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WHAT IS KNOWN ON THE SUBJECT?: Frailty and multimorbidity are common in later life. A higher level of frailty is associated with a higher risk of adverse physical and psychological health situations. Older adults with pain have been reported to be lonelier and more depressed, as well as less happy and less satisfied with their life as compared to those without pain. In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Frailty index is positively correlated with the presence of pain, and associated with gender, functional mobility and loneliness. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. All nurses are advised to improve the management of pain in older people in order to lower the levels of pain, frailty and psychological distress among this population. Nursing care should address the loneliness level especially the problem of social loneliness among older adults particularly those living in nursing homes., Abstract: Introduction In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. Aim To examine the levels of frailty, pain and psychological parameters among older adults living in Hong Kong nursing homes, and the cross-sectional relationships among these items. Methods A cross-sectional study was conducted among 178 residents from six nursing homes. Frailty, pain, mobility, happiness, loneliness and life satisfaction of participants were assessed using validated questionnaires. Results A multiple linear regression (R(2)  = 0.338, P < 0.05) showed that the frailty index was associated with loneliness, functional mobility and gender. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. Discussion It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. Findings suggest that apart from improving mobility and reducing pain, loneliness could be a target of psychosocial interventions to reduce frailty and improve quality of life. Implications for practice It is advised that nursing care should address loneliness, especially the problem of social loneliness among older adults particularly those living in nursing homes., (© 2016 John Wiley & Sons Ltd.)

Aims and Objectives: To examine the effectiveness of an integrated motivational interviewing and physical exercise programme on pain, physical and psychological function, quality of life, self-efficacy, and compliance with exercise for community-dwelling older persons with chronic pain., Background: Chronic pain is common among older persons. Indeed, motivation for managing pain is poor, and may cause negative consequences. Motivational interviewing maybe effective in treating chronic pain., Design: Single-blinded randomised control study., Methods: Older persons with chronic pain (n = 56) were recruited from two elderly community centres. They were blinded from the group allocation. The programme was conducted by an motivational interviewing-trained physiotherapist and registered nurses. Participants in the experimental group received an 8-week integrated motivational interviewing and physical exercise programme, while the control group received regular activities in the centre. Motivational interviewing used open-ended questions to encourage participants to express and recognise their pain and behaviours and professional feedback was given accordingly. Pain intensity, pain self-efficacy, anxiety, happiness, depression, mobility and quality of life were measured before and after the motivational interviewing and physical exercise programme. Attendance and compliance rate of the programme was calculated in the experimental group., Results: Significant improvements in pain intensity, pain self-efficacy, anxiety, happiness and mobility after the motivational interviewing and physical exercise programme (all p < 0.05) for experimental group, while no significant improvement in control group except on the happiness scale. Regarding group differences in the outcome measures, the change scores on pain intensity, state anxiety and depression were significantly better in the experimental group., Conclusion: Motivational interviewing and physical exercise programme is effective in improving pain, physical mobility, psychological well-being and self-efficacy for community-dwelling older persons with chronic pain., Relevance to Clinical Practice: Motivational interviewing is a feasible counselling technique whose content can be modified based on target group to change maladaptive behaviours, elicit ambivalences and enhance self-efficacy for making changes. Thus, promoting motivational interviewing and physical exercise programme to older persons with pain is effective and important., (© 2013 Blackwell Publishing Ltd.)

Aims: The purpose of this study was (1) to explore postoperative pain experience among Chinese thoracotomy patients during hospitalisation; (2) to identify patient-related barriers to pain management; and (3) to explore how these barriers were related to patients' pain experience., Background: Major thoracotomy causes severe pain and extreme stress for patients. Unrelieved postoperative pain leads to high risks of postoperative complications and chronic post-thoracotomy pain syndrome, compromising the quality of life for those patients., Design: Cross-sectional design., Methods: A tertiary general hospital in mainland China was selected for this study. A total of 94 patients undergoing scheduled major thoracotomy operations participated in the study. All patients completed Brief Pain Inventory-Chinese version, the Barrier Questionnaire-Taiwan Form Surgical version and a demographic questionnaire., Results: Patients suffered moderate to severe pain and experienced extremely high interferences with daily activities after major thoracotomy operation. Patients reported the four highest barrier scores in the subscale of Barrier Questionnaire-Taiwan Form Surgical version were fear of tolerance, inhibition of wound healing, time intervals and distracting the physician from treating the disease. Patient's demographic data had no significant impact on their concerns about communicating pain and using of analgesics with exception of the subscale 'fatalism' of the Barrier Questionnaire-Taiwan Form Surgical version in patients with higher education levels or patients with 'non-farmer' occupation. However, there were no significant correlations indicated either between Barrier Questionnaire-Taiwan Form Surgical version score and pain severity or pain interference., Conclusions: Patients were underexposure of pain treatment after thoracotomy operation in the study, while patients' concerns about reporting pain and using analgesics had minimal impacts on their pain experience., Relevance to Clinical Practice: Education approach for patients is inadequate to improve the status of unrelieved postoperative pain. Appropriate pain management regime together with attentive nursing care should be provided to achieve better pain relief for Chinese patients., (© 2011 Blackwell Publishing Ltd.)

Aim: To provide a physical exercise programme for older adults living in nursing homes., Background: Pain is common among older persons and for those already in long-term care and having difficulty in coping with pain will be at risk of further reducing their optimal independent function., Design: A quasi-experimental single group pretest-posttest design., Method: Older persons from a nursing home were invited to join an eight-week physical exercise programme. Each session lasted an hour and sessions were conducted once a week by physiotherapist and nurses. Physical exercise programme consisted of stretching, strengthening, balancing, towel dancing and self-administered massage to various acupressure points. On completion of each session, older persons were given a pamphlet with pictures to illustrate the exercise of the day and they were encouraged to practise these exercises by themselves. Outcome measures including pain intensity, range of movement, activities of daily living and mobility were collected before and after the physical exercise programme., Results: There were 75 older adult participants (57 female and 18 male, mean age 85.14 SD 5.30). Seventy-three percent (n = 55) of them had pain in the previous three months and were referred as pain group, while 25% (n = 20) were no pain group. Pain scores of 4.89 (on a 10-point scale) indicated medium pain intensity before the intervention for the pain group; the location of pain was mainly in the knee, back and shoulder. On completion of the physical exercise programme, there was a significant decrease in pain intensity to 2.89 (SD 2.14) (p < 0.01). There was a significant increase in range of movement in the neck, shoulder, back, hip and knee rotation, flex and abduction (p < 0.01). Mobility level was significantly increased post intervention, yet activities of daily living remained unchanged., Conclusions: The present study demonstrated the effectiveness of a physical exercise programme in relieving pain and enhancing functional mobility for older persons. Relevance to clinical practice.  It is important to educate older persons, especially those living in nursing homes, on the importance of engaging in regular physical exercise and maintaining mobility., (© 2011 Blackwell Publishing Ltd.)

Aims: To explore the activities of daily living and psychological well-being of older people living in nursing homes and also to examine the effectiveness of a gardening programme in enhancing socilaisation and life satisfaction, reducing loneliness and promoting activities of daily living for older people living in nursing homes., Background: Life in nursing homes can mean very limited physical and social activity, leading to further decline in function for many older people., Design: This was a quasi-experimental pre and posttest control group design., Methods: Older people from nursing homes were invited to join the eight week indoor gardening programme (experimental group), while older people in other nursing homes were treated as the control group; they received regular care without the eight week indoor gardening programme. There were 26 older people (25 female and one male; mean age 85 years) in the experimental group and 27 (20 female and seven male; mean age 82 years) in the control group. Demographic data including age, gender, educational level and financial situation were collected, in addition to information regarding life satisfaction, loneliness, physical activity and social network situation, before and after the eight week indoor gardening programme for both the experimental and control groups. Also, details of experimental group subjects' experience of the indoor gardening programme were elicited using open-ended questions., Results: There were significant improvements in life satisfaction and social network and a significant decrease in perception of loneliness for older people in the experimental group after the eight week indoor gardening programme, while the activities of daily living were unchanged for both groups after the programme., Relevance to Clinical Practice: Given the positive effects of gardening activities, it is suggested that they be promoted more widely among nursing home residents.

Objectives: To explore nursing home-related beliefs among older Hong Kong Chinese and identify strategies that make nursing homes a better place to live., Background: Increased life expectancy has markedly increased the prevalence of age-related disease and disability, which limits the self-caring ability of older persons. Nursing home placement offers one possible alternative. However, the perspectives of older persons on nursing home admission have been seriously neglected and under-reported., Methods: The research was a qualitative descriptive study. Clients of a community centre for older people were approached and invited for an interview., Results: Participants included 118 older persons (61 female and 57 male) age from 60-89 years. Ninety per cent had chronic diseases and needed regular follow-up. Half of participants had never visited a nursing home. Of them, 85% would not want to live in a nursing home upon getting old and their nursing home-related beliefs were found to be negative. Participants expressed the feeling of being abandoned by their family members, insecure and lonely regarding the nursing home placement. Living in a nursing home was considered as 'living in jail' and that their privacy would be lost. Nevertheless, positive aspects of nursing home placement were mentioned, and strategies were explored that would make nursing homes a better place for older people to live., Relevance to Clinical Practice: Positive aspects of nursing home placement need to be promoted. Nurses should be advocates for the health of the elderly, and help make nursing homes a better place to live.

Aim: To explore pain relief interventions used by older people with chronic pain in Hong Kong. The frequency and perceived effectiveness of non-prescription measures were also explored., Background: With increasing life expectancy, the incidence of chronic illness and chronic pain also increases. Chronic pain robs older people of their quality of life., Design: This was a descriptive qualitative study., Results: Forty-four older people (37 female and seven male) who were residents of a nursing home in Hong Kong took part in this study. Their ages ranged from 65 to 82 years, median age was 75 years. Almost 80% had experienced moderate to severe pain during the previous three months. The most common sites of pain were muscles and joints; 35% of subjects reported continuous pain, 27% reported pain associated with activities of daily living, and 38% reported pain during exercise but not at rest. Only a few of the study group had taken prescribed medication to relieve pain, and only two of the 44 subjects studied had used a combination of drug and non-prescription intervention for pain relief. The majority of participants used non-prescription intervention only and the most commonly used were topical analgesics with massage. The majority (58%) of the subjects perceived the used of non-prescription intervention to be very effective in pain relief., Conclusions: The prevalence of pain was found to be high among older people in this study. Yet, they were taking a pro-active and responsible role in treating their chronic pain by using non-pharmacological patient-initiated intervention; also older people perceive themselves to have control over their pain status., Relevance to Clinical Practice: This active role of older people in their pain relief is likely to enhance the effect of education seminars and workshops aimed at novel, non-pharmacological pain relief strategies for older people with chronic pain.

For many hospital patients, the experience brings pain and anxiety. Unfamiliar surroundings, various diagnostic and therapeutic procedures, and the sight and sounds of medical procedures exacerbate pain and anxiety. To block off the anxiety-inducing sights and sounds of hospital surroundings and create a pleasing environment, the therapeutic potential of visual stimulation as a nursing intervention was investigated. In a randomized, controlled, cross-over study, pain was produced by a modified tourniquet technique in 46 healthy volunteers. Subjects were randomly allocated to two groups (Group V and Group B) with subsequent cross-over. Those in Group V watched a soundless video display of natural scenery during tourniquet inflation, whereas in Group B subjects watched a static blank screen. Pain threshold was defined as the time when subjects reported the first detectable pain, whereas pain tolerance was the time the pain was reported to be intolerable and deflation of the tourniquet was requested. With the use of visual stimuli, there was a significant increase in pain threshold (P < 0.05) and pain tolerance (P < 0.01). Gender and the sequence of visual stimuli did not have any significant effect on pain threshold and pain tolerance. Further studies specifically addressing level of anxiety and physiological data correlated with pain scores and visual stimuli are needed. The findings have implications for nurses and other healthcare professionals to use various visual stimuli as positive adjuncts to other methods of pain relief and for different pain conditions in clinical areas.