機構難於口語表達長者之疼痛管理

Pain management for institutional seniors unable to self-report

老化促成了生理及結構功能上的退化，及多重慢性疾病的衍生，致使高齡者擁有極高的疼痛盛行率。許多文獻及臨床指引都強調，疼痛應被視為臨床第五生命徵象，需每日對患者進行規律和系統性的評估，進而對疼痛患者擬訂個別化的照護計畫。然遺憾的是，對大部分的長期照護機構住民而言，礙於退化的認知功能與口語能力，常使其無法有效表達自身感受，使得疼痛頻繁的被低度評估和低度處置。為能有效解決此一困境以改善機構的照顧品質，本文將由難於口語表達長者較適切的疼痛定義談起，並介紹目前較具信效度及可用性的疼痛行為觀察量表；從而說明國外最新針對難於口語表達長者所發展的階層性疼痛評估策略(the Hierarchy of Pain Assessment Techniques, HAT)，並簡述長期照顧機構可資運用的藥物及非藥物處置策略。疼痛管理是一個複雜且持續性的過程，本文期望透過知識的分享，促成機構照顧者對難於口語表達長者疼痛評估和處置的落實，進而裨益該群體的整體照顧品質。

Pain is an extremely prevalent issue in the aging population as a result of physical and functional decline and multiple chronic medical conditions. Research literature reviews and clinical guidelines have addressed the importance of pain as the fifth vital sign. Daily systematic assessment for patients' pain level should be implemented on a regular daily basis, followed by an individualized care plan. However, pain in the aged residents living in long-term care facilities are often under-detected and under-treated, especially those who are deteriorated in their capacity of cognition and verbal expression. To improve the quality of care in a long-term care setting, this paper presents some valid and feasible observational pain assessment tools with good psychometric properties based on the definition of pain fitted to this population. Furthermore, using the latest developed pain assessment strategy, called Hierarchy of Pain Assessment Techniques (HAT) the author describes pain management through pharmacologic and non-pharmacologic interventions in long-term care settings. Pain management is an ongoing complicated process. The author expects that through knowledge sharing, the caregivers in long-term care facilities can implement appropriate pain assessment and management for the elderly who have difficulty in self-reporting their pain level.