Pain

Detecting and treating pain is of great importance for well-being. For those who do not have the ability to express discomfort that the surrounding environment can interpret and understand what is tormenting. If we understand the pain, there are often complements to drug treatment.

Pain is commonly occurring among the elderly and can manifest as motor or psychological unrest and give rise to states of confusion. Untreated pain leads to a poorer quality of life and can lead to depression, impaired sleep, and reduced nutrient intake. Patients in the end stages of life who have untreated pain can experience an increased fear of death as a result of pain.

People with dementia are at greater risk than others of not receiving appropriate pain treatment in painful conditions. The VAS scale (Visual Analogue Scale) is an assessment scale that can only be used for people who can describe their own pain. In cases of impaired cognitive function, the Abbey Pain Scale should instead be used, a pain assessment tool where the person conducting the assessment makes the assessment based on the resident's behavior, expression, and symptoms of pain.

There are different types of pain and pain intensity which determines the choice of pain relief. Upon observation, a decision is made as to whether the pain is nociceptive, caused by tissue damage, or if it is nerve pain, which is common in cases of MS, stroke, herniated disc, and shingles. The pain can be psychogenic, i.e., triggered by psychological causes. There is also unexplained pain that cannot be clarified, so-called idiopathic pain.
Here, as elsewhere, there is drug treatment but also complements to drug treatment to relieve.

Highly sensitive

There are people who are extra sensitive. Their senses give stronger impressions than ours. In a nursing home where many are dependent on help to function in everyday life, it can be painful if the staff do not understand what it is about. Those who suffer from high sensitivity may need extra time and support from employees and support to adapt.

Elisabeth was a woman who was cared for in long-term care during the seventies. She had a very hard time every day when we were going to dress her. The hospital clothes used were not comfortable. She experienced that underwear and socks were tight and that the robes' seams were hard against the skin. Then no one had heard of high sensitivity, but we realized that she was suffering. Every day we who worked had to put down an extra moment to get clothes that would suit her, so that she could feel good.

People with a highly sensitive personality (HSP) "high sensitive person" can have an advantage in that they often read moods, situations, and risks earlier than others. They notice if a person is sad or tired long before others do it. High sensitivity can be an asset as it involves a sensitive talent that makes the person living with it perceive sensory impressions sharper. There are people who quality-assure perfume scent with a developed sense of smell or who are skilled at tuning pianos.

High sensitivity can apply to various stimuli that affect all our senses. Sound, light, movements, touch, and smells. Fabrics that chafe against the body or sit tight can be experienced with strong discomfort. Perfume and other scents can be perceived as disturbing. It is a personality trait, not a disease. Not infrequently, the person is more easily stressed when there are many new impressions at the same time.

One type of high sensitivity is hyperacusis, sound intolerance. Those who are affected can be disturbed even by low sounds like the rustle of a newspaper, the murmur in a restaurant, the air conditioning or a chair scraping. Almost every tenth person suffers from it.
Those who are highly sensitive may need more alone time than others to recover. Some can go and ponder for a long time over whether there are underlying messages in what someone says.

Parkinson's disease

For those who have severe Parkinson's, the support that the nursing home provides can mean increased quality of life. Lack of knowledge and wrongly designed support, on the other hand, can deteriorate the same. Knowledge is necessary to provide the best support to those living with Parkinson's disease.

Many nursing homes have one or a few people living with them who suffer from the disease. Parkinson's disease is special and can affect the resident's quality of life to a great extent. There are many small tricks that can facilitate everyday life for these people.

The disease is often noticed by the motor skills, i.e., body movements, becoming slower and that it can be difficult to get started with movements. Tremors, muscle stiffness, and poorer balance are other symptoms. The symptoms are due to the fact that nerve cells in part of the brain break down. Many get symptoms can be relieved by drugs, but for a few, they can affect everyday life to a large extent despite medication. Proximity and proximity to staff support, such as living in an apartment in a nursing home, can be a prerequisite for coping with life.

Stress can exacerbate the symptoms. It is therefore good to create calm in different situations where the resident needs help. Feel free to discuss with the resident how you can work to help in the best way. Give time so that the resident has the opportunity to do as much as possible himself. Fixed routines are usually a good support. Medication at the right time limits the symptoms. Often, the resident can have medication at far more occasions per day than other residents. If the times are shifted, it can become too tight or too long in between, which affects worsen the symptoms.

Regular exercise maintains mobility, but the training programs should be adapted to the resident's conditions. The physiotherapist can provide advice, support, and tips on how the training can be designed to work for the resident. Often it is good to train with all the senses. Rhythmical music and training support with, for example, markings in the floor can facilitate, for example, walking training.

Staff who have knowledge about the disease in general and about what is beneficial for the resident can make a big difference for the quality of life. Food affects Parkinson's and there may be reasons to contact a dietitian to get a nutrient intake that best harmonizes with drug treatment. Swallowing difficulties occur, which can also mean that the consistency of the food is adapted. The speech therapist can then make an assessment of the swallowing ability and give instructions on the consistency of food and drink.

The disease and drug treatment increase the risk of constipation. A sedentary life contributes to the resident becoming constipated more easily. Constipation is prevented by the resident drinking enough fluid, preferably water. Regular exercise and eating a high-fiber diet are good. The difficulties in coordinating movements can necessitate help with oral hygiene. The drugs often contribute with dry mouth. The dental hygienist can give advice on how you best help the resident.

If the resident has a wheelchair, the sitting position is important. The occupational therapist can assist so that the resident gets the right wheelchair and a good sitting position. The sitting position may need to be adjusted to different situations. It is not easy to eat if you sit reclined.

MS Multiple Sclerosis

Those who have MS can have various symptoms that affect the quality of life. Different areas of the central nervous system are affected during the course of the disease. Therefore, those affected by the disease may have problems from different parts of the body in MS. Often the person has several symptoms related to the nervous system. 1177 highlights examples of symptoms such as sensory disturbances and tremors, difficulties walking and keeping balance, problems with vision, decreased control over the bladder, muscle stiffness, fatigue, mood swings with depression, disturbances in memory and thought activity
and pain. The symptoms that are common can depend on things other than MS.

Many people with MS can live a good life despite the disease. However, there is a "malignant variant" that leads to severe disability.

Parkinson's and MS change over time and it is therefore important that the resident is followed up by a doctor regularly. The physiotherapist can design a training program based on the resident's needs and conditions. The occupational therapist can contribute with knowledge about transfers, support at meals, sitting positions, and other things that make everyday life work. Team collaboration where different professions contribute is important for providing the best care.

Side effects from drugs

Symptoms from the nervous system can also depend on drug side effects. It is important that the doctor receives information about things that can be drug side effects in order to take this into account in connection with drug reviews. There are also people who are "highly sensitive to drug side effects".

Reflection on functional changes in the nervous system
Care staff:
• Are there residents who seem to be affected by pain?
• In what way can you notice if someone is in pain?
• Is there anyone who is sensitive to smells, spices, disturbing noises, or if there is a lot of running?
• Do you have team conferences or further training where you have discussed how best to support residents with Parkinson's disease?

Manager, nurse, occupational therapist and physiotherapist:
• Do you have discussions in the team about pain and pain treatment?
• Do you use the VAS scale and/or Abby Pain Scale to identify and evaluate pain?
• Do you have any resident who is extra sensitive? Do you bring up questions about pain or high sensitivity in connection with team meetings?
• How do you ensure that the advice from different specialists gets through in the care of the resident?

Residents and relatives:
• Do you experience discomfort from pain or strong sensory impressions?
• Is it mentioned in implementation plans and health plans?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day