Monthly Archives: September 2013

pain elderlyApproximately 88% of seniors experience chronic pain. [1] The simple process of aging leads to conditions (the most common being arthritis) that can cause chronic pain. Seniors are typically less active which makes them vulnerable to muscle rigidity and joint calcification, all potential pain makers. As we age, because our sensation decreases, we become less coordinated and our movement (mobility) less fluid. This dynamic of aging greatly contributes to the statistic that one in three adults age 65 and older experience a fall each year. [2] And unfortunately as we age, healing from injuries takes longer.

About 20% of older adults take pain medications several times a week, usually for joint or muscle related pain. But, there are many other types of pain experienced by the elderly, especially those who live in nursing homes.

Nursing home residents typically have suffered many losses. Home, career and an independent lifestyle are given up to satisfy their need for 24-hour care. Pile on just a tad of chronic pain and you’ve got a recipe for a downward spiral into helplessness, anxiety and depression.

And nowhere is this dynamic more prevalent that in the nursing home setting.

If not taken seriously by caregivers, reports of pain by an elderly person can be discounted. When reports of pain are not taken seriously, it can be very upsetting to the person in pain which in turn makes their pain management more challenging as pain levels may be reported inaccurately or not at all.

It is the person experiencing the pain who knows just how much of it they are feeling. Pain is whatever the (older) person says it is, and exists whenever they say it does. But if on older person stops reporting pain to their caregivers, it is difficult to help them. Here are the signs to look for when someone is in pain: [3]

  • Facial expressions such as grimacing, breathing changes or sighing heavily are signs of pain or distress.
  • So are unusual body movements such as wincing or limping.
  • Behavioral changes such as not wanting to eat, sleep or socialize can be signs of pain.
  • Also emotional changes such as crying or irritability may be a sign that someone is experiencing pain even though they are not admitting it. 

Certified Nursing Assistants (CNAs) are trained to report any unusual change in their nursing home residents, especially signs of pain. And CNAs routinely report unusual pain to their charge nurse, but the savvy CNA knows that there are also other ways to help their residents who are experiencing pain.

Many pain-relieving alternatives may be included on a resident’s care plan such as a warm shower or bath, the application of heat or cold, or regular repositioning. But because CNAs spend so much time with nursing home residents, they can do other things that will encourage relaxation and perhaps even relieve pain. The following activities can be carried out by a CNA or any other caregiver in any setting, because they are techniques that utilize simple kindness and gentle human touch.

Listening is first

In the CNA world, we call it Therapeutic Communication. It bears repeating that senior citizens who live in nursing homes have, for the most part, experienced many losses. At a minimum they have given up their independent lifestyle. Compound the sadness they may be feeling, with the chronic pain that typically accompanies old age and you have a double dose of pain.

CNAs are taught to encourage residents to talk by asking open ended questions and then listening. CNAs know how important it is to be authentic when listening to a resident who is sharing their feelings. When a CNA is truly listening to a resident, the result is validation for the resident. This feeling of validation for someone who may be feeling disenfranchised can be a great source of comfort and a miracle pain reliever – at least in an emotional sense.

Empathy is Essential

It is not enough to just “feel sorry” for someone who is suffering if you want to help ease their pain. The empathetic CNA is able to “feel” their residents’ pain (while not taking it own as their own) in a way that enhances the care they give. This empathetic approach to caregiving shows in ways that only the nursing home resident can feel. When a CNA delivers daily care with empathy (vs sympathy) the result for the resident spreads across the board into all areas of their life in the nursing home – and makes it better, therefore helping with any pain they may be feeling.

Restorative Care Helps with Chronic Pain

People who live in nursing homes, as opposed to those who are there for short term rehabilitation from an injury or illness, receive Restorative Care. Restorative care is designed to optimize a resident’s experience in the nursing home by involving them in as many aspects of their activities of daily living (ADLs) as is possible, with independence fostered in every aspect of their care. Involvement in social activities is encouraged. Choices abound. It would be easy for a resident in a nursing home to feel as if they are giving up control, but with the right recipe of Restorative Care, they will feel empowered by the choices and decisions they are making for themselves. Good Restorative Care makes for a happier resident. A happier resident naturally experiences less pain.

Simple Ways to Help with Physical Pain

A soft, gentle touch in the form of a hand, foot or back massage can also help to alleviate physical pain. The benefit of gentle, relaxing massage is well documented. [4] Gentle stroking, kneading and light pressure can lubricate joints and assist in the pain management of people who suffer from the stiffness of arthritis according to the Touch Research Institute. Massage for the elderly also has physical and mental benefits that can improve their health and general well-being. At a minimum, a gentle massage of the hands, feet or back can result in a deeper, longer and more regenerative sleep and an overall state of greater well-being. A therapeutic massage given by someone trained in the treatment of the elderly can result in increased range of motion, strengthening of muscles and improved posture. But a soothing massage from a caregiver can go a long way in improving the quality of life for someone living with chronic pain.

Most nursing home residents who live with chronic pain are under the watchful eye of a physician and nursing staff who know the benefits of pain medication. And every nursing home resident benefits from being under the watchful eye of a caring CNA who listens to them and from time to time administers a kind and gentle human touch.

Bo Ramsey is a CNA Instructor at Express Training Services, LLC at the Destin Training Center. ETS is home based in Gainesville, Florida and has several other training centers in Florida that offer fast-track instruction for certification in many healthcare occupations. For more information call 866-346-0660 or go to






ImageRow, row, row your boat gently down the stream… Sing it twice as you wash your hands, working up a good lather as you go, and you will be practicing one of the most effective ways to prevent the spread of many types of infection and illness in all settings from your home and workplace to healthcare facilities.

It’s just common sense, really. Consider all the surfaces we come in contact with throughout the day – hand rails, door handles, ATM buttons and the like. What do all these things have in common? The human touch. We move about our day touching things everywhere we go.  

Imagine what it would be like to be a simple cold or flu germ.  Influenza viruses can survive on hard surfaces such as books or doorknobs between two and 8 hours. [1] Now, that may not seem like a very long time, but in “virus years” it can be an eternity.

Let’s say you are coming down with a cold and have decided to “gut it out” and go to work. With only a sore throat and a stuffy nose, you don’t realize that you are a veritable germ factory, and the first time you blow your nose and fail to wash your hands right after, you will soon be sharing your cold germs with everyone around you via everything you touch. Cold and flu germs can survive on some surfaces for up to 48 hours [2] and so the calling cards you leave behind when you handle things can be transferred by contact to anyone coming along behind you who touches it. This can include the telephone at the reception desk, the buttons on the copy machine or the handle of the coffee pot in the employee lounge. And as you run errands on the way home from work you are leaving cold germs along the way on the handle of the cart at the grocery store and the ballpoint pin you used at the bank teller’s window. 

Yes, germs are lurking around us all the time. They hitch a ride on us when we touch a surface on which they have been left. And if they make it to our eyes, nose or mouth, their most common entry point into the body, they will invade our body and perhaps make us sick. But there is a fast and easy way to defend ourselves against the spread of germs. Handwashing. 

According to the CDC (Centers of Disease Control) we should wash our hands before, during and after preparing food, before eating and before and after caring for someone who is sick or taking care of a cut or wound. Of course we all know to wash our hands after using the bathroom or changing a baby’s diaper. Hand washing is advised after taking out the trash or touching an animal, feeding it, or cleaning up after it. And of course it is especially important to wash our hands after blowing our nose, coughing or sneezing. [3] 

Now that we know when to wash our hands, let’s take a look at just how to do it. The CDC advises that we first wet our hands with warm or cold clean running water. Then apply soap. Next, rub the hands together to make a rich lather and scrub them well. Remember the backs of the hands, between the fingers and under the nails. This vigorous scrubbing should last at least 20 seconds. (Twice singing the song, Row, row, row your boat.) Then a good rinse under running water and a clean towel or air dry is the recommended finish. [3] 

As a side note, the use of waterless hand sanitizers is also addressed by the CDC. When soap and water are not available, an alcohol-based hand sanitizer containing at least 60% alcohol can reduce the number of germs on hands in some situations. Follow manufacturer’s recommendations when using them and know that they will not eliminate all types of germs. [3] 

Simple handwashing is truly the vanguard of infection control. No other infection control measure goes further in protecting us against the spread of germs. So row, row, row your boat gently to the closest sink and wash your hands. See you there!

Bo Ramsey is a CNA Instructor at Express Training Services, LLC at the Destin Training Center. ETS is home based in Gainesville, Florida and has several other training centers in Florida that offer fast-track instruction for certification in many healthcare occupations. For more information call 866-346-0660 or go to





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