Clinical Case Studies in Long-Term Care Psychiatry Navigating Common Mental Health Challenges in Geriatric Care
Book contents
- Clinical Case Studies in Long-Term Care Psychiatry
- Clinical Case Studies in Long-Term Care Psychiatry
- Copyright page
- Contents
- Preface
- Section 1 Neurocognitive Disorders
- Case 2 “I Think I Hit My Head”
- Case 3 “It’s like She’s a Different Person”
- Case 4 “I Am Tired All the Time”
- Case 5 “I Am Okay”
- Case 6 “Leave Me Alone”
- Case 7 “I Am Fine”
- Case 8 “Those Children Are Cute”
- Case 9 “Those Terrible Men Have Left”
- Case 10 “I Saw the Heavenly Gates”
- Case 11 “Leave Me Alone”
- Section 2 Mood Disorders
- Case 13 “My Mom Looks Like a Zombie!”
- Case 14 “My Soul Is in England”
- Case 15 “I Feel Terrible”
- Case 16 “I Don’t Care”
- Case 17 “I Feel Very Lonely”
- Case 18 “I Don’t Feel Right”
- Case 19 “I Am Feeling Great”
- Case 20 “I Am Staying Here Illegally”
- Section 3 Psychotic Disorders
- Case 22 “He Just Won’t Get Up”
- Case 23 “My Body Is Being Taken over by a Fungus!”
- Case 24 “This Is Humiliating”
- Case 25 “I Want to Go Home”
- Case 26 “I Am a Worrier”
- Case 27 “Get out of My House”
- Section 4 Anxiety and Related Disorders
- Case 29 “My Vision Has Been Worsening in the Last Two Weeks”
- Case 30 “I Am Not Addicted to Valium”
- Case 31 “Of Course, I Worry about Him”
- Case 32 “Bombs Are Falling! Run, Run!”
- Section 5 Substance Abuse Disorders
- Section 6 Personality Disorders
- Case 35 “I Cannot Wait to Get out of This Miserable Place”
- Section 7 Miscellaneous Neuropsychiatric Disorders Affecting Patients in Long-Term Care
- Case 37 “Everyone Is Just So Good to Me!”
- Case 38 “Why Do They Say I Have Dementia?”
- Case 39 “I Hate That Guy … I Can’t Get Any Sleep!”
- Case 40 “Just One Kiss”
- Case 41 “I Don’t Feel Well”
- Case 42 “I Like Food”
- Case 43 “I Like the Way She Laughs”
- Case 44 “This Is So Hard”
- Index
- References
Case 11 - “Leave Me Alone”
Pain Control in MNCD
Published online by Cambridge University Press: 31 October 2024
Book contents
- Clinical Case Studies in Long-Term Care Psychiatry
- Clinical Case Studies in Long-Term Care Psychiatry
- Copyright page
- Contents
- Preface
- Section 1 Neurocognitive Disorders
- Case 2 “I Think I Hit My Head”
- Case 3 “It’s like She’s a Different Person”
- Case 4 “I Am Tired All the Time”
- Case 5 “I Am Okay”
- Case 6 “Leave Me Alone”
- Case 7 “I Am Fine”
- Case 8 “Those Children Are Cute”
- Case 9 “Those Terrible Men Have Left”
- Case 10 “I Saw the Heavenly Gates”
- Case 11 “Leave Me Alone”
- Section 2 Mood Disorders
- Case 13 “My Mom Looks Like a Zombie!”
- Case 14 “My Soul Is in England”
- Case 15 “I Feel Terrible”
- Case 16 “I Don’t Care”
- Case 17 “I Feel Very Lonely”
- Case 18 “I Don’t Feel Right”
- Case 19 “I Am Feeling Great”
- Case 20 “I Am Staying Here Illegally”
- Section 3 Psychotic Disorders
- Case 22 “He Just Won’t Get Up”
- Case 23 “My Body Is Being Taken over by a Fungus!”
- Case 24 “This Is Humiliating”
- Case 25 “I Want to Go Home”
- Case 26 “I Am a Worrier”
- Case 27 “Get out of My House”
- Section 4 Anxiety and Related Disorders
- Case 29 “My Vision Has Been Worsening in the Last Two Weeks”
- Case 30 “I Am Not Addicted to Valium”
- Case 31 “Of Course, I Worry about Him”
- Case 32 “Bombs Are Falling! Run, Run!”
- Section 5 Substance Abuse Disorders
- Section 6 Personality Disorders
- Case 35 “I Cannot Wait to Get out of This Miserable Place”
- Section 7 Miscellaneous Neuropsychiatric Disorders Affecting Patients in Long-Term Care
- Case 37 “Everyone Is Just So Good to Me!”
- Case 38 “Why Do They Say I Have Dementia?”
- Case 39 “I Hate That Guy … I Can’t Get Any Sleep!”
- Case 40 “Just One Kiss”
- Case 41 “I Don’t Feel Well”
- Case 42 “I Like Food”
- Case 43 “I Like the Way She Laughs”
- Case 44 “This Is So Hard”
- Index
- References
Summary
The implications of unrecognized pain in those with MNCD are far-reaching. Untreated pain can lead to the destabilization of psychiatric conditions such as anxiety, depression, and agitation. Those with cognitive impairments are more likely to have longer waits for the evaluation of pain and receive weaker analgesia.As needed pain medications given to those with MNCD in the LTC setting may depend too heavily on the judgment of those inadequately trained to assess pain. Regularly scheduled pain medications may be a more appropriate option. Always keep the possibility of medication error in the differential diagnosis for apparent changes in mental status. Inadequate pain control negatively impacts mental health in older adults. Those with MNCD with inadequately controlled pain may present with atypical symptoms when compared to those without MNCD. Consider both pharmacologic and nonpharmacologic interventions when formulating a treatment plan for chronic pain in older adults. Opiates may have the best benefit/risk ratio for the treatment of chronic pain in some older adults.
- Type
- Chapter
- Information
- Clinical Case Studies in Long-Term Care PsychiatryNavigating Common Mental Health Challenges in Geriatric Care, pp. 52 - 56Publisher: Cambridge University PressPrint publication year: 2024
References
Duncan, R., Francis, R. M., Collerton, J., Davies, K., Jagger, C., Kingston, A., & Birrell, F. (2011). Prevalence of arthritis and joint pain in the oldest old: Findings from the Newcastle 85+ study. Age and aging, 40 (6), 752–755.CrossRefGoogle ScholarPubMed
van Kooten, J., Smalbrugge, M., van der Wouden, J. C., Stek, M. L., & Hertogh, C. M. (2017). Prevalence of pain in nursing home residents: The role of dementia stage and dementia subtypes. Journal of the American Medical Directors Association, 18 (6), 522–527.CrossRefGoogle ScholarPubMed
McDermott, J. H., Nichols, D. R., & Lovell, M. E. (2014). A case-control study examining inconsistencies in pain management following fractured neck of femur: An inferior analgesia for the cognitively impaired. Emergency medicine journal, 31 (e1), e2–e8.CrossRefGoogle ScholarPubMed
Tan, E. C., Jokanovic, N., Koponen, M. P., Thomas, D., Hilmer, S. N., & Bell, J. S. (2015). Prevalence of analgesic use and pain in people with and without dementia or cognitive impairment in aged care facilities: A systematic review and meta-analysis. Current clinical pharmacology, 10 (3), 194–203.CrossRefGoogle ScholarPubMed
van Dalen-Kok, A. H., Pieper, M. J. C., de Waal, M. W. M., van der Steen, J. T., Scherder, E. J. A., & Achterberg, W. P. (2021). The impact of pain on the course of ADL functioning in patients with dementia. Age Ageing, 50 (3), 906–913. doi: 10.1093/aging/afaa247. PMID: 33300044.CrossRefGoogle ScholarPubMed
Paulson, C. M., Monroe, T., & Mion, L. C. (2014). Pain assessment in hospitalized older adults with dementia and delirium. Journal of Gerontological Nursing, 40 (6), 10. https://doi.org/10.3928/00989134-20140428-02CrossRefGoogle Scholar
Tegenborg, S., Fransson, P., & Martinsson, L. (2022). Physicians’ and nurses’ experience of using the Abbey Pain Scale (APS) in people with advanced cancer: A qualitative content analysis. BMC Nursing, 22. www.ncbi.nlm.nih.gov/pmc/articles/PMC10071650/Google Scholar
Giorgio, R. D., Zucco, F. M., Chiarioni, G., Mercadante, S., Corazziari, E. S., Caraceni, A., Odetti, P., Giusti, R., Marinangeli, F., & Pinto, C. (2020). Management of opioid-induced constipation and bowel dysfunction: Expert opinion of an Italian multidisciplinary panel. Advances in Therapy, 38 (7), 3589–3621. www.ncbi.nlm.nih.gov/pmc/articles/PMC8279968/CrossRefGoogle Scholar
Wongrakpanich, S., Wongrakpanich, A., Melhado, K., & Rangaswami, J. (2018). A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging and Disease, 9 (1), 143–150. https://doi.org/10.14336/AD.2017.0306CrossRefGoogle ScholarPubMed
Schwan, J., Sclafani, J., & Tawfik, V. L. (2019). Chronic pain management in the elderly. Anesthesiology Clinics, 37 (3), 547. https://doi.org/10.1016/j.anclin.2019.04.012CrossRefGoogle ScholarPubMed