evaluation of the psychometric properties of the Geriatric Pain Measure (GPM-24) – polish version. BMC Geriatr. 2021;21(1):560.
²² Affaitati G, Costantini R, Tana C, Cipollone F, Giamberardino MA. Co-occurrence of pain syndromes. J Neural Transm (Vienna). 2020;127(4):625–46.
²³ Prat-Luri A, de Los Rios-Calonge J, Moreno-Navarro P, Manresa-Rocamora A, Vera-Garcia FJ, Barbado D. Effect of trunk-focused exercises on pain, disability, quality of life, and trunk physical fitness in low back pain and how potential effect modifiers modulate their effects: a systematic review with meta-analyses. J Orthop Sports Phys Ther. 2023;53(2):64–93.
²⁴ Nowak T, Neumann-Podczaska A, Tobis S, Wieczorowska-Tobis K. Characteristics of pharmacological pain treatment in older nursing home residents. J Pain Res. 2019;12:1083–9.
²⁵ Alzghoul BI, Al Humoud S, Abdullah NA. Patient-related Barriers to Effective Pain Management: A Cross-sectional Survey of Jordanian Nurses. Open Public Health J. 2022;15(1):e187494452207270.
²⁶ Ingelson BF. Factors that influence nurses’ pain management practices in hospitalized older persons living with dementia [dissertation]. Edmonton: University of Alberta; 2023.
²⁷ Geenen R, Overman CL, Christensen R,Åsenlöf P, Capela S, Huisinga KL, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(6):797–807.
²⁸ Cheung A, Fu H, Cheung MH, Chan WK, Chan PK, Yan CH, et al. How well do elderly patients do after total knee arthroplasty in the era of fast-track surgery? Arthroplasty. 2020;2(1):16.
²⁹ Qiu Y, Li H, Yang Z, Liu Q, Wang K, Li R, et al. The prevalence and economic burden of pain on middle-aged and elderly Chinese people: results from the China health and retirement longitudinal study. BMC Health Serv Res. 2020;20(1):600.
³⁰ Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, et al.; EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22 Suppl 22):4–60.
³¹ Kagarmanova A, Sparkman H, Laiteerapong N, Thompson K, Rosul L, Lazar D, et al. Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for I-COPE study. Trials. 2022;23(1):602.
³² Perra N. Non-pharmaceutical interventions during the COVID-19 pandemic: A review. Phys Rep. 2021;913:1–52.
³³ Wilfling D, Calo S, Dichter MN, Meyer G, Möhler R, Köpke SJCdosr. Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane database of systematic reviews. 2023(1).
³⁴ Simões P, Andias R, Simões D, Silva AG. Group pain neuroscience education and dance in institutionalized older adults with chronic pain: a case series study. Physiother Theory Pract. 2022;38(1):164–72.
³⁵ Paiva CF, Santos TC, Aperibense PG, Martins GD, Ennes LD, de Almeida Filho AJ. Historical aspects in pain management in palliative care in an oncological reference unit. Rev Bras Enferm. 2021;74(5):e20200761.
³⁶ Moreira RS. Santana Junior RN, Posso MB. Spirituality, nursing and pain: an indissociable triad. BrJP. 2021;4(4):344–52.

Edited by

Associate Editor
Meiry Fernanda Pinto Okuno, (https://orcid.org/0000-0003-4200-1186), Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Publication Dates

Publication in this collection
28 Mar 2025
Date of issue
2025

History

Received
13 May 2024
Accepted
26 Aug 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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[12] ¹² Ning H, Zhao Y, Liao L, Chen H, Tao Z, Chen X, et al. Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study. Pain Manag Nurs. 2022;23(3):338–44.

[13] ¹³ Tse M, Li Y, Tang SK, Ng SS, Bai X, Lee PH, et al. An exploration of the effectiveness of a peer-led pain management program (PAP) for nursing home residents with chronic pain and an evaluation of their experiences: a pilot randomized controlled trial. Int J Environ Res Public Health. 2020;17(11):4090.

[14] ¹⁴ Praveena K, Sasikumar SJ. Application of Colaizzi’s method of data analysis in phenomenological research. Med-Leg Update. 2021;21(2):914–8.

[15] ¹⁵ Sharma PK, Reddy BM. Ganguly EJJof, sarcopenia, falls. Frailty syndrome among oldest old Individuals, aged≥ 80 years. Prevalence & Correlates. J Frailty Sarcopenia Falls. 2020;5(4):92-101

[16] ¹⁶ Silveira Barezani AL, de Figueiredo Feital AM, Gonçalves BM, Christo PP, Scalzo PL. Low back pain in Parkinson’s disease: A cross-sectional study of its prevalence, and implications on functional capacity and quality of life. Clin Neurol Neurosurg. 2020;194:105787.

[17] ¹⁷ Dagnino AP, Campos MM. Campos MMJFiHN. Chronic pain in the elderly: mechanisms and perspectives. Front Hum Neurosci. 2022;16:736688.

[18] ¹⁸ Malani P, Kullgren J, Solway E, Wallace B, Singer D, Kirch M, et al. Arthritis and joint pain. Institute for Healthcare Policy & Innovation (IHPI, National Poll on Healthy Aging; 2022.

[19] ¹⁹ D’Ippolito M, Purgato A, Buzzi MG. Buzzi MGJJopr. Pain and evil: from local nociception to misery following social harm. J Pain Res. 2020;13:1139–54.

[20] ²⁰ Ritchie CS, Patel K, Boscardin J, Miaskowski C, Vranceanu AM, Whitlock E, et al. Impact of persistent pain on function, cognition, and well-being of older adults. J Am Geriatr Soc. 2023;71(1):26–35.

[21] ²¹ Puto G, Repka I, Brzyski P. Pain measurement in the older people: evaluation of the psychometric properties of the Geriatric Pain Measure (GPM-24) – polish version. BMC Geriatr. 2021;21(1):560.

[22] ²² Affaitati G, Costantini R, Tana C, Cipollone F, Giamberardino MA. Co-occurrence of pain syndromes. J Neural Transm (Vienna). 2020;127(4):625–46.

[23] ²³ Prat-Luri A, de Los Rios-Calonge J, Moreno-Navarro P, Manresa-Rocamora A, Vera-Garcia FJ, Barbado D. Effect of trunk-focused exercises on pain, disability, quality of life, and trunk physical fitness in low back pain and how potential effect modifiers modulate their effects: a systematic review with meta-analyses. J Orthop Sports Phys Ther. 2023;53(2):64–93.

[24] ²⁴ Nowak T, Neumann-Podczaska A, Tobis S, Wieczorowska-Tobis K. Characteristics of pharmacological pain treatment in older nursing home residents. J Pain Res. 2019;12:1083–9.

[25] ²⁵ Alzghoul BI, Al Humoud S, Abdullah NA. Patient-related Barriers to Effective Pain Management: A Cross-sectional Survey of Jordanian Nurses. Open Public Health J. 2022;15(1):e187494452207270.

[26] ²⁶ Ingelson BF. Factors that influence nurses’ pain management practices in hospitalized older persons living with dementia [dissertation]. Edmonton: University of Alberta; 2023.

[27] ²⁷ Geenen R, Overman CL, Christensen R,Åsenlöf P, Capela S, Huisinga KL, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(6):797–807.

[28] ²⁸ Cheung A, Fu H, Cheung MH, Chan WK, Chan PK, Yan CH, et al. How well do elderly patients do after total knee arthroplasty in the era of fast-track surgery? Arthroplasty. 2020;2(1):16.

[29] ²⁹ Qiu Y, Li H, Yang Z, Liu Q, Wang K, Li R, et al. The prevalence and economic burden of pain on middle-aged and elderly Chinese people: results from the China health and retirement longitudinal study. BMC Health Serv Res. 2020;20(1):600.

[30] ³⁰ Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, et al.; EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22 Suppl 22):4–60.

[31] ³¹ Kagarmanova A, Sparkman H, Laiteerapong N, Thompson K, Rosul L, Lazar D, et al. Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for I-COPE study. Trials. 2022;23(1):602.

[32] ³² Perra N. Non-pharmaceutical interventions during the COVID-19 pandemic: A review. Phys Rep. 2021;913:1–52.

[33] ³³ Wilfling D, Calo S, Dichter MN, Meyer G, Möhler R, Köpke SJCdosr. Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane database of systematic reviews. 2023(1).

[34] ³⁴ Simões P, Andias R, Simões D, Silva AG. Group pain neuroscience education and dance in institutionalized older adults with chronic pain: a case series study. Physiother Theory Pract. 2022;38(1):164–72.

[35] ³⁵ Paiva CF, Santos TC, Aperibense PG, Martins GD, Ennes LD, de Almeida Filho AJ. Historical aspects in pain management in palliative care in an oncological reference unit. Rev Bras Enferm. 2021;74(5):e20200761.

[36] ³⁶ Moreira RS. Santana Junior RN, Posso MB. Spirituality, nursing and pain: an indissociable triad. BrJP. 2021;4(4):344–52.