Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

Prevalence and association of musculoskeletal disorders with various risk factors among older Indian adults: Insights from a nationally representative survey

BACKGROUND

Globally, Musculoskeletal disorders (MSDs) are the biggest contributor (17%) to years lived with disability. For offering diagnosis and appropriate health interventions options along with follow-up care, it is pertinent to have a thorough awareness of its associated risk factors.

OBJECTIVES

The study aims to assess the prevalence and association between MSDs and risk factors among the Indian older adults above 45 years.

METHODOLOGY

Prevalence of MSDs among 28,436 participants was estimated using nationally representative survey on older Indian adults. Spatial distribution maps were created to display the magnitude of MSD prevalence at Indian sub-national level. Association between presence of MSDs and associated risk factors (such as occupation, employment duration, physical activity, BMI, diabetes, hypertension, tobacco usage, and alcohol consumption) was explored through Multivariate logistic regression. P-value <0.05 was considered as statistically significant.

RESULTS

MSD was prevalent in over half of participants (53.5 (52.9-54.1)%), with more among females and in those aged >60 years (60.4 (59.3-61.4)%). Overall, joint pain (41.9 (41.3-41.4)%) was more common than back pain (32.6 (32.0-33.1)%). Prevalence was highest in Manipur (81.1 (77.9-83.9)%) and lowest in West Bengal (33.1 (30.7-35.5)%). MSD presence was positively associated with certain occupational groups, pre-obesity (BMI 25-29.9 Kg/m2), currently hypertensive, vigorous physical activity among overall population. Tobacco usage was positively associated, while alcohol consumption was linked to a lower occurrence of MSDs for 45-60 years age group.

CONCLUSIONS

Customised policy interventions can be developed for specific age category of older Indian adults and musculoskeletal health can be improved by addressing modifiable risk factors such as physical inactivity, tobacco usage, avoiding workplace risks in occupations requiring manual labour as revealed by this study.

A community-based study on health seeking behaviour among NCD patients in rural and urban Tamil Nadu - A convergent mixed method study

This study focusses on the health seeking behaviour of NCD patients which entails regularity of health care facility visitations and adherence to lifestyle modifications.

Aims

To analyse the hospital visitations and lifestyle modifications of NCD patients. To do a comparative study about the health seeking behaviour among NCD patients in Rural and Urban areas. To explore the various difficulties that patients face with regards to Lifestyle modifications.

Settings and Design

It is a convergent type mixed-methods design, undertaken in the field practicing areas of RHTCs and UPHCs of Government Medical College, Omandurar Government Estate.

Methods and Material

The data was collected by means of Free listing, Focussed Group Discussions, Key Informant Interviews and Structured Questionnaires from patients diagnosed with one or more non-communicable diseases.

Statistical analysis used

Smith's S value Manual Content Analysis Bivariate analysis.

Results

The health seeking behaviour of NCD patients is influenced by lesser crowding and shorter distance to travel, reduced waiting time, focused attention from and familiarity with the healthcare provider, community health, systematic dispensing of medications and regularised testing. Rural population have a higher positively inclined health seeking behaviour than urban population.

Conclusions

The health seeking behaviour of patients with NCDs seem to be on the positive trend and is influenced by the locality of the respondents.

Effectiveness of health education program on knowledge regarding health promotion strategies in the geriatric population of selected old age homes at Raipur, Chhattisgarh

Background

The elderly is defined as the person who is beyond middle age and approaching old age (60 or above), also called senior citizens. The number of older adults globally is expected to increase from 420 million in 2000 to 974 million in 2030. In 2017. The objectives of the study were to assess the existing level of knowledge regarding health promotion strategies and to determine the effectiveness of health education program on knowledge regarding health promotion among the elderly in old age home.

Materials and Methods

The study employed one-group pretest and posttest preexperimental design without a control group. The sample size of 50 was selected using a non-probability convenient sampling technique. Baseline data were collected by a structured questionnaire, and a structured teaching program was given for 2 weeks, and after 15 days, a posttest was conducted with the same tool.

Statistical Analysis

Data collected were analyzed by using both descriptive and inferential statistics.

Results

The knowledge score increased significantly from baseline. The mean score of the pretest was 18.38, the mean score of the posttest was 21.78, the mean improvement was 3.40, and the paired value obtained for knowledge was 17.36, which was found significant at 0.05 level (P < 0.05). There was a significant improvement in the knowledge regarding health promotion strategies in the geriatric population.

Conclusions

The result of the study concluded that health education program was effective in improving the knowledge regarding health promotion strategies in the geriatric population.

Functional Disability Due to Chronic Low Back Pain in the Geriatric Population of a Tertiary Care Hospital in North India: A Cross-Sectional Study

Background Chronic low back pain (CLBP) is one of the painful and disabling conditions affecting the young as well as the geriatric population. There is a limited body of research to find out the impact of CLBP and functional disability on geriatric adults in the Indian region. Aim This study aims to determine the prevalence of functional disability due to CLBP in the geriatric population and to investigate the correlation between functional disability due to CLBP and other sociodemographic factors. Methodology A total of 157 geriatric adults were enrolled in the study, fulfilling the inclusion and exclusion criteria. Basic sociodemographic data, along with a clinical-radiological examination, was recorded. The Numeric Pain Rating Scale (NPRS), the Roland and Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale were used as study tools. Summary measures (frequency, mean, median, etc.) are calculated according to the level of measurement of variables. The point prevalence of functional disability due to CLBP in the geriatric population, along with 95% confidence intervals, has been calculated. The prevalence estimates were estimated and calculated with SD variables using a t-test, chi-square test, or Fisher's exact test under bivariate analysis. The linear/logistic regression analysis was used to control for the effects of covariates. A significance level of 5% was set for all analyses due to the exploratory nature of the study. Statistical significance was considered at p < 0.05. Results According to the Roland and Morris Disability Questionnaire, 29% (N = 46) of the study geriatric participants had a severe disability, 45% (N = 70) had a moderate disability, and 26% (N = 41) had a mild disability. According to the Quebec Back Pain Disability Scale, 34% (N = 53) had scored more than 50, and 66% (N = 104) had scored less than 50. Statistically significant correlations have been found between the level of functional disability and intensity of pain (NPRS score), gender, associated illness, current and past occupation, and clinical diagnosis of CLBP (p < 0.05). Conclusion The prevalence of functional disability due to CLBP is higher in the geriatric population. It is associated with many influencing sociodemographic factors like gender, occupation, associated musculoskeletal illness, the intensity of low back pain, and clinico-radiological diagnosis. Early identification and timely interventions to reduce functional disability due to CLBP and associated risk factors are the need of the hour. Regular back muscle exercises, ergonomic modifications, and modification of activities of daily life are recommended to prevent functional disability due to CLBP.

Artificial intelligence-based intelligent surveillance for reducing nurses' working hours in nurse-patient interaction: A two-wave study

AIM

To explore the feasibility of applying artificial intelligence in nurse-patient interaction to assist nurses in grasping patient status and reducing their working hours.

BACKGROUND

Artificial intelligence has been reshaping the health care industry and has immense potential in nursing care, but there is still a lack of suitable artificial intelligence methods to improve the efficiency of the nurse-patient interaction that takes much time of nurses.

METHODS

An artificial intelligence-based intelligent surveillance system was developed to reduce nurses' working hours in nurse-patient interaction, and a two-wave follow-up design was adopted in this study. The data were collected in a nursing home in Guangzhou, China. The first and second waves of data were recorded in the same format on the same patients by the same nurses. The only difference is the deployment of artificial intelligence technology between the two waves of data.

RESULTS

Artificial intelligence-based intelligent surveillance can provide statistical health data for nurses to grasp the patients' status more intuitively, reducing the average nurse-patient interaction time per patient from 18 to 10 min. In addition, artificial intelligence's real-time response to the abnormal health status of patients not only avoids more serious secondary injuries for patients but also prevents nurses from consuming energy in detecting emergencies.

CONCLUSION

The application of artificial intelligence has great potential to reduce nurses' working hours in nurse-patient interaction. There are still many limitations in artificial intelligence technology at this stage, and it is not feasible to completely rely on artificial intelligence. However, as a tool to assist decision-making, it can still have beneficial impacts on nursing management.

IMPLICATIONS FOR NURSING MANAGEMENT

Artificial intelligence has great potential in daily nurse-patient interaction, and nursing facility managers and nurses need to be more open to this new technology.

Elder care: The need for interprofessional collaboration between Family Physicians, Clinical Pharmacists, and Physiotherapists in home-based primary care teams

Background

Elderly patients with pain and falls are commonly seen in family practice.

Aims

(1) Highlight the role of a physiotherapist in the primary care team; (2) Discuss the collaboration between a family physician clinical pharmacist dyad and the physiotherapist that emerged; and (3) Share practice tools that emerged from our teamwork.

Settings and Design

Home Based Primary Care Practice (a core component of family practice). We have described our home based primary care practice model in earlier publications. Our model utilizes a team based approach to address the prevention of diseases, promotion of health, provision of care for acute and chronic conditions (especially concurrent multi morbidity), and delivery of rehabilitation services in the home setting.

Methods and Materials

Selection of three cases from our daily practice. Reflective discussion and learning towards arriving at novel insights and improving our care model.

Results

Case discussion from the perspectives of the family physician, clinical pharmacist, and physiotherapist reveal important insights on the roles, responsibilities, benefits and tensions. A process flow to facilitate team based care is also outlined along with a referral communication tool.

Conclusion

For our population of the elderly with falls and pain, there was a need for a physiotherapist, as part of the team, instead of a mere referral service. This was felt because of the growing needs of patients, multiple gaps in communication with external referrals, mismatch of values and approaches, and missed opportunities for high quality care. This enhances access, optimizes clinical outcomes, delivers patient centred care, reduces unnecessary hospitalizations, and avoids catastrophic and unwarranted costs. The paper highlights the critical need for interprofessional collaboration between family physicians, clinical pharmacists and Physiotherapist in elder care.

Chronic Pain in the Elderly: Mechanisms and Perspectives

Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives.

Prevalence and characteristics of chronic Pain in the Chinese community-dwelling elderly: a cross-sectional study

BACKGROUND

Chronic pain adversely affects health and daily life in the elderly. Gaining insight into chronic pain that affects the community-dwelling elderly is crucial for pain management in China, which possesses the largest elderly population in the world.

METHODS

This is a cross-sectional design study that followed the STROBE Guideline. A randomized cluster sampling method was used to recruit participants in the Sichuan Province from Dec 2018 to May 2019. In addition, face-to-face interviews were conducted to collect socio-demographic data, characteristics and health-seeking behaviors of chronic pain through a self-designed questionnaire.

RESULTS

A total of 1381 older adults participated in this study. Among these participants, 791 (57.3%) had chronic pain. Here, prevalence and pain intensity were both found to increase from the 60-69 group to the 70-79 group, which then decreased in the ≥80 group with no significant differences in sex (p > 0.05). The most common pain locations were observed in the legs/feet (53.5%), head (23.6) and abdomen/pelvis (21.1%). Among the elderly suffering from chronic pain, 29.4% sought medical help, 59.2% received medication and 59.7% adopted non-drug therapy.

CONCLUSION

Chronic pain is a common health concern in the Chinese community-dwelling elderly, which possesses different characteristics than other countries' populations. Therefore, easier access to medication assistance and provision of scientific guidance for non-drug therapy may serve as satisfactory approaches in improving pain management.

Process of Developing Palliative Care Curriculum for Training Medical Interns in a Tertiary Care Teaching Hospital in Puducherry, India

Objectives

The department of community medicine (DCM) has been training medical interns for palliative care in the hospital and community setting. There was no specific curriculum or course material available for training them. This study aims to develop, implement and evaluate the palliative care curriculum for training medical interns.

Materials and Methods

The present program development and evaluation of palliative care curriculum was done in the DCM, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. We followed the Kern's six steps for curriculum development. It was done during July 2016 and May 2017. We framed expected outcomes from literature review and interviews with experts. The curriculum was delivered through small group sessions followed by hands-on exposure to hospital- and community-based palliative care programs guided by a workbook. Medical interns were given feedback on their field assignments on history taking, followed by reflection using structured template incorporated in the workbook. The reaction to the curriculum was collected from various stakeholders.

Results

Medical interns found the curriculum useful for them to acquire basic skills of pain management, communication skills and teamwork. Patients and family felt satisfied with the quality of care provided.

Conclusion

The new palliative care curriculum was well received by all the stakeholders involved. This can be adopted in similar context for training medical interns in palliative care.

Assessment of Mental Health Elderly with Chronic Pain Based on Quranic Components

Considering the presence of mental disorders during illness or old age, it is necessary to pay attention to the mental health of the elderly. A modeling of the God's attributes means that one understands God's perception of his/her existential poverty; and on the other hand, one endeavors to work in the human domain in order to replicate and utilize the names and attributes of God the Almighty. For this reason, this study aims to determine the mental health (MH) assessment of elderly people with chronic pain (CP) based on Quranic components. The study is a descriptive cross-sectional study. A total of 138 elderly people who are aged over 65 years and had history of CP were enrolled. Data were collected using Islamic Questionnaire of Identifying God's Traits in the same, and analysis was performed using SPSS ver. 16. The mean (SD) of age in elderly is 81.00 (12.07), and as the age increased, the God's Traits score of the elderly increased (p = 0.003, R = 0.34). The mean overall God's Traits score was 234.68 (3.61). In the elderly who lived with their spouse and had higher social support, the score of God's Traits was higher (p > 0.05), but there was no relationship between other demographic characteristics and status of God's Traits (p > 0.05). This study is the first study to evaluate the MH status of chronic patients based on Quranic components, and their MH status has been high. It is suggested that the relationship between MH based on Quranic components and variables related to health be measured.

A cross-sectional survey of the perspectives of older people in the Scottish Highlands on the management of their chronic pain

BACKGROUND

Although there is evidence of suboptimal outcomes in older people with chronic pain, little emphasis has been placed on those in remote and rural settings.

OBJECTIVE

To describe the perspectives of older people in the Scottish Highlands on their chronic pain management.

DESIGN

Cross-sectional survey.

SETTING

NHS Highland, the most remote and rural geographical health board in Scotland.

SUBJECTS

Home-dwelling members of the public aged ≥70 years.

METHODS

Anonymised questionnaires were mailed to a random sample of 1800 older people. Questionnaire items were demographics, nature of any chronic pain, management regimens and perceived effectiveness. Validated scales were the Pain Disability Questionnaire and the Tampa Scale for Kinesiophobia.

RESULTS

Adjusted response rate was 39.3% (709/1755). One-quarter (25.0%, n = 177) were experiencing chronic pain, being more likely to live in deprived areas (P < 0.05). Median pain intensity was 6 (IQR 4-7, 10 high), causing distress (median 5, IQR 3-7). Respondents largely consulted GPs (66.1%, n = 117) with a minority (16.4%, n = 29) referred to a specialist pain clinic and few consulting other health professionals. Over three quarters (78.0%, n = 138) were receiving prescribed medicines, most commonly paracetamol, alone (35.6%, n = 63) or in combination with opioids (16.4%, n = 29). One-third (31.6%, n = 56) expressed a desire for more effective medicines; few reported using any non-pharmacological therapies. The median scores for the Pain Disability Questionnaire and Tampa Scale for Kinesiophobia were 74 (IQR 34-104.5, 150 high) and 40 (IQR 35-45, 68 high).

CONCLUSIONS

Evidence of provision of appropriate integrated and person-centred chronic pain care is lacking.