Comprehensive Geriatric Assessment (CGA): Pain and joint problems
Pain should be considered in all patients as part of the process of CGA, and there are many tools available to facilitate the assessment of pain in individuals who may struggle to report it.
Pain is very common in older people, but it is often under-recognised and under-treated. The reasons for this are multi-factorial but include misconceptions about pain being a normal part of ageing, and concerns about the side effects of analgesic medications. Untreated pain is a major cause of reduced mobility, functional decline and social isolation.1 There are also consequences for sleep, mood, and cognitive function.
A holistic approach to the assessment of pain is required, that involves addressing both physical, psychological and social factors. In addition, older people may be living with cognitive impairment and/or communication difficulties, and this can make the accurate assessment of pain more challenging.
Pain should be considered in all patients as part of the process of CGA, and there are many tools available to facilitate the assessment of pain in individuals who may struggle to report it.2 These include observational tools such as the Abbey pain scale3 and the Pain Assessment in Advanced Dementia (PAINAD) scale.4
Effective management of the causes of pain, plus careful use of appropriate analgesics,5 can dramatically improve quality of life and mental wellbeing in older people.
Non-pharmacological options such as physiotherapy may also be integral to the approach to managing pain for some individuals.
Joint pain
Joint problems are a common cause of pain in older people, particularly osteoarthritis which often affects the knees and fingers. Alongside pain, joint stiffness and functional limitation can contribute significantly to reduced mobility and functional decline, and can increase the risk of falls. A careful assessment of the joints is therefore an important part of CGA, using a methodical approach and considering holistic aspects of life that may be impacted such as being able to dress, prepare food and open medication.
Physical signs on examination such as swelling, tenderness and reduced range of motion will help to identify problematic joints. A more detailed assessment of joint function by a physiotherapist may then be required to develop a management plan.
When assessing an older person who has fallen, there should be a low threshold for radiological investigation if injury to the joint is suspected.
References
References
Click to expand
- Ali A, Arif AW, Bhan C, Kumar D, Malik MB, Sayyed Z, Akhtar KH, Ahmad MQ. Managing Chronic Pain in the Elderly: An Overview of the Recent Therapeutic Advancements. Cureus. 2018 Sep 13;10(9):e3293. doi: 10.7759/cureus.3293. PMID: 30443463; PMCID: PMC6235641.
- Pat Schofield, The Assessment of Pain in Older People: UK National Guidelines, Age and Ageing, Volume 47, Issue suppl_1, March 2018, Pages i1–i22, https://doi.org/10.1093/ageing/afx192
- Abbey Pain Scale https://rightdecisions.scot.nhs.uk/media/z3pfhrt2/abbey_pain_scale.pdf
- Pain Assessment in Advanced Dementia scale (PAINAD) https://www.mdcalc.com/calc/3701/pain-assessment-advanced-dementia-scale-painad
- Hoi Kei Iki Chan, Chin Pang Ian Chan, Managing chronic pain in older people, Clinical Medicine, Volume 22, Issue 4, 2022, Pages 292-294, ISSN 1470-2118, https://doi.org/10.7861/clinmed.2022-0274
