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home | Drugs & Medications | Offering Assisted Living and Nursing . . .

Offering Assisted Living and Nursing Home Residents Pain Medication "As Needed" (PRN)

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Is the assisted living residence or nursing home encouraging your senior to ask for pain relief "as needed" because that's how the doctor prescribed pain medications? This could actually be a significant contributor to an elderly resident's decline.

One would logically think that a patient who has the option of receiving pain medication "prn" ("pro re nata," or "as needed") would generally have less pain, and be more comfortable, than a patient who isn't permitted to receive medication whenever requested. Surprisingly, the facts show otherwise.

Most older adults - some say as many as 80% of all seniors and 85% of all nursing home patients - have medical conditions that cause chronic pain. Arthritis, neuropathy, degenerative joint disease and circulatory diseases are common among nursing home patients. These painful conditions can't be cured, but the constant discomfort they cause can be relieved with good pain management practices.

Experiencing constant, chronic pain will typically have a negative impact on every aspect of a senior's quality of life. It can impair a person's ability to move freely, so they often lose the ability to independently do common daily activities such as dressing, using the toilet, performing basic hygiene, transferring and moving around. The risk of falls increases as mobility decreases. Depression becomes a serious issue, as do loss of appetite, weight loss and insomnia. Cognitive impairments and "agitation" often worsen. The desire to withdraw, remaining in bed and avoiding moving around contribute to skin breakdown, loss of muscle, and frequently an increase in pain.

Yet poor communication and pain medications ordered to be given "as needed" are seriously hampering good pain control for many nursing home patients.

Experts in pain management have stated over and over that the essence of good pain management is taking pain medication regularly. Medication staff in facilities are not supposed to offer pain medication that the doctor has ordered to be given "prn" until the patient asks for it. If a resident does not ask, and if the nurse does not do a frequent and thorough pain screening, patients in pain will not be offered relief.

Seniors with cognitive impairment may not be able to identify the source of their discomfort. Their pain can be difficult even for experienced nurses to identify. Patients who are confused, or who have speech impairments may not be verbal enough to formulate a request. Some are reluctant to "bother" the staff. Others may believe that their pain is a normal part of growing old, so they do not report it. Some may perceive asking for pain medication as complaining, and they do not want to be identified as "troublesome."

When patients do ask, they have often waited until their pain is extreme. It then takes longer for their pain to be relieved than if they had asked sooner, of if they had been given medication earlier to prevent serious pain from occurring at all.

If your senior with chronic pain living in a facility has pain medication available "if he asks for it," ask if you can review the facility medication administration record. If you see that your senior has only received this pain medication irregularly, infrequently, or even not at all, be proactive.

Speak with your parent's nurse and get his or her opinion about why your parent hasn't been regularly asking for relief.

Review your senior's list of pain-relief medications with the nurse in charge. Unless he or she has a very reasonable reason why the medications should remain "prn," ask the nurse to talk to the doctor about changing the distribution to "scheduled" (i.e., dispensed routinely every 4, 6, 8, 12 hours, etc. as appropriate). Most nurses will be more than willing.

If the nurse is reluctant and cannot give you a good reason why you shouldn't try this kind of change, speak directly with the doctor. This may take some doing, but it is possible.

Monitor your senior to see if he or she seems to be more comfortable, less confused, less agitated, more interested in eating, and more willing to participate in therapy and activities. Medication that actually gets out of the bottle and into the patient who needs it often has this kind of positive effect.